***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  Depressive symptoms in older home care clients are common but poorly recognized and treated , result ing in adverse health outcomes , premature institutionalization , and costly use of health services . The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional ( IP ) nurse-led mental health promotion intervention , and to explore its effects on reducing depressive symptoms in older home care clients ( ≥ 70 years ) using personal support services . Methods A prospect i ve one-group pre-test/post-test study design was used . The intervention was a six-month evidence -based depression care management strategy led by a registered nurse that used an IP approach . Of 142 eligible consenting participants , 98 ( 69 % ) completed the six-month and 87 ( 61 % ) completed the one-year follow-up . Outcomes included depressive symptoms , anxiety , health-related quality of life ( HRQoL ) , and the costs of use of all types of health services at baseline and six-month and one-year follow-up . An interpretive descriptive design was used to explore clients ’ , nurses ’ , and personal support workers ’ perceptions about the intervention ’s appropriateness , benefits , and barriers and facilitators to implementation . Results Of the 142 participants , 56 % had clinical ly significant depressive symptoms , with 38 % having moderate to severe symptoms . The intervention was feasible and acceptable to older home care clients with depressive symptoms . It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up , with small additional improvements six months after the intervention . The intervention also reduced anxiety at one year follow-up . Significant reductions were observed in the use of hospitalization , ambulance services , and emergency room visits over the study period . Conclusions Our findings provide initial evidence for the feasibility , acceptability , and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes , reducing use of expensive health services , and improving clinical practice behaviours of home care providers . Future research should evaluate its efficacy using a r and omized clinical trial design , in different setting s , with an adequate sample of older home care recipients with depressive symptoms . Trial registration Clinical trials.gov identifier : NCT01407926 Technology and improved care coordination models can help diabetes educators and providers meet national care st and ards and provide culturally sensitive diabetes education that may improve diabetes outcomes . The purpose of the study was to evaluate the clinical usefulness of a nurse-led diabetes care program ( Comprehensive Diabetes Management Program , CDMP ) for poorly controlled Hispanic type 2 diabetes ( T2DM ) patients in an urban community health center setting . Patients were r and omized to the intervention condition ( IC ; n = 21 ) or an attention control condition ( AC ; n = 18 ) . IC and AC conditions were compared on rates of adherence to national clinical practice guidelines ( blood glucose , blood pressure , foot exam , eye exam ) , and levels of diabetes distress , depression , and treatment satisfaction . IC patients had a significant improvement in A1C from baseline to 12-month follow-up compared with AC ( −1.6 % ± 1.4 % versus −0.6 % ± 1.1 % ; P = .01 ) . The proportion of IC patients meeting clinical goals at follow-up tended to be higher than AC for A1c ( IC = 45 % ; AC = 28 % ) , systolic blood pressure ( IC = 55 % ; AC = 28 % ) , eye screening ( IC = 91 % ; AC = 78 % ) , and foot screening , ( IC = 86 % ; AC = 72 % ) . Diabetes distress and treatment satisfaction also showed greater improvement for IC than AC ( P = .05 and P = .06 , respectively ) , with no differences for depression . The CDMP intervention was more effective than an attention control condition in helping patients meet evidence -based guidelines for diabetes care Lars Åke Persson and colleagues conduct a  cluster r and omised control in northern Vietnam to analyze the effect of the activity of local community-based maternal- and -newborn stakeholder groups  on neonatal mortality . Please see later in the article for the Editors ' OBJECTIVE To compare the effects of low-level facility-based interventions on patient retention rates for cardiovascular ( CV ) disease in an environment of task shifting and nurse-led care in rural health districts in Central Cameroon . METHODS This study is an open-label , three-arm , cluster-r and omised trial in nurse-led facilities . All three groups implemented a treatment contract . The control group ( group 1 ) had no additional intervention , group 2 received the incentive of 1 month of free treatment every forth month of regularly respected visits , and group 3 received reminder letters in case of a missed follow-up visit . The primary outcome was patient retention at 1 year . Secondary outcomes were adherence to follow-up visit schemes and changes in blood pressure ( BP ) and blood glucose levels . Patients ' monthly spending for drugs and transport was calculated retrospectively . RESULTS A total of 33 centres and 221 patients were included . After 1 year , 109 patients ( 49.3 % ) remained in the programme . Retention rates in groups 2 and 3 were 60 % and 65 % , respectively , against 29 % in the control group . The differences between the intervention groups and the control group were significant ( P < 0.001 ) , but differences between the two intervention groups were not ( P = 0.719 ) . There were no significant differences in BP or fasting plasma glucose trends between retained patients in the study groups . Average monthly cost to patients for antihypertensive medication was € 1.1 ± 0.9 and for diabetics € 1.2 ± 1.1 . Transport costs to the centres were on average € 1.1 ± 1.0 for hypertensive patients and € 1.1 ± 1.6 for patients with diabetes . CONCLUSIONS Low-cost interventions suited to an environment of task shifting and nurse-led care and needing minimal additional re sources can significantly improve retention rates in CV disease management in rural Africa . The combination of a treatment contract and reminder letters in case of missed appointments was an effective measure to retain patients in care Abstract In Tanzania , the impact , on clinical outcomes and treatment-seeking behaviour , of a rural , nurse-led clinic that provides free , antivenom-based treatment of snakebite envenomation was recently assessed . Data on all 85 patients who , between April 2007 and the end of 2009 , received treatment for snakebite envenomation at the Snake Park clinic in Meserani , Tanzania , were collected prospect ively . Although only four cases of snakebite envenomation were treated in the last 9 months of 2007 , 34 such cases were treated in 2008 and 47 in 2009 . The 85 snakebite cases had a mean age of 23 years and a male : female ratio of 1.4 . Most of the bites occurred in the evening or at night and most also occurred during the rainy season . In some cases , the seeking of treatment from traditional healers delayed treatment at the clinic . After being bitten , the snakebite cases travelled a mean of 82 km ( range=2–550 km ) to reach the clinic . Thirty-two ( 37 % ) of the cases were each unable to identify the snake that had bit them . Of the bites in which the snake was identified , the puff adder ( Bitis arietans ) caused more ( 24 ) than any other snake . Forty-two of the snakebite cases received antivenom . Only one patient ( 1 % ) , a 12-year-old girl , was believed to have died as the result of a snakebite but another six ( 7 % ) each required a skin graft or the amputation of a limb or digit . Establishment of the Snake Park clinic appears to have improved access to snakebite treatment , with cases of snakebite travelling long distances to reach the clinic ( because of the lack of any other source of antivenom in Tanzania ) . Although the clinic is nurse-led , treatment outcomes among the snakebite victims who attend the clinic appear to be good OBJECTIVE the aim of two related studies was an in-depth knowledge of psychosocially and health-related vulnerable families and the ' portfolio ' of care that family midwives ( FM ) provide . Besides factors which influence acceptance and access from the mothers ' perspective , the effectiveness of FM with regard to care , infant nutrition , and parent-child relationship as well as multidisciplinary collaboration were of interest , especially against the backdrop of Germany 's national aim to strengthen prevention of neglect and abuse of infants . In addition , the reasons why families did not want FM care were explored . DESIGN two FM model projects in Saxony-Anhalt ( SA ) and Lower Saxony ( LS ) , Germany , were evaluated . Quantitative data were prospect ively collected on 93 % of vulnerable families being cared for by FM ( SA ) and regarding vulnerable families that declined FM care ( LS ) . These data were complemented by problem-focused interviews with 14 mothers and six social workers ( LS ) . SETTING AND INTERVENTIONS the 33 FM in SA and 11 FM in LS are community-based and visit vulnerable families from pregnancy up to the first birthday of the child , maximally . They provide health promotion , maternal and infant care , and multidisciplinary support geared towards early prevention of child neglect and abuse . PARTICIPANTS from May 2006 until 2008 ( SA ) and from January 2008 until December 2009 ( LS ) 814 and 235 vulnerable families , respectively , were cared for by FM .  Complete data on 734 families were analysed ( SA ) as were 30 question naires on ' non-compliant ' families ( LS ) . Problem-focused interviews were conducted with 14 mothers and 6 social workers ( LS ) . MEASUREMENTS AND FINDINGS many families exhibited a high vulnerability score of complex risk factors . Four vulnerability patterns were statistically extracted explaining 40 % of the total variance . The highest frequencies of care activities related to infant care and nutrition , giving advice on the Mother-Child relationship , and psychosocial support . The Youth Welfare Services ( YWS ) were significant collaboration partners , especially regarding families whose child was taken out for safety reasons . By conclusion of care , significantly higher mean scores were observed regarding ' parent-child relationship ' and ' maternal care for child ' ( compared to the outset of care ) when mean duration of care was at least 6 months . The children who were taken out of their families had significantly lower scores in nutritional care , and were given solids at a significantly earlier time . From the mothers ' perspective it was important to have early access to the FM and easy between-visits communication via phone calls , or text messages . They appreciated the physical and psychosocial care for the infant and herself , an uncomplicated transition from caseload midwifery , and collaboration among providers . Families who declined FM care wanted to stay with their self-chosen midwife , were afraid of external control , or felt they were able to cope without professional support . KEY CONCLUSIONS AND IMPLICATION S FOR PRACTICE when families can access FM early on and home-visits are sustained , maternal competencies in caring for , and relating to , the child can potentially be strengthened . FM seem to fill a gap between st and ard care by caseload midwives ending at 8 weeks postpartum and YWS whose personnel is not skilled in the assessment of health-related problems , such as inadequate infant nutrition . As a relatively high percentage of the families were challenged by domestic violence , drug addiction , and teenage pregnancy , ongoing educational activities should address these topics Background This systematic review set out to examine the impact , if any , of  nursing workload and staffing  on creating and maintaining healthy work environments . For the purpose s of this review , the term ‘ healthy work environment ’ was defined as ‘ … a practice setting that maximizes the health and well‐being of nurses , quality patient outcomes and organizational performance ’ . This definition identifies nurse , patient and organisational outcomes as indicators of the establishment and maintenance of a healthy work environment . Objectives The review sought to determine the impact of : Patient characteristics , nurse characteristics , system characteristics and system processes on workload , scheduling and concepts of productivity and utilisation Workload , scheduling and concepts of productivity and utilisation on the quality of outcomes for clients , nurses and the system/organisation Search strategy The search strategy sought to find both published and unpublished studies and papers written in the English language . A three‐step search strategy approach was used . An initial limited search of MEDLINE and CINAHL data bases was undertaken to identify optimal search terms followed by an analysis of the text words contained in the title and abstract , and of the index terms used to describe the article . A second extensive search using all identified keywords and index terms was then undertaken . The third step consisted of a search of the reference lists of all identified reports and articles for additional studies . Selection criteria Types of studies : This review considered research papers that addressed the appropriateness and effectiveness of workload and staffing concepts in fostering a healthy work environment in healthcare . The types of papers to be considered included : meta‐ analysis , r and omised controlled trials , quasi‐r and omised controlled trials , cohort studies , case‐control studies , descriptive studies and correlational studies . Types of participants : The review considered all participants involved or affected by workload and staffing concepts within the nursing workforce in a healthcare environment , including staff and patients . System and policy issues were also considered . Types of interventions : All workload and staffing strategies that impact on the work environment , patient and nurse outcomes were considered in this review . Types of outcome measures : Outcomes of interest were categorised into four groups : nursing staff outcomes , patient outcomes , organisational outcomes and system outcomes . Data collection and analysis Following assessment of method ological quality , data were extracted using data extraction tools based on the work of the Cochrane Collaboration and the Centre for Review s and Dissemination . Statistical pooling was not possible and findings were presented in narrative 
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This review identified collaboration between nurses and midwives and other health providers and organizations , across sectors , and with communities and individuals that result ed in improved health care and outcomes .
Conclusions The findings of this review confirm the importance of a conceptual framework for underst and ing and planning leadership and governance approaches , management strategies and collaboration and education and training efforts to scale up and support nurses and midwives in existing or exp and ed roles to improve access to PHC for vulnerable population