***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: 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 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 Objective To evaluate whether  nurse run clinics in general practice improve secondary prevention in patients with coronary heart disease . Design R and omised controlled trial . Setting A r and om sample of 19 general practice s in northeast Scotl and . Patients 1173 patients ( 685 men and 488 women ) under 80 years with working diagnoses of coronary heart disease , but without terminal illness or dementia and not housebound .  Intervention Nurse run clinics promoted medical and lifestyle aspects of secondary prevention and offered regular follow up . Main outcome measures Components of secondary prevention assessed at baseline and one year were : aspirin use ; blood pressure management ; lipid management ; physical activity ; dietary fat ; and smoking status . A cumulative score was generated by counting the number of appropriate components of secondary prevention for each patient . Results There were significant improvements in aspirin management ( odds ratio 3.22 , 95 % confidence interval 2.15 to 4.80 ) , blood pressure management ( 5.32 , 3.01 to 9.41 ) , lipid management ( 3.19 , 2.39 to 4.26 ) , physical activity ( 1.67 , 1.23 to 2.26 ) and diet ( 1.47 , 1.10 to 1.96 ) . There was no effect on smoking cessation ( 0.78 , 0.47 to 1.28 ) . Of six possible components of secondary prevention , the baseline mean was 3.27 . The adjusted mean improvement attributable to intervention was 0.55 of a component ( 0.44 to 0.67 ) . Improvement was found regardless of practice baseline performance . Conclusions  Nurse run clinics proved practical to implement in general practice and effectively increased secondary prevention in coronary heart disease . Most patients gained at least one effective component of secondary prevention and , for them , future cardiovascular events and mortality could be reduced by up to a third Background Dyspepsia is a common disorder in the community , with many patients referred for diagnostic gastroscopy by their General Practitioner ( GP ) . The National Institute of Clinical Excellence ( NICE ) recommends follow-up after investigation for cost effective management , including lifestyle advice and drug use . An alternative strategy may be the use of a gastro-intestinal nurse practitioner ( GNP ) instead of the GP . The objective of this study is to compare the effectiveness and costs of systematic GNP led follow-up to usual care by GPs in dyspeptic patients following gastroscopy . Results Direct access adult dyspeptic patients referred for gastroscopy ; without serious pathology , were followed-up in a structured nurse-led outpatient clinic . Outcome measurement used to compare the two study cohorts ( GNP versus GP ) included Glasgow dyspepsia severity ( Gladys ) score , Health Status Short Form 12 ( SF12 ) , ulcer healing drug ( UHD ) use and costs .  One hundred and seventy five patients were eligible after gastroscopy , 89 were r and omised to GNP follow-up  and 86 to GP follow-up  . Follow-up at 6 months was 81/89 ( 91 % ) in the GNP arm and 79/86 ( 92 % ) in the GP arm . On an intention to treat analysis , adjusted mean differences ( 95%CI ) at follow-up between Nurse and GP follow-up were : Gladys score 2.30 ( 1.4–3.2 ) p < 0.001 , SF12 140.6 ( 96.5–184.8 ) p = < 0.001 and UHD costs £ 39.60 ( £ 24.20–£55.10 ) p = < 0.001 , all in favour of nurse follow-up . Conclusion A st and ardised and structured follow-up by one gastrointestinal nurse practitioner was effective and may save drug costs in patients after gastroscopy . These findings need replication in other centres Objectives : To evaluate the effects of nurse-led secondary prevention clinics for coronary heart disease ( CHD ) in primary care on total mortality and coronary event rates after 10 years . Design : Follow-up of a r and omised controlled trial by review of national data sets . Setting : Stratified r and om sample of 19 general practice s in northeast Scotl and . Participants : Original study cohort of 1343 patients , aged < 80 years , with a working diagnosis of CHD , but without dementia or terminal illness and not housebound . Intervention : Nurse-led secondary prevention clinics promoted medical and lifestyle aspects of secondary prevention and offered regular follow-up for 1 year , Main outcome measures : Total mortality and coronary events ( non-fatal myocardial infa rct ions ( MIs ) and coronary deaths ) . Results : Mean ( SD ) follow-up was at 10.2 ( 0.19 ) years . No significant differences in total mortality or coronary events were found at 10 years . 254 patients in the intervention group and 277 patients in the control group had died : cumulative death rates were 38 % and 41 % , respectively ( p = 0.177 ) . 196 coronary events occurred in the intervention group and 195 in the control group : cumulative event rates were 29.1 % and 29.1 % , respectively ( p = 0.994 ) . When Kaplan – Meier survival analysis , adjusted for age , sex and general practice , was used , proportional hazard ratios were 0.88 ( 0.74 to 1.04 ) for total mortality and 0.96 ( 0.79 to 1.18 ) for coronary death or non-fatal MI . No significant differences in the distribution of cause of death classifications was found at either 4 or 10 years . Conclusions : After 10 years , differences between groups were no longer significant . Total mortality survival curves for the intervention and control groups had not converged , but the coronary event survival curves had . Possibly , therefore , the earlier that secondary prevention is optimised , the less likely a subsequent coronary event is to prove fatal Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more AIM This paper is a report of a study conducted to evaluate process and outcomes of care provided to patients with common complaints by general practitioners or specially trained nurse practitioners as first point of contact . BACKGROUND Studies in the United States of America and Great Britain show that substituting nurse practitioners for general practitioners results in higher patient satisfaction and higher quality of care . As the American and British healthcare system and setting s differ from that in The Netherl and s , a Dutch trial was conducted . METHODS A total of 1501 patients in 15 general practice s were r and omized to consultation by a general practitioner or a nurse practitioner . Data were collected over a 6-month period in 2006 by means of question naires , extracting medical records from practice computer systems and recording the length of consultations . FINDINGS In both groups , the patients highly appreciated the quality of care . No statistically significant differences were found in health status , medical re source consumption and compliance of practical guidelines in primary care in The Netherl and s. Patients in the NP intervention group were more often invited to re-attend , had more follow-up consultations and their consultations took statistically significantly longer . CONCLUSION Nurse practitioners and general practitioners provide comparable care . Our findings support an increased involvement of specially trained nurse practitioners in the Dutch primary care and contribute to knowledge of the effectiveness of care provision by nurse practitioners from a national and international perspective Abstract Objective To establish the cost effectiveness of  nurse led secondary prevention clinics for coronary heart disease based on four years ' follow up of a r and omised controlled trial . Design Cost effectiveness analysis . Setting 19 general practice s in north east Scotl and . Participants 1343 patients ( 673 in intervention group and 670 in control group , as originally r and omised ) aged under 80 years with a diagnosis of coronary heart disease but without terminal illness or dementia and not housebound . Intervention Nurse led clinics to promote medical and lifestyle components of secondary prevention . Main outcome measures Costs of clinics ; overall costs to health service ; and cost per life year and per quality adjusted life year ( QALY ) gained , expressed as incremental gain in intervention group compared with control group . Results The cost of the intervention ( clinics and drugs ) was £ 136 ( $ 254 ; € 195 ) per patient higher ( 1998 - 9 prices ) in the intervention group , but the difference in other NHS costs , although lower for the intervention group , was not statistically significant . Overall , 28 fewer deaths occurred in the intervention group leading to a gain in mean life years per patient of 0.110 and of 0.124 QALYs . The incremental cost per life year saved was £ 1236 and that per QALY was £ 1097 . Conclusion Nurse led clinics for the secondary prevention of coronary heart disease in primary care seem to be cost effective compared with most interventions in health care , with the main gains in life years saved Abstract Objective : To ascertain any differences between care from  nurse practitioners and that from general practitioners for patients seeking “ same day ” consultations in primary care . Design : R and omised controlled trial with patients allocated by one of two r and omisation schemes  ( by day or within day ) . Setting : 10 general practice s in south Wales and south west Engl and . Subjects : 1368 patients requesting same day consultations .  Main outcome measures : Patient satisfaction , resolution of symptoms and concerns , care provided ( prescriptions , investigations , referrals , recall , and length of consultation ) , information provided to patients , and patients ' intentions for seeking care in the future . Results : Generally patients consulting nurse practitioners were significantly more satisfied with their care , although for adults this difference was not observed in all practice s. For children , the mean difference between general and nurse practitioner in percentage satisfaction score was −4.8 ( 95 % confidence interval −6.8 to −2.8 ) , and for adults the differences ranged from −8.8 ( −13.6 to −3.9 ) to 3.8 ( −3.3 to 10.8 ) across the practice s. Resolution of symptoms and concerns did not differ between the two groups ( odds ratio 1.2 ( 95 % confidence interval 0.8 to 1.8 ) 
    Output:
    
The evidence has limitations , but suggests that the effects may be influenced by the utilization of re sources , context of care , available guidance , and supervision .
Cost data suggest physician – nurse salary and physician ’s time spent on supervision and delegation are important components of nurse-led care costs .