***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 effectiveness of a reduced-frequency prenatal visit schedule by comparing perinatal outcomes , anxiety and maternal satisfaction with prenatal care . METHODS pregnancy outcomes of infant and maternal morbidity and mortality , anxiety and satisfaction for 81 women receiving prenatal care at a free-st and ing birthing center according to either an alternative prenatal care visit schedule ( APCVS ) ( n = 43 ) or the traditional prenatal care visit schedule ( TPCVS ) ( n = 38 ) were examined in this prospect i ve r and omized study . Upon entry into prenatal care , all women were of low obstetrical risk status . RESULTS major findings revealed no significant differences in selected perinatal outcomes between the two study groups . Women in the APCVS group reported significantly higher levels of satisfaction than women in the TPCVS group on both the satisfaction with provider subscale ( F = 5.74 , P = .02 ) and the satisfaction with the prenatal care system subscale ( F = 2.01 , P = .04 ) . There were no statistically significant differences found in anxiety scores between women in the two study groups . CONCLUSIONS low-risk women who followed the  reduced-frequency visit schedule experienced no difference in perinatal outcomes or anxiety . Women in the reduced-frequency ( APCVS ) group reported an increased level of satisfaction with both provider and the prenatal care system Objectives : To conduct an economic evaluation comparing a traditional antenatal visiting schedule ( traditional care ) with a reduced schedule of visits ( new style care ) for women at low risk of complications . Methods : Economic evaluation using the results of a r and omised controlled trial , the Antenatal Care Project . This took place between 1993 and 1994 in antenatal clinics in South East London and involved 2794 women at low risk of complications . Results : The estimated baseline costs to the UK National Health Service ( NHS ) for the traditional schedule were £ 544 per woman , of which £ 251 occurred antenatally , with a range of £ 327–1203 per woman . The estimated baseline costs to the NHS for the reduced visit schedule was £ 563 per woman , of which £ 225 occurred antenatally , with a range of £ 274–1741 per woman . Savings from new style care that arose antenatally were offset by the greater numbers of babies in this group who required special or intensive care . Sensitivity analyses based on possible variations in unit costs and re source use and modelled postnatal stay showed considerable variation and substantial overlap in costs . Conclusions : Patterns of antenatal care involving fewer routine visits for women at low risk of complications are unlikely to result in savings to the Health Service . In addition , women who had the reduced schedule of care reported greater dissatisfaction with their care and poorer psychosocial outcomes which argues against reducing numbers of antenatal visits OBJECTIVE To investigate the impact of an alternative prenatal care program for low-risk patients . STUDY DESIGN Five hundred forty-nine low-risk pregnant women were allocated to the study and control groups . The study group received , on average , eight visits , all of them with one of nine study providers . Each study visit had specific objectives and accompanying targeted patient education h and outs . The control group received the usual prenatal care ( on average , 13 visits ) with different providers , according to the customary schedule . RESULTS There were no significant pregnancy outcome differences between the groups . The study vs. control group differed significantly ( P < .0001 ) in patient satisfaction regarding the number of prenatal visits . There was a higher level of satisfaction in the study group concerning continuity of care ( P < .0001 ) . The alternative prenatal care program reduced the number of prenatal visits by 27 % and was not associated with any change in maternal or perinatal outcomes . Patient satisfaction parameters were either maintained or improved with alternative prenatal care . CONCLUSION An alternative prenatal care program for low-risk patients reduced re source utilization without adversely affecting prenatal care process variables , pregnancy outcome or patient satisfaction BACKGROUND We undertook a multicentre r and omised controlled trial that compared the st and ard model of antenatal care with a new model that emphasises actions known to be effective in improving maternal or neonatal outcomes and has fewer clinic visits . METHODS Clinics in Argentina , Cuba , Saudi Arabia , and Thail and were r and omly allocated to provide either the new model ( 27 clinics ) or the st and ard model currently in use ( 26 clinics ) . All women presenting for antenatal care at these clinics over an average of 18 months were enrolled . Women enrolled in clinics offering the new model were classified on the basis of history of obstetric and clinical conditions . Those who did not require further specific assessment or treatment were offered the basic component of the new model , and those deemed at higher risk received the usual care for their conditions ; however , all were included in the new-model group for the analyses , which were by intention to treat . The primary outcomes were low birthweight ( < 2500 g ) , pre-eclampsia/eclampsia , severe postpartum anaemia ( < 90 g/L haemoglobin ) , and treated urinary-tract infection . There was an assessment of quality of care and an economic evaluation . FINDINGS Women attending clinics assigned the new model ( n=12568 ) had a median of five visits compared with eight within the st and ard model ( n=11958 ) . More women in the new model than in the st and ard model were referred to higher levels of care ( 13.4 % vs 7.3 % ) , but rates of hospital admission , diagnosis , and length of stay were similar . The groups had similar rates of low birthweight ( new model 7.68 % vs st and ard model 7.14 % ; stratified rate difference 0.96 [ 95 % CI -0.01 to 1.92 ] ) , postpartum anaemia ( 7.59 % vs 8.67 % ; 0.32 ) , and urinary-tract infection ( 5.95 % vs 7.41 % ; -0.42 [ -1.65 to 0.80 ] ) . For pre-eclampsia/eclampsia the rate was slightly higher in the new model ( 1.69 % vs 1.38 % ; 0.21 [ -0.25 to 0.67 ] ) . Adjustment by several confounding variables did not modify this pattern . There were negligible differences between groups for several secondary outcomes . Women and providers in both groups were , in general , satisfied with the care received , although some women assigned the new model expressed concern about the timing of visits . There was no cost increase , and in some setting s the new model decreased cost . INTERPRETATIONS Provision of routine antenatal care by the new model seems not to affect maternal and perinatal outcomes . It could be implemented without major resistance from women and providers and may reduce cost The World Health Organization and collaborating institutions in four developing countries have conducted a multi-centre r and omized controlled trial , in which clinics were allocated at r and om to two antenatal care ( ANC ) models .  These were the  st and ard ' Western ' ANC model and a ' new ' ANC model consisting of tests , clinical procedures and follow-up actions scientifically demonstrated to be effective in improving maternal and newborn outcomes . The two models were compared using the equivalence approach . This paper discusses the implication s of the equivalence approach in the sample size calculation , analysis and interpretation of results of this cluster r and omized trial . It review s the ethical aspects regarding informed consent , concluding that the Zelen design has a place in cluster r and omization trials . It describes the estimation of the intracluster correlation coefficient ( ICC ) in a stratified cluster r and omized trial using two methods and reports estimates of the ICC obtained for many maternal , newborn and perinatal outcomes . Finally , it discusses analytical problems that arose : issues encountered using a composite index , heterogeneity of the intervention effect across sites , the choice of the method of analysis and the importance of efficacy analyses . The choice of the clustered Woolf estimator and the generalized estimating equations ( GEE ) as the methods of analysis applied is discussed We discuss method ological issues arising in a recent evaluation trial of a new antenatal care programme , as sponsored by the Special Programme of Research , Development and Research Training in Human Reproduction , and WHO 's Division of Reproductive Health ( Technical Support ) . The r and omisation unit for the trial is the  antenatal care clinic , with 53 clinics located in four countries r and omly allocated to provide either the new programme  or the traditional programme currently in use . Approximately 24,000 women presenting for antenatal care over an average period of 18 months will have been recruited Methods of confidence interval construction are provided for summary measures of treatment effect arising from design s r and omizing clusters to one of two treatment groups . Three basic design s are considered for the case of continuous and dichotomous variables : completely r and omized , pair-matched and stratified BACKGROUND Many of the individual components of antenatal care have been studied in r and omised controlled trials , but few studies have compared whole programmes of antenatal care . Our aim was to test the hypothesis that a new programme of antenatal care with fewer goal -oriented visits would give an equivalent or better result in the outcomes associated with pregnancy and delivery . METHODS In a r and omised clinical trial in Harare , Zimbabwe , we compared a new programme of antenatal care with the st and ard programme . The new programme consisted of fewer but more objective ly oriented visits and fewer procedures per visit .  Seven primary care clinics were r and omly assigned to the two programmes-three to the st and ard programme and four to the new programme . FINDINGS Over a 2-year period , 15,994 women were recruited into the study at the time they booked antenatal care .  97 % of the women were followed up , 9,394 who had followed the new programme , and 6,138 from clinics with the st and ard one . Women allocated to the new programme made , as planned , fewer visits than those in the st and ard programme ( median 4 vs 6 visits , respectively ) . The proportion of antenatal referrals was also lower ( 13.6 vs 15.3 % ; odds ratio 0.87 [ 95 % CI 0.79 - 0.95 ] ) because of significantly fewer referrals for pregnancy-induced hypertension ( 2.5 vs 3.8 % ; 0.66 [ 0.55 - 0.79 ] ) . Nevertheless , there were significantly fewer labour referrals for severe hypertension or eclampsia ( 2.1 vs 2.6 % ; 0.81 [ 0.66 - 1.00 ] ) . The risk for preterm ( < 37 weeks ) delivery was significantly lower for women on the new programme ( 10.1 vs 11.5 % ; 0.86 [ 0.78 - 0.96 ] ) . There were no other significant differences between the programmes in other major indices of pregnancy outcome , including antenatal referrals for other causes , labour referrals , obstetric interventions , low birthweight , and perinatal and maternal mortality and morbidity . INTERPRETATION An antenatal care programme with fewer more objective ly oriented visits can be introduced without adverse effects on the main intermediate outcome pregnancy variables 
    Output:
    
The rates of perinatal mortality were similar , although the rarity of the outcome did not allow formal statistical equivalence to be attained .
Some dissatisfaction with care , particularly among women in more developed countries , was observed with the new model .
The cost of the new model was equal to or less than that of the st and ard model .
INTERPRETATION A model with a reduced number of antenatal visits , with or without goal -oriented components , could be introduced into clinical practice without risk to mother or baby , but some degree of dissatisfaction by the mother could be expected .
Lower costs can be achieved