***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 : With the decrease in junior doctor hours , the advent of specialist registrars , and the availability of highly trained and experienced nursing personnel , the service needs of patients with chronic respiratory diseases attending routine outpatient clinics may be better provided by appropriately trained nurse practitioners . Methods : A r and omised controlled crossover trial was used to compare nurse practitioner led care with doctor led care in a bronchiectasis outpatient clinic . Eighty patients were recruited and r and omised to receive 1 year of nurse led care and 1 year of doctor led care in r and om order . Patients were followed up for 2 years to ensure patient safety and acceptability and to assess differences in lung function . Outcome measures were forced expiratory volume in 1 second ( FEV1 ) , 12 minute walk test , health related quality of life , and re source use . Results : The mean difference in FEV1 was 0.2 % predicted ( 95 % confidence interval –1.6 to 2.0 % , p=0.83 ) . There were no significant differences in the other clinical or health related quality of life measures . Nurse led care result ed in significantly increased re source use compared with doctor led care ( mean difference £ 1497 , 95 % confidence interval £ 688 to £ 2674 , p<0.001 ) , a large part of which result ed from the number and duration of hospital admissions . The mean difference in re source use was greater in the first year ( £ 2625 ) than in the second year ( £ 411 ) . Conclusions : Nurse practitioner led care for stable patients within a chronic chest clinic is safe and is as effective as doctor led care , but may use more re sources Background No midwifery-led units existed in Irel and before 2004 . The aim of this study was to compare midwife-led ( MLU ) versus consultant-led ( CLU ) care for healthy , pregnant women without risk factors for labour and delivery . Methods An unblinded , pragmatic r and omised trial was design ed , funded by the Health Service Executive ( Dublin North-East ) . Following ethical approval , all women booking prior to 24 weeks of pregnancy at two maternity hospitals with 1,300 - 3,200 births annually in Irel and were assessed for trial eligibility .1,653 consenting women were central ly r and omised on a 2:1 ratio to MLU or CLU care , ( 1101:552 ) . ' Intention-to-treat ' analysis was used to compare 9 key neonatal and maternal outcomes . Results No statistically significant difference was found between MLU and CLU in the seven key outcomes : caesarean birth ( 163 [ 14.8 % ] vs 84 [ 15.2 % ] ; relative risk ( RR ) 0.97 [ 95 % CI 0.76 to 1.24 ] ) , induction ( 248 [ 22.5 % ] vs 138 [ 25.0 % ] ; RR 0.90 [ 0.75 to 1.08 ] ) , episiotomy ( 126 [ 11.4 % ] vs 68 [ 12.3 % ] ; RR 0.93 [ 0.70 to 1.23 ] ) , instrumental birth ( 139 [ 12.6 % ] vs 79 [ 14.3 % ] ; RR 0.88 [ 0.68 to 1.14 ] ) , Apgar scores < 8 ( 10 [ 0.9 % ] vs 9 [ 1.6 % ] ; RR 0.56 [ 0.23 to 1.36 ] ) , postpartum haemorrhage ( 144 [ 13.1 % ] vs 75 [ 13.6 % ] ; RR 0.96 [ 0.74 to 1.25 ] ) ; breastfeeding initiation ( 616 [ 55.9 % ] vs 317 [ 57.4 % ] ; RR 0.97 [ 0.89 to 1.06 ] ) . MLU women were significantly less likely to have continuous electronic fetal monitoring ( 397 [ 36.1 % ] vs 313 [ 56.7 % ] ; RR 0.64 [ 0.57 to 0.71 ] ) , or augmentation of labour ( 436 [ 39.6 % ] vs 314 [ 56.9 % ] ; RR 0.50 [ 0.40 to 0.61 ] ) . Conclusions Midwife-led care , as practised in this study , is as safe as consultant-led care and is associated with less intervention during labour and delivery . Trial registration numberIS RCT N : IS RCT AIM to explore whether nurses can undertake the pre operative assessment of children prior to day case surgery as safely as senior house officers . DESIGN a r and omised controlled trial involving 595 children , using an equivalence methodology ( a method which looks for similarity rather than a significant difference ) . Pre-operative assessment prior to day case surgery was r and omised to either a nurse ( experimental group ) or a junior doctor ( control group ) . Blinded expert verification of nurse/junior doctor performance was ascertained by an experienced anaesthetist ( the ' gold st and ard ' ) . RESULTS there was equivalence between nurses and senior house officers in their ability to detect clinical ly significant abnormalities within the sample population . Subgroup analysis also demonstrated equivalence in respect of history taking abilities . The smaller number of clinical ly significant physical findings within the sample meant that equivalence in respect of physical examination remains uncertain . Although the study was limited to a single setting , the results demonstrate nurses ' equivalence with junior doctors in a discrete paediatric context BACKGROUND Medical abortion is under-used in developing countries . We assessed whether early fi rst-trimester medical abortion provided by midlevel providers ( government-trained , certified nurses and auxiliary nurse midwives ) was as safe and effective as that provided by doctors in Nepal . METHODS This multicentre r and omised controlled equivalence trial was done in fi ve rural district hospitals in Nepal . Women were eligible for medical abortion if their pregnancy was of less than 9 weeks ( 63 days ) and if they resided less than 90 min journey away from the study clinic . Women were ineligible if they had any contraindication to medical abortion . We used a computer-generated r and omisation scheme stratified by study centre with a block size of six . Women were r and omly assigned to a doctor or a midlevel provider for oral administration of 200 mg mifepristone followed by 800 μg misoprostol vaginally 2 days later , and followed up 10 - 4 days later . The primary endpoint was complete abortion without manual vacuum aspiration within 30 days of treatment . The study was not masked . Abortions were recorded as complete , incomplete , or failed ( continuing pregnancy ) . Analyses for primary and secondary endpoints were by intention to treat , supplemented by per- protocol analysis of the primary endpoint . This trial is registered with Clinical Trials.gov , NCT01186302 . FINDINGS Of 1295 women screened , 535 were r and omly assigned to a doctor and 542 to a midlevel provider . 514 and 518 , respectively , were included in the analyses of the primary endpoint . Abortions were judged complete in 504 ( 97.3 % ) women assigned to midlevel providers and in 494 ( 96.1 % ) assigned to physicians . The risk difference for complete abortion was 1.24 % ( 95 % CI -0.53 to 3.02 ) , which falls within the predefined equivalence range ( -5 % to 5 % ) . Five cases ( 1 % ) were recorded as failed abortion in the doctor cohort and none in the midlevel provider cohort ; the remaining cases were recorded as incomplete abortions . No serious complications were noted . INTERPRETATION The provision of medical abortion up to 9 weeks ’ gestation by midlevel providers and doctors was similar in safety and effectiveness . Where permitted by law , appropriately trained midlevel health-care providers can provide safe , low-technology medical abortion services for women independently from doctors . FUNDING UNDP/UNFPA/WHO/World Bank Special Programme of Research , Development and Research Training in Human Reproduction ( HRP ) , Department of Reproductive Health and Research ( RHR ) , World Health Organization Objectives To compare the outcome of two methods of  maternity care during the antenatal period and at delivery . One was to be midwife‐led for both antenatal care and delivery , the latter taking place in rooms similar to those in one 's own home to simulate home confinement . The other would be consultant‐led with the mothers labouring in the delivery suite rooms with resuscitation equipment for both mother and baby in evidence , monitors present and a delivery bed on which both anaesthetic and obstetric procedures could be easily and safely carried out Background  Clinical officers  perform much of major emergency surgery in Malawi , in the absence of medical officers . The aim of this study was to vali date the advantages and disadvantages of delegation of major obstetric surgery to non-doctors . Methods During a three month period , data from 2131 consecutive obstetric surgeries in 38 district hospitals in Malawi were collected prospect ively . The interventions included caesarean sections alone and those that were combined with other interventions such as subtotal and total hysterectomy repair of uterine rupture and tubal ligation . All these surgeries were conducted either by clinical officers or by medical officers . Results During the study period , clinical officers performed 90 % of all straight caesarean sections , 70 % of those combined with subtotal hysterectomy , 60 % of those combined with total hysterectomy and 89 % of those combined with repair of uterine rupture . A comparable profile of patients was operated on by clinical officers and medical officers , respectively . Postoperative outcomes were almost identical in the two groups in terms of maternal general condition – both immediately and 24 hours postoperatively – and regarding occurrence of pyrexia , wound infection , wound dehiscence , need for re-operation , neonatal outcome or maternal death . Conclusion Clinical officers perform the bulk of emergency obstetric operations at district hospitals in Malawi . The postoperative outcomes of their procedures are comparable to those of medical officers . Clinical officers constitute a crucial component of the health care team in Malawi for saving maternal and neonatal lives given the scarcity of physicians Aim : We conducted a r and omized controlled trial to assess the effectiveness of a support intervention delivered by health professionals to increase the rate and duration of breastfeeding . Methods : A r and omized controlled intervention study was conducted in the period 2000–2001 among 605 mothers who had given birth in a public maternity ward located in the city of Rome , Italy . The intervention consisted of a home visit by a midwife from the maternity ward of the hospital . The outcome of the study was the infant 's feeding habits , assessed by a 24‐h recall . The effect of the intervention on the duration of breastfeeding was estimated by the Kaplan‐Meier method and by the Cox multivariate regression model . Results : According to intention‐to‐treat analysis , there was no significant difference between the intervention and the control group , after controlling for confounding factors ( hazard ratio ( HR ) 1.04 ; 95 % confidence interval ( 95 % CI ) : 0.85–1.26 ) . The duration of breastfeeding was shorter ( HR 1.61 ; 95 % CI : 1.13–2.31 ) for women in the intervention group who refused the obstetric visit Background : Morbidity and mortality associated with severe asthma might be reduced by interventions that address psychosocial factors contributing to adverse outcomes . A study was undertaken to assess the effectiveness of a 6 month home based psychoeducational intervention delivered by a respiratory nurse specialist for adults at risk of adverse asthma outcomes . Methods : A pragmatic r and omised controlled trial was performed in 92 adults registered with hospital or primary care asthma clinics . All had previous hospital admissions and /or were on British Thoracic Society step 4–5 treatment and had failed to attend clinic appointments or were considered to have poor adherence to other aspects of their agreed management . Patients were visited in their homes for assessment and , where appropriate , intervention . The main outcomes measured were symptom control , asthma specific quality of life , and generic health status . Results : At the 6 month primary time point there were no significant differences between usual care and intervention groups in mean symptom control , physical functioning , or mental health scores ( differences ( with 95 % CI ) −0.35 ( −1.83 to 1.13 ) , 3.10 ( −11.42 to 17.63 ) , 0.42 ( −10.22 to 11.07 ) , respectively ) . Small effects on asthma specific quality of life up to 12 months ( e.g. adjusted difference at 12 months 0.13 ( 95 % CI 0.02 to 0.25 ) ) and short term effects on generic health status , which mirrored improvements in aspects of self-care observed at the end of the intensive phase of the intervention , were apparent only from fully adjusted analyses . Conclusions : A home based intervention provided by a nurse receiving psychological supervision may have effects on quality of life but is overall of limited long term benefit to adults at risk of adverse asthma outcomes A shortage of doctors limits the provision of post-partum sterilisation services in rural areas of Thail and . To overcome this problem nurse-midwives with theatre experience were trained to perform post-partum tubal ligation by a mini-laparotomy incision under local anaesthesia . The performance of the nurse-midwives was compared with that of doctors in a controlled , r and omised clinical trial 
    Output:
    
In general , there was no difference between the effectiveness of care provided by mid-level health workers in the areas of maternal and child health and communicable and noncommunicable diseases and that provided by higher level health workers .
However , the rates of episiotomy and analgesia use were significantly lower in women giving birth who received care from midwives alone than in those who received care from doctors working in teams with midwives , and women were significantly more satisfied with care from midwives .
No difference between the effectiveness of care provided by mid-level health workers and that provided by higher level health workers was found .