cause for concern. Reviewing the service after the nurses have more experience running it and estimating the real cost effectiveness outside the artificial restrictions of a trial would be useful. It would also be interesting to study the longer term effects of the nurses' service on patients' attitudes to their illnesses and behaviour in seeking health care.Various members of the South Thames Research Network provided invaluable support during all stages of this study, in particular Dr Sarah Clement. The network is funded by the South East and London regions of the NHS Executive. Statistical analysis was supervised by Dr Pak Sham. Thanks are also owed to the staff of the five practices, to the nurses who volunteered to participate in the study, and to the patients who took part.Contributors: CS initiated and coordinated the formulation of the hypothesis, discussed core ideas, designed the study protocol and questionnaires, analysed the data, acted as overall coordinator for the trial, and participated in writing the paper. CS is guarantor for the paper. AH helped formulate the core ideas and the study protocol, participated in data collection, and contributed to writing the paper. DW helped formulate the core ideas and study protocol and participated in writing the paper. MAC helped formulate the hypothesis and protocol and participated in writing the paper. SK participated in collecting the data and coordinating the day to day running of the study. SC helped formulate the hypothesis and core ideas, designed the protocol for data analysis, and participated in writing the paper.Funding: This project was funded by the project grant scheme of the South Thames region of the NHS Executive.Competing interests: None declared. AbstractObjective To ascertain any differences between care from nurse practitioners and that from general practitioners for patients seeking "same day" consultations in primary care.

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This study reports on the results of a discrete choice experiment undertaken in Zambia to assess the factors influencing the demand for hospital care in Zambia, in particular the role of (perceived) quality and trade-offs between price and quality. Valuations of quality were evaluated for the treatment of two acute medical conditions, cerebral malaria in adults and acute pneumonia in children. Marginal utilities and willingness-to-pay for attributes of quality of hospital care were estimated, together with the influence of socioeconomic characteristics on these valuations and the extent of non-linearities in valuations of time and money. We find the technical quality of care, as represented by the thoroughness of examination, to be the most important quality attribute, followed by staff attitudes and drug availability. Valuations of examination thoroughness increase with increasing socioeconomic status. The disutility of cost was found to decrease with higher socioeconomic status, as was the value of drug availability. The implications of the findings for Zambian hospital sector reforms are discussed.

Medline is the key source for reviews of economic evaluations. Researchers may select from the search strategies proposed in this paper the one that offers an optimal balance between sensitivity and specificity in relation to the aims of their review. Manual searches and searches of databases other than Medline have a limited incremental yield. The sensitivity of all search strategies increases when tighter methodological standards are set, but more research is needed on methods for identifying methodologically sound studies.

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