***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: Despite formal recommendations for dietary change to reduce the incidence of ischaemic heart disease , the acceptability and effectiveness of the proposed diets have not been well investigated in population based studies . In this preliminary investigation of nutritional advice in a well population , subjects in one group practice were r and omized to receive either dietary instruction or simple follow up without instruction . The dietary recommendations were well received , and a substantial proportion of subjects reported altering their diets in accordance with them . There were modest beneficial changes in plasma lipid levels among men . Thus , using general practice as an avenue for promoting dietary change is feasible , and may be effective among men The purpose of this study was to determine whether a brief , tailored counselling intervention is effective for increasing physical activity in sedentary women when delivered in the workplace . This prospect i ve r and omized trial used a brief intervention based on the Transtheoretical Model . The intervention group received health screening , a brief intervention , and , 2 weeks later , a booster telephone call from a nurse practitioner . The intervention was tailored to each woman 's reported exercise behaviour . The 134 women r and omized to the intervention were compared with 153 women in a control group who received health counselling not tailored to their exercise behaviour and no telephone call . Six weeks later , the intervention group , when compared to baseline , had significantly improved their physical activity , increasing their amount of weekend physical activity as well as minutes walked for exercise , on err and s , total walking , and total daily blocks walked . When compared to controls , they showed significantly greater gains . This test of a brief , tailored strategy provides a critical contribution to the search for efficient , effective ways for nurses to deliver workplace health promotion interventions Purpose . Evaluate the long-term impact of telephone-based interventions that target high risk , ready-to-change individuals . Design . Quasi-experimental design with pre/post comparisons of lifestyle-related health risks between participants and non participants . Setting . Six organizations from the private and public sectors . Subjects . Subjects were 607 intervention participants who were compared with a control group of 1134 eligible non participants . Measures . Health risk assessment at baseline and at an average of 2 years later measured risk in 13 lifestyle areas . Intervention . Programs were offered in seven areas : back care , cholesterol control , eating habits , exercise and activities , stress management , tobacco use , and weight control . Each program was conducted by a trained health educator who provided information and counseling to facilitate change in the area selected by the participant . All counseling was done by telephone and included three to five contacts over a 1-year period . Results . Binary logistic regression models controlling for gender and age revealed both specific and general effects . Participants were 1.8 to 3.5 times as likely as non participants to reduce the targeted risk in six of seven risk areas . In addition , participants were 1.7 to 3.5 times as likely as non participants to reduce their risks in nine of 13 areas not targeted by the intervention ( i.e. , general effect ) . Overall , participants significantly reduced their number of risks , whereas non participants significantly increased their risk ( difference of .85 risks ) . Conclusions . Results show that at-risk participants make long-term improvements in health risks directly related to the intervention in which they participate . Results also suggest that this intervention may help individuals develop behavior-change skills they can apply to other lifestyle issues Background Cardiovascular disease is the leading cause of death for adults in Australia . In recent years there has been a shift in health service delivery from institutional to community‐based care for chronic conditions , including cardiovascular disease . The general practice setting is seen to offer greater flexibility , higher levels of efficiency and more client focused healthcare delivery than is possible in the acute care sector . It has been suggested that practice nurses represent a useful adjunct to current models of cardiovascular disease management . To date , significant descriptive research has been conducted exploring the demographics , roles , educational needs and issues facing practice nurses . However , there is a need to evaluate the effectiveness of practice nurse interventions in terms of patient outcomes , clinician satisfaction and cost‐effectiveness . Objectives This review seeks to present the best available evidence regarding the efficacy of general practice nurse interventions for cardiac risk factor reduction in healthy adults , as well as those with established cardiovascular disease or known cardiac risk factors . Search Strategy A systematic literature search was performed using Medline ( 1966 ‐ 2005 ) , CINAHL ( 1982 −2005 ) , Cochrane Controlled Trials Register ( Issue 4 , 2005 ) and the Joanna Briggs Institute Evidence Library . In addition , the reference lists of retrieved papers , conference proceedings and the Internet , were scrutinised for additional trials . Selection Criteria This review considered any English language r and omised trials that investigated interventions conducted by the practice nurse for cardiovascular disease management or reduction of cardiac risk factors . Interventions conducted by specialist cardiac nurses in general practice were excluded . Outcomes measured included blood pressure , smoking cessation , total cholesterol , exercise , body weight/body mass index and cost‐effectiveness . Results Eighteen trials , reported in 33 papers , were included in the review . Ten trials investigated multifaceted interventions , while the remaining eight trials reported targeted interventions . Of the trials that reported multifaceted interventions , three trials investigated risk reduction in those with established cardiovascular disease , four trials focused on those with known cardiovascular disease risk factors and three trials included the general community . The eight trials which examined the efficacy of targeted interventions focused upon dietary intake ( two trials ) , smoking cessation ( three trials ) , weight reduction ( one trial ) and physical activity ( two trials ) . The effect of both the multifaceted and targeted interventions on patient outcomes was variable . However , both the multifaceted and targeted interventions demonstrated similar outcome trends for specific variables . Improvements were demonstrated by most studies in blood pressure , cholesterol level , dietary intake and physical activity . The variation in outcome measures and contradictory findings between some studies makes it difficult to draw definitive conclusions . Conclusions While interventions to reduce cardiovascular disease risk factors have produced variable results , they offer significant potential to assist patients in modifying their personal risk profile and should be developed . The public health importance of these changes is dependant upon the sustainability of the change and its effect on the health outcomes of these individuals . Further well‐ design ed research is required to establish the effectiveness of practice nurse interventions for cardiovascular disease management and risk factor reduction in terms of patient outcomes and cost‐effectiveness PURPOSE the purpose of this study was to compare selected diabetes care processes and outcomes of nurse practitioners ( NPs ) and physicians ( MDs ) in the primary care of adults with type 2 diabetes . METHODS Adults with type 2 diabetes and no regular source of primary care were enrolled from the emergency room and r and omized to an NP or MD practice .  Chart review s were conducted to assess processes of care ; patient interviews and hemoglobin Al C ( Al C ) testing were performed to measure patient outcomes . RESULTS NPs were more likely than MDs to document provision of general diabetes education and education about nutrition , weight , exercise , and medications . They were more likely to document patient height , urinalyses results , and Al C values . No differences were found in documenting current medications ; alcohol , illicit drug , or tobacco use ; depression ; weight and blood pressure ; foot and cardiovascular exams ; blood glucose and creatinine testing ; or referral to ophthalmologists . No differences were found in patient outcomes . CONCLUSIONS This study provides preliminary evidence of interdisciplinary differences in the processes of care employed by primary care NPs and MDs in caring for patients with type 2 diabetes . NPs documented the provision of diabetes education and selected monitoring tests more frequently than MDs ; however , these differences were not reflected in 6-month patient outcomes Abstract Objective : To determine the relative efficacy in general practice of dietary advice given by a dietitian , a practice nurse , or a diet leaflet alone in reducing total and low density lipoprotein cholesterol concentration . Design : R and omised six month parallel trial . Setting : A general practice in Oxfordshire . Subjects : 2004 subjects aged 35 - 64 years were screened for hypercholesterolaemia ; 163 men and 146 women with a repeat total cholesterol concentration of 6.0 - 8.5 mmol/l entered the trial . Interventions : Individual advice provided by a dietitian using a diet history , a practice nurse using a structured food frequency question naire , or a detailed diet leaflet sent by post . All three groups were advised to limit the energy provided by fat to 30 % or less and to increase carbohydrate and dietary fibre . Main outcome measures : Concentrations of total cholesterol and low density and high density lipoprotein cholesterol after six months ; antioxidant concentration and body mass index . Results : No significant differences were found at the end of the trial between groups in mean concentrations of lipids , lipoproteins , and antioxidants or body mass index . After data were pooled from the three groups , the mean total cholesterol concentration fell by 1.9 % ( 0.13 mmol/l , 95 % confidence interval 0.06 to 0.22 , P<0.001 ) to 7.00 mmol/l , and low density lipoprotein cholesterol also fell . The total carotenoid concentration increased by 53 nmol/l ( 95 % confidence interval 3.0 to 103 , P=0.039 ) . Conclusions : Dietary advice is equally effective when given by a dietitian , a practice nurse , or a diet leaflet alone but results in only a small reduction in total and low density lipoprotein cholesterol . To obtain a better response more intensive intervention than is normally available in primary care is probably necessary . Key messages Key messages In this study dietary advice had only a modest effect on lipid and lipoprotein concentrations Personalised advice from a nurse or dietitian was no more effective than a detailed diet leaflet Antioxidant concentrations increased slightly , but this requires further study A mass approach to dietary change is needed to produce significant Background Postpartum weight retention may contribute to the development of obesity . We studied whether individual counselling on diet and physical activity from 2 to 10 months postpartum has positive effects on diet and leisure time physical activity and increases the proportion of primiparas returning to their pre-pregnancy weight . Methods A controlled trial including ninety-two postpartum primiparas was conducted in three intervention and three control child health clinics in primary health care in Finl and . The intervention included individual counselling on diet and physical activity during five routine visits to a public health nurse ; the controls received the usual care . Results In total , 50 % of the intervention group and 30 % of the control group returned to their pre-pregnancy weight ( weight retention ≤ 0 kg ) by 10 months postpartum ( p = 0.06 ) . The confounder-adjusted odds ratio for returning to pre-pregnancy weight was 3.89 ( 95 % CI 1.16–13.04 , p = 0.028 ) for the intervention group compared with the controls . The mean proportion of high-fibre bread ( of total weekly amount of bread ) increased by 16.1 % ( 95 % CI 4.3–27.9 ) by 10 months postpartum in the intervention group compared with the controls when adjusted for confounders ( p = 0.008 ) . No significant differences were observed in changes in leisure time physical activity between the groups . Conclusion The intervention increased the proportion of  primiparas returning to pre-pregnancy weight  and the proportion of high-fibre bread in their diet . Larger r and omized controlled trials are needed to show whether counselling can improve dietary and leisure time physical activity habits in postpartum women and also to confirm the results concerning the effect on reducing postpartum weight retention . Trial registration Current Controlled Trials IS RCT Background Physical inactivity is an independent risk factor for diabetes and heart disease . There is evidence that increasing physical activity can reduce the risk of developing these chronic diseases , but less evidence about effective ways to increase adherence to physical activity . Interventions are therefore needed that produce sustained increases in adherence to physical activity , are cost-effective and improve clinical endpoints . Methods The Women 's Lifestyle Study is a two year r and omized controlled trial involving a nurse-led intervention to increase physical activity in 40–74 year old physically inactive women recruited from primary care . Baseline measures were assessed in a face-to-face interview with a primary care nurse . The intervention involved delivery of a ' Lifestyle script ' by a primary care nurse followed by telephone counselling for nine months and a face-to-face nurse visit at six months . Outcome measurements are assessed at 12 and 24 months . The primary outcome is physical activity measured using a vali date d physical activity question naire . Secondary outcomes include blood pressure , weight , waist circumference , physical fitness ( step test ) , serum HbA1c , fasting glucose , lipids , insulin , and quality of life ( SF36 ) . Costs were measured prospect ively to allow a subsequent cost-effectiveness evaluation if the trial is positive . Discussion Due to report in 2008 , the Women 's Lifestyle Study tests the effectiveness of an enhanced low-cost , evidence -based intervention in increasing physical activity , and improving cardiovascular and diabetes risk indicators over two years . If successful in demonstrating improvements in health outcomes , this r and omized controlled trial will be the first to demonstrate long-term cardiovascular and diabetes risk health benefit , in addition to improvements in physical activity , from a sustainable physical activity intervention based in primary care . Trial Registration Australian Clinical Trials Registry ( ACTR ) , ACTRN012605000490673 In the GRADE approach , r and omized tri 
    Output:
    
The evidence supports the effectiveness of lifestyle interventions delivered by nurses in PHC to affect positive changes on outcomes associated with the prevention of chronic disease including : weight , blood pressure , cholesterol , dietary and physical activity behaviours , patient satisfaction , readiness for change and quality of life .