***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 
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    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 BACKGROUND Continence services in the UK have developed at different rates within differing care models , result ing in scattered and inconsistent services . Consequently , questions remain about the most cost-effective method of delivering these services . AIM To evaluate the impact of a new service led by a continence nurse practitioner compared with existing primary / secondary care provision for people with urinary incontinence and storage symptoms . DESIGN OF STUDY R and omised controlled trial with a 3- and 6-month follow-up in men and women ( n = 3746 ) aged 40 years and over living in private households ( intervention [ n = 2958 ] ; control [ n = 788 ] ) . SETTING Leicestershire and Rutl and , UK . METHOD The continence nurse practitioner intervention comprised a continence service provided by specially trained nurses delivering evidence -based interventions using predetermined care pathways . They delivered an 8-week primary intervention package that included advice on diet and fluids ; bladder training ; pelvic floor awareness and lifestyle advice . The st and ard care arm comprised access to existing primary care including GP and continence advisory services in the area . Outcome measures were recorded at 3 and 6 months post-r and omisation . RESULTS The percentage of individuals who improved ( with at least one symptom alleviated ) at 3 months was 59 % in the intervention group compared with 48 % in the st and ard care group ( difference of 11 % , 95 % CI = 7 to 16 ; P<0.001 ) The percentage of people reporting no symptoms or ' cured ' was 25 % in the intervention group and 15 % in the st and ard care group ( difference of 10 % , 95 % CI = 6 to 13 , P = 0.001 ) . At 6 months the difference was maintained . There was a significant difference in impact scores between the two groups at 3 and 6 months . CONCLUSIONS The continence nurse practitioner-led intervention reduced the symptoms of incontinence , frequency , urgency and nocturia at 3 and 6 months ; impact was reduced ; and satisfaction with the new service was high 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 T h e increasing dem and for health-care services in the United States has been documented in several studies . The obvious solution , more manpower in all disciplines , is somewhat unrealistic . In all probability , the dem and for health services , as presently organized , can not be met at the rate that current education programs in the health professions can be exp and ed or replicated . ’ There is considerable discussion regarding the delegation of certain aspects of medical care to new types of health professionals as a means of increasing the quantity of services available . Another possibility is to define more adequately the roles of existing disciplines , on the assumption that they might work together more efficiently in providing interprofessional care for a larger number of patients . Although the hospital is the focus of medical care , the greatest dem and s for health services are made by vertical , rather than horizontal , patients . Inordinately large dem and s for ambulatory patient care are created by two groups of consumers . During the first few years of life , children must be seen frequently to provide optimal preventive care . At the other end of the life cycle of man ,  aging patients with chronic diseases  accumulate . They too require frequent medical attention . Considering the “ excessive ” medical care needs of these two segments of the population , it is not surprising that they have been the subjects of experimentation in the delivery of services . Projects have been described in which nurses have assumed some of the functions of physicians engaged in the practice of obstetrics and pediatrics.2 - 4 With 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 Summary Background Robust evidence of the effectiveness of task shifting of antiretroviral therapy ( ART ) from doctors to other health workers is scarce . We aim ed to assess the effects on mortality , viral suppression , and other health outcomes and quality indicators of the Streamlining Tasks and Roles to Exp and Treatment and Care for HIV ( STRETCH ) programme , which provides educational outreach training of nurses to initiate and represcribe ART , and to de central ise care . Methods We undertook a pragmatic , parallel , cluster-r and omised trial in South Africa between Jan 28 , 2008 , and June 30 , 2010 . We r and omly assigned 31 primary -care ART clinics to implement the STRETCH programme ( intervention group ) or to continue with st and ard care ( control group ) . The ratio of r and omisation depended on how many clinics were in each of nine strata . Two cohorts were enrolled : eligible patients in cohort 1 were adults ( aged ≥16 years ) with CD4 counts of 350 cells per μL or less who were not receiving ART ; those in cohort 2 were adults who had already received ART for at least 6 months and were being treated at enrolment . The primary outcome in cohort 1 was time to death ( superiority analysis ) . The primary outcome in cohort 2 was the proportion with undetectable viral loads ( < 400 copies per mL ) 12 months after enrolment ( equivalence analysis , prespecified difference < 6 % ) . Patients and clinicians could not be masked to group assignment . The interim analysis was blind , but data analysts were not masked after the data base was locked for final analysis . Analyses were done by intention to treat . This trial is registered , number IS RCT N46836853 . Findings 5390 patients in cohort 1 and 3029 in cohort 2 were in the intervention group , and 3862 in cohort 1 and 3202 in cohort 2 were in the control group . Median follow-up was 16·3 months ( IQR 12·2–18·0 ) in cohort 1 and 18·0 months ( 18·0–18·0 ) in cohort 2 . In cohort 1 , 997 ( 20 % ) of 4943 patients analysed in the intervention group and 747 ( 19 % ) of 3862 in the control group with known vital status at the end of the trial had died . Time to death did not differ ( hazard ratio [ HR ] 0·94 , 95 % CI 0·76–1·15 ) . In a preplanned subgroup analysis of patients with baseline  CD4 counts of 201–350 cells per μL , mortality was slightly lower in the intervention group than in the control group ( 0·73 , 0·54–1.00 ; p=0·052 ) , but it did not differ between groups in patients with baseline CD4 of 200 cells per μL or less ( 0·94 , 0·76–1·15 ; p=0·577 ) . In cohort 2 , viral load suppression 12 months after enrolment was equivalent in intervention ( 2156 [ 71 % ] of 3029 patients ) and control groups ( 2230 [ 70 % ] of 3202 ; risk difference 1·1 % , 95 % CI −2·4 to 4·6 ) . Interpretation Expansion of primary -care nurses ' roles to include ART initiation and represcription can be done safely , and improve health outcomes and quality of care , but might not reduce time to ART or mortality . Funding UK Medical Research Council , Development Cooperation Irel and , and Canadian International Development Agency 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 ( 
    Output:
    
Despite the method ological limitations and the varying nurses ' roles and competencies across studies ,  specially trained nurses  can provide care that is at least as equivalent to care provided by physicians for the management of chronic diseases , in terms of process of care .