***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: Purpose .To provide a practical quantitative tool for appraising the quality of  cost-effectiveness ( CE ) studies . Methods .A committee comprised of health economists selected a set of criteria for the instrument from an item pool . Data collected with a conjoint analysis survey on 120 international health economists were used to estimate weights for each criterion with a r and om effects regression model . To vali date the grading system , a survey was sent to 60 individuals with health economics expertise . Participants first rated the quality  of three CE studies  on a visual analogue scale , and then evaluated each study using the  grading system . Spearman rho and Wilcoxon tests were used to detect convergent validity and analysis of covariance ( ANCOVA ) for discriminant validity . Agreement between the global rating by experts and the grading system was also examined . Results .Sixteen criteria were selected . Their coefficient estimates ranged from 1.2 to 8.9 , with a sum of 93.5 on a 100-point scale . The only insignificant criterion was “ use of subgroup analyses . ” Both convergent validity and discriminant validity of the grading system were shown by the results of the Spearman rho ( correlation coefficient = 0.78 , P < 0.0001 ) , Wilcoxon test ( P = 0.53 ) , and ANCOVA ( F3,146 = 5.97 , P = 0.001 ) . The grading system had good agreement with global rating by experts . Conclusions . The instrument appears to be simple , internally consistent , and valid for measuring the perceived quality of CE studies . Applicability for use in clinical and re source allocation decision-making deserves further study BACKGROUND The objective of this study was to determine whether the management of type 2 diabetes ( DM2 ) can be transferred from an internist to a nurse specialised in diabetes ( NSD ) . METHODS Ninety-three patients with DM2 referred by their general practitioner were r and omised ; 84 patients completed the study . The intervention group received care from an NSD who treated glycaemia , blood pressure and lipid profile by protocol . The control group received care from an internist . The primary endpoint was the main decrease in HbA1c . Secondary endpoints included blood pressure , lipid profile , healthcare costs , QOL , and patient satisfaction . RESULTS HbA1c , total cholesterol , LDL cholesterol and cholesterol/HDL ratio decreased significantly in both study population s after a follow-up time of 12 months . Cholesterol/HDL ratio decreased by 0.4 and 0.9 in the NSD and control group respectively ( p=0.034 for the difference between groups ) . The decreases ( 95 % confidence interval ) in systolic blood pressure were 8.6 mmHg ( 2.6 , 14.7 ) in the NSD group and 4.0 mmHg ( -0.9 , 8.9 ) in the control group , without a significant difference between groups . After one year , 33.3 % of the patients in the NSD group achieved an HbA1c level . < 7 % compared with 2.2%at baseline ( p=0.002 ) . Healthcare costs were less and patient satisfaction with the NSD s was significantly better(p<0.001 ) , while maintaining the same QOL . CONCLUSION NSD s using treatment protocol s are able to provide effective care for patients with DM 2 , comparable with the care provided by an internist , with respect to clinical parameters , and superior with respect to healthcare costs and patient satisfaction AIM This paper is a report of a study conducted to evaluate process and outcomes of care provided to patients with common complaints by general practitioners or specially trained nurse practitioners as first point of contact . BACKGROUND Studies in the United States of America and Great Britain show that substituting nurse practitioners for general practitioners results in higher patient satisfaction and higher quality of care . As the American and British healthcare system and setting s differ from that in The Netherl and s , a Dutch trial was conducted . METHODS A total of 1501 patients in 15 general practice s were r and omized to consultation by a general practitioner or a nurse practitioner . Data were collected over a 6-month period in 2006 by means of question naires , extracting medical records from practice computer systems and recording the length of consultations . FINDINGS In both groups , the patients highly appreciated the quality of care . No statistically significant differences were found in health status , medical re source consumption and compliance of practical guidelines in primary care in The Netherl and s. Patients in the NP intervention group were more often invited to re-attend , had more follow-up consultations and their consultations took statistically significantly longer . CONCLUSION Nurse practitioners and general practitioners provide comparable care . Our findings support an increased involvement of specially trained nurse practitioners in the Dutch primary care and contribute to knowledge of the effectiveness of care provision by nurse practitioners from a national and international perspective Abstract Objective : To ascertain any differences between care from  nurse practitioners and that from general practitioners for patients seeking “ same day ” consultations in primary care . Design : R and omised controlled trial with patients allocated by one of two r and omisation schemes  ( by day or within day ) . Setting : 10 general practice s in south Wales and south west Engl and . Subjects : 1368 patients requesting same day consultations .  Main outcome measures : Patient satisfaction , resolution of symptoms and concerns , care provided ( prescriptions , investigations , referrals , recall , and length of consultation ) , information provided to patients , and patients ' intentions for seeking care in the future . Results : Generally patients consulting nurse practitioners were significantly more satisfied with their care , although for adults this difference was not observed in all practice s. For children , the mean difference between general and nurse practitioner in percentage satisfaction score was −4.8 ( 95 % confidence interval −6.8 to −2.8 ) , and for adults the differences ranged from −8.8 ( −13.6 to −3.9 ) to 3.8 ( −3.3 to 10.8 ) across the practice s. Resolution of symptoms and concerns did not differ between the two groups ( odds ratio 1.2 ( 95 % confidence interval 0.8 to 1.8 ) for symptoms and 1.03 ( 0.8 to 1.4 ) for concerns ) . The number of prescriptions issued , investigations ordered , referrals to secondary care , and reattendances were similar between the two groups . However , patients managed by nurse practitioners reported receiving significantly more information about their illnesses and , in all but one practice , their consultations were significantly longer . Conclusion : This study supports the wider acceptance of the role of nurse practitioners in providing care to patients requesting same day consultations BACKGROUND As studies evaluating substitution of care have revealed only limited evidence on cost-effectiveness , a trial was conducted to evaluate  nurse practitioners as a first point of contact in Dutch general practice s. AIM To estimate costs of GP versus nurse practitioner consultations from practice and societal perspectives . DESIGN OF STUDY An economic evaluation was conducted alongside a r and omised controlled trial between May and October 2006 , wherein 12 nurse practitioners and 50 GPs working in 15 general practice s ( study practice s ) participated .  Consultations by study practice s were also compared with an external reference group , with 17 GPs working in five general practice s without the involvement of nurse practitioners .  METHOD Direct costs within the healthcare sector included re source use , follow-up consultations , length of consultations , and salary costs . Costs outside the healthcare sector were productivity losses . Sensitivity analyses were performed . RESULTS Direct costs were lower for nurse practitioner consultations than for GP consultations at study practice s. This was also the case for direct costs plus costs from a societal perspective for patients aged < 65 years .  Direct costs of consultations at study practice s were lower than those of reference practice s , while practice s did not differ for direct costs plus costs from a societal perspective for patients aged < 65 years . Cost differences are mainly caused by the differences in salary . CONCLUSION By involving nurse practitioners , substantial economic ' savings ' could be used for re design ing primary care , to optimise the best skill mix , and to cover the full range of primary care activities The aim of this study was to investigate whether , in a r and omized controlled trial ( RCT ) of vulnerable elders with heart failure ( HF ) , advanced practice nurses ( APNs ) who were coordinating care in the transition from hospital to home could improve outcomes , prevent rehospitalizations , and reduce costs when compared with usual care . The APN strategies focused on improving patient and family or caregiver effectiveness in managing their illnesses , strengthening the patient-provider relationship , and managing comorbid conditions while improving overall health . The results were positive . By capitalizing on the patient 's desire to achieve their identified goals , APNs successfully educated patients about the meaning of their symptoms and appropriate self-management strategies ; improved patient-provider communication patterns ; and marshaled caregiver and community re sources to maximize patient adherence to the treatment plan and overall quality of life . While HF was the primary reason for enrollment in the study , optimal health outcomes dem and ed a strong focus on integrating management of comorbid conditions and other long-st and ing health problems . Specific strategies used by the APN to achieve these positive outcomes are addressed in this report . These strategies are compared with nursing interventions used in other RCTs of HF home management . Directions for future research are explored AIMS AND OBJECTIVES To determine whether the management of  type 2 diabetes mellitus  in a primary care setting can be safely transferred to practice nurses . BACKGROUND Because of the increasing prevalence of type 2 diabetes mellitus and the burden of caring for individual patients , the dem and type 2 diabetes mellitus patients place on primary health care re sources has become overwhelming . DESIGN R and omised controlled trial . METHODS The patients in the intervention group were cared for by practice nurses who treated glucose levels , blood pressure and lipid profile according to a specified protocol . The control group received conventional care from a general practitioner . The primary outcome measure was the mean decrease seen in glycated haemoglobin ( HbA1c ) levels at the end of the follow-up period ( 14 months ) . RESULTS A total of 230 patients was r and omised with 206 completing the study . The between-group differences with respect to reduction in HbA1c , blood pressure and lipid profile were not significant . Blood pressure decreased significantly in both groups ; 7.4/3.2 mm Hg in the intervention group and 5.6/1.0 mm Hg in the control group . In both groups , more patients met the target values goals for lipid profile compared to baseline . In the intervention group , there was some deterioration in the health-related quality of life and an increase in diabetes-related symptoms . Patients being treated by a practice nurse were more satisfied with their treatment than those being treated by a general practitioner . CONCLUSION Practice nurses achieved results , which were comparable to those achieved by a general practitioner with respect to clinical parameters with better patient satisfaction . RELEVANCE TO CLINICAL PRACTICE This study shows that diabetes management in primary care can be safely transferred to practice nurses This study reports results of the 2-year follow-up phase of a r and omized study comparing outcomes of patients assigned to a nurse practitioner or a physician primary care practice .  In the sample of 406 adults , no differences were found between the groups in health status , disease-specific physiologic measures , satisfaction or use of specialist , emergency room or inpatient services . Physician patients averaged more primary care visits than nurse practitioner patients . The results are consistent with the 6-month findings and with a growing body of evidence that the quality of primary care delivered by nurse practitioners is equivalent to that by physicians Abstract Objective : To compare the cost effectiveness of general practitioners and nurse practitioners as first point of contact in primary care . Design : Multicentre r and omised controlled trial of  patients requesting an appointment the same day . Setting : 20 general practice s in Engl and and Wales . Participants : 1716 patients were eligible for r and omisation , of whom 1316 agreed to r and omisation and 1303 subsequently attended the clinic . Data were available for analysis on 1292 patients ( 651 general practitioner consultations and 641 nurse practitioner consultations ) . Main outcome measures : Consultation process ( length of consultation , examinations , prescriptions , referrals ) , patient satisfaction , health status , return clinic visits over two weeks , and costs . Results : Nurse practitioner consultations were significantly longer than those of the general practitioners ( 11.57 v 7.28 min ; adjusted difference 4.20 , 95 % confidence interval 2.98 to 5.41 ) , and nurses carried out more tests ( 8.7 % v 5.6 % of patients ; odds ratio 1.66 , 95 % confidence interval 1.04 to 2.66 ) and asked patients to return more often ( 37.2 % v 24.8 % ; 1.93 , 1.36 to 2.73 ) . There was no significant difference in patterns of prescribing or health status outcome for the two groups . Patients were more satisfied with nurse practitioner consultations ( mean score 4.40 v 4.24 for general practitioners ; adjusted difference 0.18 , 0.092 to 0.257 ) . This difference remained after consultation length was controlled for . There was no significant difference in health service costs ( nurse practitioner £ 18.11 v general practitioner £ 20.70 ; adjusted difference £ 2.33 , −£1.62 to £ 6.28 ) . Conclusions : The clinical care and health service costs of nurse practitioners and general practitioners were similar . If nurse practitioners were able to maintain the benefits while reducing their return consultation rate or shortening consultation times , they could be more cost effective than general practitioners The impact of multidisciplinary teams that incorporate 
    Output:
    
APN groups demonstrated equal or better outcomes than physician groups for physiologic measures , patient satisfaction and cost .
There were few differences in primary care provided by APNs and physicians ; for some measures APN care was superior .
While studies are needed to assess longer term outcomes , these data suggest that the APN workforce is well-positioned to provide safe and effective primary care