14 492 calls were received during the specified times in the trial year (7308 in the control arm and 7184 in the intervention arm) concerning 10 134 patients (10.4% of the registered population). There were no substantial differences in the age and sex of patients in the intervention and control groups, though male patients were underrepresented overall. Reasons for calling the service were consistent with previous studies. Nurses managed 49.8% of calls during intervention periods without referral to a general practitioner. A 69% reduction in telephone advice from a general practitioner, together with a 38% reduction in patient attendance at primary care centres and a 23% reduction in home visits was observed during intervention periods. Statistical equivalence was observed in the number of deaths within seven days, in the number of emergency hospital admissions, and in the number of attendances at accident and emergency departments. Conclusions Nurse telephone consultation produced substantial changes in call management, reducing overall workload of general practitioners by 50% while allowing callers faster access to health information and advice. It was not associated with an increase in the number of adverse events. This model of out of hours primary care is safe and effective.

Or by faxing us at: +44 (0) 23 8059 5639Or by emailing us at: hta@soton.ac.ukOr by ordering from our website: http://www.ncchta.org NHSnet: http://nww.hta.nhsweb.nhs.ukThe website also provides information about the HTA Programme and lists the membership of the various committees. NHS R&D HTA ProgrammeT he NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS.Initially, six HTA panels (pharmaceuticals, acute sector, primary and community care, diagnostics and imaging, population screening, methodology) helped to set the research priorities for the HTA Programme. However, during the past few years there have been a number of changes in and around NHS R&D, such as the establishment of the National Institute for Clinical Excellence (NICE) and the creation of three new research programmes: Service Delivery and Organisation (SDO); New and Emerging Applications of Technology (NEAT); and the Methodology Programme.This has meant that the HTA panels can now focus more explicitly on health technologies ('health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care) rather than settings of care. Therefore the panel structure has been redefined and replaced by three new panels: Pharmaceuticals; Therapeutic Procedures (including devices and operations); and Diagnostic Technologies and Screening.The HTA Programme will continue to commission both primary and secondary research. The HTA Commissioning Board, supported by the National Coordinating Centre for Health Technology Assessment (NCCHTA), will consider and advise the Programme Director on the best research projects to pursue in order to address the research priorities identified by the three HTA panels.The research reported in this monograph was funded as project number 94/40/38.The views expressed in this publication are those of the authors and not necessarily those of the HTA Programme or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for any recommendations made by the authors. Criteria for inclusion in the HTA monograph seriesReports are published in the HTA monograph series if (1) they have resulted from work commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.

1993-94), 8.2% (1993-94 to 1994-95), and 9.4% (1994-95 to 1995-96).' There has been increasing concern that the needs of many callers may be more appropriately met in ways other than the dispatch of an emergency ambulance with paramedic crew, travelling at high speed with lights and sirens. This paper reviews the literature concerning the appropriateness of use of 999 vehicles.Sources of material For this review, the search strategy used was a search of Medline (1989-97), Healthplan (1983-95), Helmis (1983-95), and BIDS Embase .Keywords entered into these databases of health related references were explode "ambulances/utilisation or ambulance* and (inappropriate* or appropriate* or abuse or misuse)"; "health care and (utilis/zation or delivery or need or planning)"; "emergency and (ambulance or health service or treatment or medicine)", "pre-hospital care", and "out of hours".Further references were followed up from the citations at the end of papers obtained from these initial searches. This review covers all major papers published in English over the last 15 years, as well as some foreign language papers and some work which has not yet been formally published in full.

Objective To determine whether preoperative assessments carried out by appropriately trained nurses are inferior in quality to those carried out by preregistration house officers.

Practicality and quality of implementationWe carried out this trial in everyday practice. We included thousands of women who might have received the 10 leaflets, but only 70% reported receiving one of them. Studies reported in the systematic review of decision aids were explanatory trials, with the implicit assumption that all patients received the intervention.3 One conclusion might be that the systematic review showed that decision aids can be effective under certain circumstances but that our study showed that they are not necessarily effective in the real world. 7 The pragmatic nature of our design may have affected the outcome, but that outcome represents a true picture of the impact of introducing the leaflets into routine practice.We thank midwives, managers, and administrative staff in the maternity units in Wales (unnamed to ensure confidentiality of participating units), who worked so hard to help us with data collection. We thank the thousands of women who completed our questionnaires at such an important time in their lives.

No abstract

We recently published the results of a randomised controlled trial of a nurse telephone consultation service in primary care out of hours. 1 The new service, operating at evenings and weekends, significantly reduced general practitioners' workload and was at least as safe as the existing out of hours service. Contacts diminish sharply after about 10 pm, 2 and, anecdotally, a higher proportion of night calls necessitate consultation with a general practitioner. We report here a parallel trial aimed at establishing whether nurse telephone consultation was equally effective in managing workload at night. Subjects, methods, and resultsThis study was an adjunct to a randomised controlled trial in a 55 member general practice cooperative serving 97 000 patients in Wiltshire. The design has been described. 1 The night nurse telephone consultation service ran over two two-week periods (15-28 October 1997 and 12-25 November 1997) from 11.15 pm until 8 am. Outcome measures were as used in the main trial with one addition: the number of patients attending daytime surgery within three days of a call.1 One of us (FT) visited each surgery to extract details of attendances from patient records.In the main study 49.8% of calls were handled by the nurse alone. Specifying = 0.1 (0.05 in a one sided calculation) and = 0.2, we calculated that the night nurse service would need to receive 78 calls to establish equivalence with this figure, with equivalence limits being 40% and 60%.3 A one sided calculation was used as we were interested to establish only whether the night nurse intervention produced worse results (lower numbers of calls handled without referral to a doctor) than the evening and weekend service. For other within-trial outcomes, results are presented as relative risks with 95% confidence intervals, calculated with EpiInfo. This trial was not powered to show within-trial equivalence in numbers of adverse events.During the study 210 callers made 223 calls, 123 in the control group and 100 in the nurse telephone consultation (intervention) group. Follow up was 94% complete: 12 sets of patient records (6%) could not be found, seven in the control group and five in the intervention group. The median age (range) of patients was 34.0 ( 0.01-97.2) years in the control group and 32.5 (0.49-97.0) years in the intervention group. Fifty three patients (43%) in the control group and 44 (44%) in the intervention group were male.The table shows details of call management and outcome. Altogether 59% of calls (95% confidence interval 48.7% to 68.7%) were handled by the nurse alone. As we were interested only in whether the nurse service handled fewer calls at night, this can be interpreted as showing equivalence with the proportion observed in the main trial. The proportions of calls in which callers received advice from a general practitioner and calls ending in a home visit showed clear reductions, with 95% confidence intervals not embracing 1. A lower proportion of calls resulted in a daytime surgery attendance in the intervention ...

A new drug, gestrinone, was subjected to the first double blind, randomised placebo controlled trial of any treatment of endometriosis. The disease deteriorated in eight (47%) of the 17 patients prescribed placebo (95% confidence limits 23% and 71%) compared with none of the 18 patients prescribed gestrinone (p=0002). There was a difference in elimination of the endometriosis in the gestrinone group compared with placebo but this was not statistically significant (p=0 057). There was a significant difference in improvement of the disease in the gestrinone group compared with placebo (p=0004), confirming that gestrinone is an effective treatment of endometriosis.Endometriosis deteriorates in at least 23% of patients; as it is impossible to predict in whom this will happen, treatment appears to be warranted in all cases.