***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 Good blood pressure ( BP ) control reduces the risk of complications in people with type 2 diabetes , yet many do not achieve this . Guidelines for managing hypertension recommend increasing antihypertensive medications until control is achieved , but the effect of such recommendations in routine primary care is unknown . AIM To evaluate the effectiveness of a BP treatment algorithm in primary care patients with type 2 diabetes . DESIGN OF STUDY A cluster r and omised controlled trial of 1534 patients with type 2 diabetes . SETTING Forty-two practice s in Nottingham , UK . METHOD Practice s were r and omised to continue usual care or to use a treatment algorithm design ed so that practice nurses and GPs would increase antihypertensive treatment in steps until the target of 140/80 mmHg was reached . Participants were assessed by a clinical interview and case note review at recruitment and at 1 year . The primary outcome measure was the proportion of participants achieving target BP at 1 year . RESULTS At 1 year there was no difference between the proportions of participants with well controlled BP in the intervention and control arms ( 36.6 % versus 34.3 % ; P = 0.27 ) . Mean systolic and diastolic blood pressures were identical in the two arms ( 143/78 mmHg ) . There was some evidence that participants in the intervention arm were more likely to be receiving higher doses of their antihypertensive drugs , although there was no significant difference in the number of different antihypertensive drugs prescribed . Participants in the intervention arm had a higher rate of primary care BP-related consultations over 12 months than those receiving usual care ( rate ratio = 1.55 , 95 % confidence interval [ CI ] = 1.26 to 1.88 , P<0.001 ) . CONCLUSION Despite increased monitoring and possibly higher doses of medication there was no improvement in blood pressure control . Improvements achieved by specialist nurse-led clinics in secondary care may not translate to people with type 2 diabetes in primary care setting BACKGROUND There is increased pressure on primary care physicians to monitor oral anticoagulation . OBJECTIVE To test the null hypothesis that oral anticoagulation care can be provided at least as well in primary care through a nurse-led clinic , involving near-patient testing and computerized decision support software , compared with routine hospital management based on a variety of clinical outcome measures . METHODS A r and omized , controlled trial in 12 primary care practice s in Birmingham , Engl and ( 9 intervention and 3 control ) . Two control population s were used :  patients individually r and omly allocated as controls in the intervention practice s ( intra practice controls ) and all patients in control practice s ( inter practice controls ) . Intervention practice s ' patients were r and omized to the intervention ( practice -based anticoagulation clinic ) or control ( hospital clinic ) group . The main outcome measure was therapeutic control of the international normalized ratio . RESULTS Three hundred sixty-seven patients were recruited ( 122 intervention patients , 102 intra practice control patients , and 143 inter practice control patients ) . St and ard measures of control of the international normalized ratio ( point prevalence ) showed no significant difference between the intervention and control groups . Data on proportion of time spent in the international normalized ratio range showed significant improvement for patients in the intervention group ( paired t test , P = .008 ) . CONCLUSIONS Nurse-led anticoagulation clinics can be implemented in novice primary care setting s by means of computerized decision support software and near-patient testing . Care given by this model is at least as good as routine hospital follow-up . The model is generalizable to primary health care centers operating in developed health care systems BACKGROUND The benefit of multidimensional assessment and management of older people remains controversial . Most trials have been too small to produce adequate evidence to inform policy . We aim ed to measure the effects of different approaches to assessment and management of older people . METHODS We undertook a cluster-r and omised factorial trial in 106 general practice s ( 43219 eligible patients aged 75 years and older , 78 % participation ) , comparing ( 1 ) universal versus targeted assessment and ( 2 ) subsequent management by hospital outpatient geriatric team versus the primary -care team .  All participants received a brief multidimensional assessment followed by a nurse-led in-depth assessment in the universal group , whereas in the targeted group the in-depth assessment was offered only to those with problems established at the brief assessment . Referrals to the r and omised team ( geriatric management or primary care ) , other medical or social services , health-care workers , or agencies , and emergency referrals to the general practitioner were based on a st and ard protocol at the in-depth assessment . The primary endpoints were mortality , admissions to hospital and institution , and quality of life . Analysis was by intention to treat and per protocol . This trial has been assigned the International St and ardised R and omised Controlled Trial Number IS RCT N23494848 . FINDINGS Mortality and hospital or institutional admissions did not differ between groups . During 3 years ' follow-up , significant improvements in quality of life result ed from universal versus targeted assessment in terms of homecare , and from management by geriatric team versus primary -care team , in terms of mobility , social interaction , and morale . However , only the result for social interaction was consistent with a small but important effect . INTERPRETATION The different forms of multidimensional assessment offered almost no differences in patient outcome 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 A r and omised trial of  nurse-led secondary prevention clinics for coronary heart disease result ed in improved secondary prevention and significantly lowered all-cause mortality at 4-year follow-up . This qualitative trial was conducted to explore the experience of health professionals that had been involved in running the clinics . AIM To identify the barriers and facilitators to establishing secondary prevention clinics for coronary heart disease within primary care . DESIGN OF STUDY Semi-structured audiotaped telephone interviews with  GPs and nurses involved in running clinics .  SETTING A stratified , r and om sample of 19 urban , suburban , and rural general practice s in north-east Scotl and . METHOD Semi-structured telephone interviews with 19 GPs and 17 practice -based nurses involved in running nurse-led clinics for the secondary prevention of coronary heart disease .  RESULTS Eight practice s had run clinics continuously and 11 had stopped , with eight subsequently restarting . Participants accounted for these patterns by referring to advantages and disadvantages of the clinics in four areas : patient care , development of nursing skills , team working , and infrastructure . Most practitioners perceived benefits for patients from attending secondary prevention clinics , but some , from small rural practice s , thought they were unnecessary . The extended role for nurses was welcomed , but was dependent on motivated staff , appropriate training and support . Clinics relied on , and could enhance , team working , however , some doctors were wary of delegating . With regard to infrastructure , staff shortages ( especially nurses ) and accommodation were as problematic as lack of funds . CONCLUSIONS Nurse-led secondary prevention clinics were viewed positively by most healthcare professionals that had been involved in running them , but barriers to their implementation had led most to stop running them at some point . Lack of space and staff shortages are likely to remain ongoing problems , but improvements in funding training and communication within practice s could help clinics to be put into practice and sustained BACKGROUND There is a paucity of r and omised controlled trials of weight management in primary care . AIM To ascertain the feasibility of a full trial of a nurse-led weight-management programme in general practice . DESIGN OF STUDY Factorial r and omised control trial . SETTING Primary care , UK . METHOD A total of 123 adults ( 80.3 % women , mean age 47.2 years ) with body mass index > or = 27 kg/m(2 ) , recruited from eight practice s , were r and omised  to receive structured lifestyle support ( n = 30 ) , structured lifestyle support plus pedometer ( n = 31 ) , usual care ( n = 31 ) , or usual care plus pedometer ( n = 31 ) for a 12-week period . RESULTS A total of 103 participants were successfully followed up . The adjusted mean difference in weight in structured support compared to usual care groups was -2.63 kg ( 95 % confidence interval [ CI ] = -4.06 to -1.20 kg ) , and for pedometer compared to no pedometer groups it was -0.11 kg ( 95 % CI = -1.52 to 1.30 kg ) . One in three participants in the structured-support groups ( 17/50 , 34.0 % ) lost 5 % or more of their initial weight , compared to less than one in five ( 10/53 , 18.9 % ) in usual-care groups ; provision of a pedometer made little difference ( 14/48 , 29.2 % pedometer ; 13/55 , 23.6 % no pedometer ) . Difference in waist circumference change between structured-support and usual-care groups was -1.80 cm ( 95 % CI = -3.39 to -0.20 cm ) , and between the pedometer and no pedometer groups it was -0.84 cm ( 95 % CI = -2.42 to 0.73 cm ) . When asked about their experience of study participation , most participants found structured support helpful . CONCLUSION The structured lifestyle support package could make substantial contributions to improving weight-management services . A trial of the intervention in general practice is feasible and practicable 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 Abstract Objective : To assess the effectiveness of three different methods of promoting secondary prevention of coronary heart disease in primary care . Design : Pragmatic , unblinded , cluster r and omised controlled trial . Setting : Warwickshire . Subjects : 21 general practice s received intervention ; outcome measured in 1906 patients aged 55 - 7 
    Output:
    
CONCLUSION New Zeal and and Australia lag behind the United Kingdom in practice nurse development .
Implementation of clinical governance was fundamental to the development of nurse-led care in the UK