***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: Objective . To evaluate the effect of a nurse-led heart failure clinic on drug therapy and hospitalization in a community hospital setting . Design . Prospect i ve , observational study of out patients referred to a heart failure clinic . Nurses directed drug uptitration and delivered patient education . Utilization and doses of ACE inhibitors and beta-blockers were analyzed as were heart failure related admissions in the years before and after establishing the clinic . Results . 138 patients ( median age 68.5 years ) were enrolled . After three months 94 % of patients were taking an ACE inhibitor and beta-blockade was prescribed for 91 % . Mean ACE inhibitor dose relative to target dose after three months was 77±30 % and mean beta-blocker dose was 53±31 % of the target dose . Heart failure admissions decreased by 45 % after the clinic was established . Conclusions . Community hospital based heart failure clinics may promote utilization of evidence based drug therapy and cause a substantial decrease in heart failure admissions , producing results comparable to those obtained in studies of university hospital based heart failure management programs This study reports results from a r and omised controlled trial of nurse-led care and was design ed to determine whether nurse-led follow up improved patients morbidity and satisfaction with care in men treated with radical radiotherapy for prostate and bladder cancer . The aim was to compare outcomes in terms of toxicity , symptoms experienced , quality of life , satisfaction with care and health care costs , between those receiving nurse-led care and a group receiving st and ard care .  The study population was of men prescribed radical radiotherapy ( greater than 60 Gy ) .  Participants completed self- assessment question naires for symptoms and quality of life within the first week of radiotherapy treatment , at week 3 , 6 and 12 weeks from start of radiotherapy .  Satisfaction with clinical care was also assessed at 12 weeks post-treatment . Observer-rated RTOG toxicity scores were recorded pre-treatment , weeks 1 , 3 , 6 and 12 weeks from start of radiotherapy . The results presented in this paper are on 115 of 132 ( 87 % ) of eligible men who agreed to enter the r and omised trial . 6 men ( 4 % ) refused and 11 ( 8 % ) were missed for inclusion in the study . Data were analysed as a comparison at cross-sectional time points and as a general linear model using multiple regression . There was no significant difference in maximum symptom scores over the time of the trial between nurse-led follow-up care and conventional medical care . Differences were seen in scores in the initial self assessment of symptoms ( week 1 ) that may have been as a result of early nursing intervention . Those men who had received nurse-led care were significantly more satisfied ( P < 0.002 ) at 12 weeks and valued the continuity of the service provided . There were also significant ( P < 0.001 ) cost benefits , with a 31 % reduction in costs with nurse-led , compared to medically led care . Evidence from this study suggests that a specialist nurse is able to provide safe follow up for men undergoing radiotherapy . The intervention focused on coping with symptoms , and provided continuity of care and telephone support . Further work is required to improve the management of patients during and after radiotherapy . © 2001 Cancer Research Campaign CONTEXT Upper gastrointestinal cancer is associated with a poor prognosis . The multidimensional problems of incurable patients require close monitoring and frequent support , which can not sufficiently be provided during conventional one to two month follow-up visits to the outpatient clinic . OBJECTIVES To compare nurse-led follow-up at home with conventional medical follow-up in the outpatient clinic for patients with incurable primary or recurrent esophageal , pancreatic , or hepatobiliary cancer . METHODS Patients were r and omized to nurse-led follow-up at home or conventional medical follow-up  in the outpatient clinic . Outcome parameters were quality of life ( QoL ) , patient satisfaction , and health care consumption , measured by different question naires at one and a half and four months after r and omization . As well , cost analyses were done for both follow-up strategies in the first four months . RESULTS In total , 138 patients were r and omized , of which 66 ( 48 % ) were evaluable . At baseline , both groups were similar with respect to clinical and sociodemographic characteristics and health-related QoL. Patients in the nurse-led follow-up group were significantly more satisfied with the visits , whereas QoL and health care consumption within the first four months were comparable between the two groups . Nurse-led follow-up was less expensive than conventional medical follow-up . However , the total costs for the first four months of follow-up in this study were higher in the nurse-led follow-up group because of a higher frequency of visits . CONCLUSION The results suggest that conventional medical follow-up is interchangeable with nurse-led follow-up . A cost utility study is necessary to determine the preferred frequency and duration of the home visits Abstract Objectives : To determine whether specialist nurse intervention improves outcome in patients with chronic heart failure . Design : R and omised controlled trial . Setting : Acute medical admissions unit in a teaching hospital . Participants : 165 patients admitted with heart failure due to left ventricular systolic dysfunction . The intervention started before discharge and continued thereafter with home visits for up to 1 year . Main outcome measures : Time to first event analysis of death from all causes or readmission to hospital with worsening heart failure . Results : 31 patients ( 37 % ) in the intervention group died or were readmitted with heart failure compared with 45 ( 53 % ) in the usual care group ( hazard ratio=0.61 , 95 % confidence interval 0.33 to 0.96).Compared with usual care , patients in the intervention group had fewer readmissions for any reason ( 86 v 114 , P=0.018 ) , fewer admissions for heart failure ( 19 v 45 , P<0.001 ) and spent fewer days in hospital for heart failure ( mean 3.43 v 7.46 days , P=0.0051 ) . Conclusions : Specially trained nurses can improve the outcome of patients admitted to hospital with heart failure . What is already known on this topic Studies have suggested that nurse intervention may reduce readmission in patients with heart failure What this study adds Home based intervention from nurses reduces readmissions for worsening heart failure Regular contact to review treatment and patient education are likely to contribute to this OBJECTIVE To determine the economic feasibility in Australian general practice s of using a practice nurse (PN)-led care model of chronic disease management . METHODS A cost- analysis of item numbers from the Medicare Benefit Schedule ( MBS ) was performed in three Australian general practice s , one urban , one regional and one rural . Patients ( n = 254 ; > 18 years of age ) with chronic conditions ( type 2 diabetes , hypertension , ischaemic heart disease ) but without unstable or major health problems were r and omised into usual general practitioner ( GP ) or PN-led care for management of their condition over a period of 12 months . After the 12-month intervention , total MBS item charges were evaluated for patients managed for their stable chronic condition by usual GP or PN-led care . Zero-skewness log transformation was applied to cost data and log-linear regression analysis was undertaken . RESULTS There was an estimated A$ 129 mean increase in total MBS item charges over a 1-year period ( controlled for age , self-reported quality of life and geographic location of practice ) associated with PN-led care . The frequency of GP and PN visits varied markedly according to the chronic disease . CONCLUSIONS Medicare reimbursements provided sufficient funding for general practice s to employ PNs within limits of workloads before the new Practice Nurse Incentive Program was introduced in July 2012 It was postulated that home hospitalisation ( HH ) of selected chronic obstructive pulmonary disease ( COPD ) exacerbations admitted at the emergency room ( ER ) could facilitate a better outcome than conventional hospitalisation . To this end , 222 COPD patients ( 3.2 % female ; 71±10 yrs ( mean±sd ) ) were r and omly assigned to HH ( n=121 ) or conventional care ( n=101 ) . During HH , integrated care was delivered by a specialised nurse with the patient 's free-phone access to the nurse ensured for an 8‐week follow-up period . Mortality ( HH : 4.1 % ; controls : 6.9 % ) and hospital readmissions ( HH : 0.24±0.57 ; controls : 0.38±0.70 ) were similar in both groups . However , at the end of the follow-up period , HH patients showed : 1 ) a lower rate of ER visits ( 0.13±0.43 versus 0.31±0.62 ) ; and 2 ) a noticeable improvement of quality of life ( Δ St George 's Respiratory Question naire ( SGRQ ) , −6.9 versus −2.4 ) . Furthermore , a higher percentage of patients had a better knowledge of the disease ( 58 % versus 27 % ) , a better self-management of their condition ( 81 % versus 48 % ) , and the patient 's satisfaction was greater . The average overall direct cost per HH patient was 62 % of the costs of conventional care , essentially due to fewer days of inpatient hospitalisation ( 1.7±2.3 versus 4.2±4.1 days ) . A comprehensive home care intervention in selected chronic obstructive pulmonary disease exacerbations appears as cost effective . The home hospitalisation intervention  generates better outcomes at lower costs than conventional care Background —Although disease management programs for patients hospitalized with heart failure ( HF ) are effective , they are , however , often re source intensive , limiting their uptake . Peer support programs have led to improved outcomes among patients with other chronic conditions and may result in similar improvements for patients with HF . Methods and Results —In this r and omized controlled trial , Reciprocal Peer Support ( RPS ) arm patients participated in a HF nurse practitioner – led goal setting group session , received brief training in peer communication skills , and were paired with another participant in their cohort with whom they were encouraged to talk weekly using a telephone platform . Participants were also encouraged to attend 3 nurse practitioner – facilitated peer support group sessions .  Patients in the nurse care management arm attended a nurse practitioner – led session to address their HF care questions and receive HF educational material s and information on how to access care management services .  The median age of the patients was 69 years ; 51 % were female and 26 % were racial/ethnic minorities . Only 55 % of RPS patients participated in peer calls or group sessions . In intention-to-treat analyses , the RPS and nurse care management groups did not differ in time-to-first all-cause rehospitalization or death or in mean numbers of rehospitalizations or deaths . There were no differences in improvements in 6-month measures of HF-specific quality of life or social support . Conclusions —Among patients recently hospitalized for HF , more than half of RPS participants had no or minimal engagement with the RPS program , and the program did not improve outcomes compared with usual HF nurse care management . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT00508508 Objectives : To determine the effects of a nurse led intermediate care programme in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease ( AE COPD ) . Design : R and omised controlled trial . Setting : Community and hospital care in west London . Participants : 122 patients with COPD . Intervention : A care package incorporating initial pulmonary rehabilitation and self-management education , provision of a written , personalised COPD action plan , monthly telephone calls and 3 monthly home visits by a specialist nurse for a period of 2 years . Main outcome measure : Hospital readmission rate . Secondary outcomes : Unscheduled primary care consultations and quality of life . Results : There were no differences in hospital admission rates or in exacerbation rates between the two groups . Self-management of exacerbations was significantly different and the intervention group were more likely to be treated with oral steroids alone or oral steroids and antibiotics , and the initiators of treatment for exacerbations were statistically more likely to be the patients themselves . 12 patients in the control group died during the 2 year period , eight as a result of COPD , compared with six patients in the intervention group , of whom one died from COPD . This is a significant difference . When the numbers were adjusted to reflect the numbers still alive at 2 years , in the intervention group patients reported a total of 171 unscheduled contacts with their general practitioner ( GP ) and in the control group , 280 contacts . The number needed to treat was 0.558—ie , for every one COPD patient receiving the intervention and self-management advice , there were 1.79 fewer unscheduled contacts with the GP . Conclusions : An intermediate care package incorporating pulmonary rehabilitation , self-management education and the receipt of a written COPD action plan , together with regular nurse contact , is associated with a reduced need for unscheduled primary care consultations and a reduction in deaths due to COPD but did not affect the hospital readmission rate While disease management appears to be effective in selected , small groups of CHF patients from r and omized controlled trials , its effectiveness in a broader CHF patient population is not known . This prospect i ve , quasi-experimental study compared patient outcomes under a nurse practitioner-led disease management model ( intervention group ) with outcomes under usual care ( control group ) in both primary and tertiary medical centers . The study included 969 veterans ( 458 intervention , 511 control ) treated for CHF at six VA medical centers . Intervention patients had significantly fewer ( p<0.05 ) CHF and all-cause admissions at one-year follow-up , and lower mortality at both one- and two-year follow-up . These data provide support for 
    Output:
    
Conclusion : Clinical Nurse Specialist interventions may be effective in reducing specific re source use such as hospitalizations/re-hospitalizations/admissions , length of stay and health care costs .
There is mixed evidence regarding their cost-effectiveness .