***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 Objective To determine the clinical effectiveness and cost-effectiveness of nurse-led care ( NLC ) for people with rheumatoid arthritis ( RA ) . Methods In a multicentre pragmatic r and omised controlled trial , the assessment of clinical effects followed a non-inferiority design , while patient satisfaction and cost assessment s followed a superiority design . Participants were 181 adults with RA r and omly assigned to either  NLC or rheumatologist-led care ( RLC ) , both arms carrying out their normal practice . The primary outcome was the disease activity score ( DAS28 ) assessed at baseline , weeks 13 , 26 , 39 and 52 ; the non-inferiority margin being DAS28 change of 0.6 . Mean differences between the groups were estimated controlling for covariates following per- protocol ( PP ) and intention-to-treat ( ITT ) strategies . The economic evaluation ( NHS and healthcare perspectives ) estimated cost relative to change in DAS28 and quality -adjusted life-years ( QALY ) derived from EQ5D . Results Demographics and baseline characteristics of patients under NLC ( n=91 ) were comparable to those under RLC ( n=90 ) . Overall baseline-adjusted difference in DAS28 mean change ( 95 % CI ) for RLC minus NLC was −0.31 ( −0.63 to 0.02 ) for PP and -0.15 ( −0.45 to 0.14 ) for ITT analyses . Mean difference in healthcare cost ( RLC minus NLC ) was £ 710 ( −£352 , £ 1773 ) and −£128 ( −£1263 , £ 1006 ) for PP and ITT analyses , respectively . NLC was more cost-effective with respect to cost and DAS28 , but not in relation to QALY utility scores . In all secondary outcomes , significance was met for non-inferiority of NLC . NLC had higher ‘ general satisfaction ’ scores than RLC in week 26 . Conclusions The results provide robust evidence to support non-inferiority of NLC in the management of RA . Trial registration IS RCT Abstract Background : Disease management programmes ( DMPs ) improve quality of care for patients with heart failure ( HF ) . However , only a limited number of trials have studied the efficacy of such programmes for patients with heart failure with preserved ejection fraction ( HFPEF ) . Objective : To estimate the impact of a structured , nurse-led patient education programme and care plan in general practice on outcome parameters and events in patients with HFPEF . Methods : Single blinded r and omized clinical trial with an intervention over six months and a follow-up during 12 additional months . In the control group , the patients ( n = 41 ) were managed according to Russian national guidelines . Patients in the intervention group ( n = 44 )  received education on individual lifestyle changes and modifications of cardiovascular disease ( CVD ) risk factors , home-based exercise training and weekly nurse consultations in addition to usual care . Results : Six months after their inclusion , patients in the intervention group significantly improved body mass index , waist circumference , six-min walk test distance , total cholesterol , low-density lipoprotein , left ventricular end-diastolic volume index , quality of life and level of anxiety . After 18 months , there were 11 deaths ( 25 % ) or hospitalizations in the intervention group and 12 ( 29 % ) in the control group ( P = 0.134 ) . Cardiovascular mortality and readmission rate were not reduced significantly after six months of follow-up : the hazard ratio was 0.47 ( 95 % CI : 0.17–1.28 ; P = 0.197 ) . After 18 months , this was 0.85 ( 0.42–1.73 ; P = 0.658 ) . Conclusion : This primary care based DMP for patients with HFPEF improved the patients ’ emotional status and quality of life , positively influenced body weight , functional capacity and lipid profile , and attenuated heart remodelling Aim To compare and evaluate the treatment outcomes of a nurse-led rheumatology clinic and a rheumatologist-led clinic in patients with low disease activity or in remission who are undergoing biological therapy .  Background Patients with chronic inflammatory arthritis treated with biological therapy  are usually monitored by rheumatologists . Nurse-led rheumatology clinics have been proposed in patients with low disease activity or in remission . Design R and omized controlled trial . Methods A 12-month follow-up trial was conducted between October 2009 and August 2011 , where 107 patients were r and omized into two groups with a 6-month follow-up to a nurse-led rheumatology clinic based on person-centred care ( intervention group ; n = 53 ) or to a rheumatologist-led clinic ( control group ; n = 54 ) . The hypothesis was that the nurse-led clinic outcomes would not be inferior to those obtained from a rheumatologist-led clinic at the 12-month follow-up . The primary outcome was disease activity measured by Disease Activity Score 28 . Results A total of 47 patients in the intervention group and 50 in the control group completed the 12-month trial . The trial revealed no statistically significant differences between groups in mean change of Disease Activity Score 28 , Visual Analogue Scales for pain , the Health Assessment Question naire , satisfaction with or confidence in obtaining rheumatology care . Conclusion Patients with stable chronic inflammatory arthritis undergoing biological therapy  could be monitored by a nurse-led rheumatology clinic without difference in outcome as measured by the Disease Activity Score 28 AIMS For children with stable asthma , to test non-inferiority of care provided by a hospital-based specialised asthma nurse versus a general practitioner ( GP ) or paediatrician . METHODS R and omised controlled trial evaluating st and ard care by a GP , paediatrician or an asthma nurse , with two-year follow-up . RESULTS 107 children were recruited , 45 from general practice and 62 from hospital . After two years , no significant differences between groups were found for airway responsiveness , FEV1 , asthma control , medication , school absence or parental work absence . In the general practice group there was a significantly lower frequency of regular review visits ( ' regular ' = at least one review per six months ) compared to the paediatrician and specialised asthma nurse group , both after one year [ 45.7 % versus 87.9 % and 94.3 % , respectively , ( p<0.0005 ) ] and after two years [ 26.5 % versus 87.9 % and 75.8 % , respectively , ( p<0.0005 ) ] . We found no significant differences in unplanned visits . In most cases the asthma nurse was able to provide care without consultation with the paediatrician . CONCLUSION The degree of disease control in stable childhood asthma managed by an asthma nurse is not inferior to traditional management by primary or secondary care physicians . The results also suggest that a lower review frequency does not detract from good disease control Background Enhanced secondary preventive follow-up after stroke or transient ischemic attack ( TIA ) is necessary for improved adherence to recommendations regarding blood pressure ( BP ) and low-density lipoprotein cholesterol ( LDL-C ) levels . We investigated whether nurse-led , telephone-based follow-up was more efficient than usual care at improving BP and LDL-C levels at 12 months after hospital discharge . Methods We r and omized 537 patients to either nurse-led , telephone-based follow-up ( intervention ) or usual care ( control ) .  BP and LDL-C measurements were performed at 1 month ( baseline ) and 12 months post-discharge . Intervention group patients who did not meet target values at baseline received additional follow-up , including titration of medication and lifestyle counselling , to reach treatment goals ( BP < 140/90 mmHg , LDL-C < 2.5 mmol/L ) . Results At 12 months , mean systolic BP , diastolic BP and LDL-C was 3.3 ( 95 % CI 0.3 to 6.3 ) mmHg , 2.3 mmHg ( 95 % CI 0.5 to 4.2 ) and 0.3 mmol/L ( 95 % CI 0.1 to 0.4 ) lower in the intervention group compared to controls . Among participants with values above the treatment goal at baseline , the difference in systolic BP and LDL-C was more pronounced ( 8.0 mmHg , 95 % CI 4.0 to 12.1 , and 0.6 mmol/L , 95 % CI 0.4 to 0.9 ) . A larger proportion of the intervention group reached the treatment goal for systolic BP ( 68.5 vs. 56.8 % , p = 0.008 ) and LDL-C ( 69.7 % vs. 50.4 % , p < 0.001 ) . Conclusions Nurse-led , telephone-based secondary preventive follow-up , including medication adjustment , was significantly more efficient than usual care at improving BP and LDL-C levels by 12 months post-discharge . Trial Registration IS RCT N Registry IS RCT Background Recommendations for rheumatology nursing management of chronic inflammatory arthritis ( CIA ) from European League Against Rheumatism ( EULAR ) states that nurses should take part in the monitoring patients ’ disease and therapy in order to achieve cost savings . The aim of the study was to compare the costs of rheumatology care between a nurse-led rheumatology clinic ( NLC ) , based on person-centred care ( PCC ) , versus a rheumatologist-led clinic ( RLC ) , in monitoring of patients with CIA undergoing biological therapy . Methods Patients with CIA undergoing biological therapy ( n = 107 ) and a Disease Activity Score of 28 ≤ 3.2 were r and omised to follow-up by either NLC or RLC . All patients met the rheumatologist at inclusion and after 12 months . In the intervention one of two annual monitoring visits in an RLC was replaced by a visit to an NLC . The primary outcome was total annual cost of rheumatology care . Results A total of 97 patients completed the RCT at the 12 month follow-up . Replacing one of the two annual rheumatologist monitoring visits by a nurse-led monitoring visit , result ed in no additional contacts to the rheumatology clinic , but rather a decrease in the use of re sources and a reduction of costs . The total annual rheumatology care costs including fixed monitoring , variable monitoring , rehabilitation , specialist consultations , radiography , and pharmacological therapy , generated € 14107.7 per patient in the NLC compared with € 16274.9 in the RCL ( p = 0.004 ) , giving a € 2167.2 ( 13 % ) lower annual cost for the NLC . Conclusions Patients with CIA and low disease activity or in remission undergoing biological therapy can be monitored with a reduced re source use and at a lower annual cost by an NLC , based on PCC with no difference in clinical outcomes . This could free re sources for more intensive monitoring of patients early in the disease or patients with high disease activity . Trial registration The trial is registered as a clinical trial at the Clinical Trials.gov ( NCT01071447 ) . Registration date : October 8 , 2009 Background The ESTEEM trial was a cluster r and omised controlled trial that compared two telephone triage management systems ( general practitioner ( GP ) or a nurse supported by computer decision support software ) with usual care , in response to a request for same-day consultation in general practice . Aim To investigate associations between trial patients ’ demographic , health , and lifestyle characteristics , and their reported experiences of care . Setting Recruitment of 20 990 patients occurred between May 2011 and December 2012 in 42 GP practice s in Engl and ( 13 GP triage , 15 nurse triage , 14 usual care ) . Method Patients reported their experiences via a postal question naire issued 4 weeks after their initial request for a same-day consultation .  Overall satisfaction , ease of accessing medical help/advice , and convenience of care were analysed using linear hierarchical modelling . Results Question naires were returned by 12 132 patients ( 58 % ) . Older patients reported increased overall satisfaction compared with patients aged 25–59 years , but patients aged 16–24 years reported lower satisfaction . Compared with white patients , patients from ethnic minorities reported lower satisfaction in all three arms , although to a lesser degree in the GP triage arm . Patients from ethnic minorities reported higher satisfaction in the GP triage than in usual care , whereas white patients reported higher satisfaction with usual care . Patients unable to take time away from work or who could only do so with difficulty reported lower satisfaction across all three trial arms . Conclusions Patient characteristics , such as age , ethnicity and ability to attend their practice during work hours , were associated with their experiences of care following a same-day consultation request in general practice 
    Output:
    
Study findings suggest that care delivered by nurses , compared to care delivered by doctors , probably generates similar or better health outcomes for a broad range of patient conditions ( low‐ or moderate‐certainty evidence ): • Nurse‐led primary care may lead to slightly fewer deaths among certain groups of patients , compared to doctor‐led care .
However , the results vary and it is possible that nurse‐led primary care makes little or no difference to the number of deaths ( low‐certainty evidence ) . •
Blood pressure outcomes are probably slightly improved in nurse‐led primary care .
Other clinical or health status outcomes are probably similar ( moderate‐certainty evidence ) .
• Patient satisfaction is probably slightly higher in nurse‐led primary care ( moderate‐certainty evidence ) .
Quality of life may be slightly higher ( low‐certainty evidence ) .
The effect of nurse‐led care on utilisation of care is mixed and depends on the type of outcome .
Consultations are probably longer in nurse‐led primary care ( moderate‐certainty evidence ) , and numbers of attended return visits are slightly higher for nurses than for doctors ( high‐certainty evidence ) .
Authors ' conclusions This review shows that for some ongoing and urgent physical complaints and for chronic conditions , trained nurses , such as nurse practitioners , practice nurses , and registered nurses , probably provide equal or possibly even better quality of care compared to primary care doctors , and probably achieve equal or better health outcomes for patients .
Nurses probably achieve higher levels of patient satisfaction , compared to primary care doctors .
Furthermore , consultation length is probably longer when nurses deliver care and the frequency of attended return visits is probably slightly higher for nurses , compared to doctors .
The effects of nurse‐led care on process of care and the costs of care are uncertain , and we also can not ascertain what level of nursing education leads to the best outcomes when nurses are substituted for doctors