***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 African American men with hypertension in low socioeconomic urban population s achieve poor rates of hypertension control and suffer early from its complications . METHODS In a r and omized clinical trial with 309 hypertensive urban African American men aged 21 to 54 years , we evaluated the effectiveness of a more intensive comprehensive educational-behavioral-pharmacologic intervention by a nurse practitioner-community health worker-physician ( NP/CHW/MD ) team and a less intensive education and referral intervention in controlling blood pressure ( BP ) and minimizing progression of left ventricular hypertrophy ( LVH ) and renal insufficiency . Changes in BP , left ventricular mass ( LVM ) , and serum creatinine from baseline to 36 months were compared between groups . RESULTS At 36 months , the mean systolic BP/diastolic BP change from baseline was -7.5/-10.1 mm Hg for the more intensive group and + 3.4/-3.7 mm Hg for the less intensive group ( P = .001 and .005 for between-group differences in systolic BP and diastolic BP , respectively ) . The proportion of men with controlled BP ( < 140/90 mm Hg ) was 44 % in the more intensive group and 31 % in the less intensive group ( P = .045 ) . The LVM was significantly lower in the more intensive group than in the less intensive group ( more intensive , 274 g ; less intensive , 311 g ; P = .004 ) . There was a trend toward slowing of the progression of renal insufficiency ( incidence of 50 % increase in serum creatinine ) in the more intensive group compared to the less intensive group ( more intensive , 5.2 % ; less intensive , 8.0 % ; P = .08 ) . CONCLUSIONS During 36 months , the more intensive intervention led to a lower BP and decreased progression of LVH in a sample of hypertensive young African American men BACKGROUND Cardiovascular disease ( CVD ) is a major cause of mortality in the United States , representing the highest total expenditures among major diseases . To improve CVD-associated outcomes , medication therapy management ( MTM ) services have been included in essential health benefit packages offered by various health plans . Nevertheless , the impact of such MTM services on outcomes is still unclear , especially from the perspective of the self-insured employer . OBJECTIVES To ( a ) compare economic outcomes between patients who received and those who did not receive MTM services from the self-insured employer 's perspective and ( b ) compare clinical outcomes before and after receiving MTM services . METHODS This study consisted of 2 pre- and post-retrospective design s : ( 1 ) a cohort study with comparison groups and ( 2 ) a cohort study within group comparison . Patients were beneficiaries aged 19 years or older who were diagnosed with CVD conditions according to ICD-9-CM codes and continuously enrolled in a public university-sponsored insurance plan between 2008 - 2010 . Patients were divided into MTM and non-MTM groups . The first MTM encounter was assigned as the index date for the MTM group . Match-paired patients who did not receive MTM services were r and omly assigned the index date based on age category , gender , and comorbidity . Measures for pharmacy , medical , and total expenditures were obtained from medical and pharmacy cl aims . Paired t-tests and independent t-tests using data generated from 1000 bootstraps compared mean cost difference within and between groups . The return on investment ( ROI ) was calculated by dividing the average net benefit from MTM services by the average cost of MTM services . Clinical parameters , including blood pressure ( BP ) and body mass index ( BMI ) , were retrieved from electronic medical records from a pharmacist-provided clinic where MTM services took place . Paired-t tests were used to compare the mean difference between baseline and endpoint values . Further , this study examined changes in the proportion of patients who achieved an individualized treatment goal for BP and BMI . The study also quantified the improvement in disease stages after the index date using the McNemar 's test . Statistical analyses were performed by using SAS software version 9.2 with statistical significance level of 0.05 . RESULTS A total of 63 patients and 62 match-paired patients were included in the MTM group and the non-MTM group , respectively . The mean cost ( SD ) per patient in the MTM group during the 6 months post-index period for CVD-related pharmacy , all-cause medical , and total expenditures was lower than the 6 months pre-index period by $ 22.0 ( 19.1 ) , $ 79.2 ( 99.6 ) , and $ 75.1 ( 136.2 ) , respectively . In contrast , the mean cost ( SD ) for the non-MTM group increased during the 6 months post-index date by $ 10.7 ( 24.2 ) , $ 246.4 ( 248.4 ) , and $ 289.0 ( 269.5 ) for pharmacy , medical , and total expenditure , respectively . When comparing the 2 groups , the MTM group had statistically significantly lower costs per patient for pharmacy expenditures ( difference of -31.9 ± 25.1 , P less than 0.0001 ) , medical expenditures ( difference of -$325.6 ± 271.2 , P less than 0.0001 ) , and total direct expenditures ( difference of -$359.3 ± 219.2 , P less than 0.0001 ) . Given the net benefit of MTM services ( $ 359.3 ) and the average cost of MTM service ( $ 134.6 ) , the ROI was $ 1.67 per $ 1 in MTM cost . Regarding clinical outcomes , while no statistically significant differences were observed in clinical outcomes , MTM services demonstrated clinical benefits . At the post-index period , the percentage of patients who had achieved their goals increased from 55 % to 70 % for BP and from 13.0 % to 21.7 % for normal BMI compared with the pre-index period . In terms of the extent of improvement in disease stages , clinical improvements in the stages of hypertension ( χ2 = 12.77 , P less than 0.05 ) as well as BMI ( χ2 = 6.39 , P less than 0.05 ) at the endpoint were observed . CONCLUSIONS Cardiovascular-related pharmacy , all-cause medical , and total expenditures were statistically lower among beneficiaries who received MTM services compared with those who did not . In addition , MTM services had a positive ROI and demonstrated clinical significance s by the increasing number of patients who achieved treatment goals and improved disease stages for hypertension and BMI Background Many older people in long-term care do not receive evidence -based diagnosis or management for heart failure ; it is not known whether this can be achieved for this population . We initiated an onsite heart failure service , compared with ‘ usual care ’ with the aim of establishing the feasibility of accurate diagnosis and appropriate management . Methods A pilot r and omised controlled trial which r and omised residents from 33 care facilities in North-East Engl and with left ventricular systolic dysfunction ( LVSD ) to usual care or an onsite heart failure service . The primary outcome was the optimum prescription of angiotensin-converting enzyme inhibitors and beta-adrenergic antagonists  at 6 months . Results Of 399 echocardiographically-screened residents aged 65–100 years , 30 subjects with LVSD were eligible ; 28 ( 93 % ) consented and were r and omised ( HF service : 16 ; routine care : 12 ) . Groups were similar at baseline ; six month follow-up was completed for 25 patients ( 89 % ) ; 3 ( 11 % ) patients died . Results for the primary outcome were not statistically significant but there was a consistent pattern of increased drug use and titration to optimum dose in the intervention group ( 21 % compared to 0 % receiving routine care , p=0.250 ) . Hospitalisation rates , quality of life and mortality at 6 months were similar between groups . Conclusions This study demonstrated the feasibility of an on-site heart failure service for older long-term care population s. Optimisation of medication appeared possible without adversely affecting quality of life ; this questions clinicians ’ concerns about adverse effects in this group . This has international implication s for managing such patients . These methods should be replicated in a large-scale study to quantify the scale of benefit . Trial registration IS RCT N19781227 http://www.controlled-trials.com/IS RCT OBJECTIVES To compare compliance with national paediatric HIV treatment guidelines between nurse prescribers and doctors at a paediatric referral centre in Gaborone , Botswana . METHODS A cross-sectional study was conducted in 2009 at the Botswana-Baylor Children 's Clinical Centre of Excellence ( COE ) , Gaborone , Botswana , comparing the performance of nurse prescribers and physicians caring for HIV-infected paediatric patients . Selected by stratified r and om sampling , 100 physician and 97 nurse prescriber encounters were retrospectively review ed for successful documentation of eight separate clinical ly relevant variables : pill count charted ; chief complaint listed ; social history up date d ; disclosure review ed ; physical exam ; laboratory testing ; World Health Organization ( WHO ) staging documented ; paediatric dosing . RESULTS Nurse prescribers and physicians correctly documented 96.0 % and 94.9 % of the time , respectively . There was a trend towards a higher proportion of social history documentation by the nurses , but no significant difference in any other documentation items . CONCLUSIONS Our findings support the continued investment in programmes employing properly trained nurses in southern Africa to provide quality care and ART services to HIV-infected children who are stable on therapy . Task shifting remains a promising strategy to scale up and sustain adult and paediatric ART more effectively , particularly where provider shortages threaten ART rollout . Policies guiding ART services in southern Africa should avoid restricting the delivery of crucial services to doctors , especially where their numbers are limited BACKGROUND Pharmacists have been shown to positively impact the outcomes of care for treatment of many different kinds of disease states . In particular , pharmacist-run lipid clinics have enjoyed varying degrees of success , depending on the outcome assessed . At our hospital , when a patient is transferred to the pharmacist-coordinated lipid clinic , the primary care pharmacist is responsible for ordering and interpreting labs and prescribing and monitoring lipid-altering therapy . OBJECTIVE This study was design ed to assess if there is a statistically significant difference between the magnitude of serum cholesterol reduction for patients receiving lipid-altering pharmacotherapy  when clinical ly trained pharmacists are actively prescribing and adjusting the drug therapy compared to other health care practitioners ( usual care ) . METHODS Patient records from the hospital computer data bases were retrospectively and r and omly selected for analysis . Following evaluation for inclusion s and exclusions , 41 patient records remained for statistical analysis for the cohort group , and 47 records remained from the group of patients managed by a clinical pharmacist . RESULTS Management of dyslipidemia by a clinical pharmacist was associated with a significant reduction in overall mean low-density lipoprotein ( LDL , 18.5 % ) compared to the cohort that did not have a clinical pharmacist as the primary manager of dyslipidemia ( 6.5 % , P=0.049 ) . This suggests improved clinical outcomes , defined as greater LDL reduction , when clinical pharmacists participate in lipid management , including drug prescribing . The magnitude reduction in LDL was found to be related to the number of clinical pharmacy visits ( 11.4 % for 1 visit , 23.2 % for 2 visits , and 23.7 % for > 3 visits ) , compared to the usual care group ( -11.0 % , 18.0 % , and 7.4 % ; statistically significant , P=0.038 , for > 3 visits only ) . These results occurred even though the group of dyslipidemic patients managed primarily by a clinical pharmacist contained a statistically greater number of patients with 2 or more risk factors and high-density lipoprotein ( HDL ) levels less than 40 mg/dL. CONCLUSION Interdisciplinary medical teams that include clinical pharmacists who are actively prescribing and adjusting lipid drug therapy may achieve greater reductions in LDL for patients who have been assessed with multiple risk factors compared to patients managed without clinical pharmacists . Active participation by clinical pharmacists in lipid management for patients with elevated LDL result ed in improved treatment success as measured by the magnitude reduction in LDL . The reduction in LDL was between 5 % and 22 % per visit greater for patients being treated by clinical pharmacists versus usual care , even in a patient population with more risk factors . These intermediate outcomes may translate into long-term outcomes in fewer cardiovascular events , improved quality of life for patients with dyslipidemia , and lower costs associated with sequelae of dyslipidemias Background Supplementary prescribing for  mental health nurses was first introduced in the UK in 2003 . Since then , a number of studies have reported stakeholders ' perceptions of the success of the initiative . However , there has been little experimental research conducted into its effectiveness . This paper reports findings from the first known study to compare the cost and clinical impact of mental health nurse supplementary prescribing to independent medical prescribing . Methods A post-test control group experimental design was used to compare the treatment costs , clinical outcomes and satisfaction of patients in receipt of mental health nurse supplementary prescribing 
    Output:
    
non-medical prescribing versus medical prescribing in acute care ; 2 .
While little difference was seen in patient-related adverse events between treatment groups , we down grade d the certainty of evidence to low due to indirectness , as the range of adverse events may not be related to the intervention and selective reporting failed to adequately report adverse events in many studies .
The findings suggest that non-medical prescribers , practising with varying but high levels of prescribing autonomy , in a range of setting s , were as effective as usual care medical prescribers .
Non-medical prescribers can deliver comparable outcomes for systolic blood pressure , glycated haemoglobin , low-density lipoprotein , medication adherence , patient satisfaction , and health-related quality of life .
It was difficult to determine the impact of non-medical prescribing compared to medical prescribing for adverse events and re source use outcomes due to the inconsistency and variability in reporting across studies .