title: Effectiveness of nurse delivered endoscopy: findings from randomised multi-institution nurse endoscopy trial (MINuET).
abstract: OBJECTIVE
  To compare the clinical effectiveness of doctors and nurses in undertaking upper and lower gastrointestinal endoscopy.
  
  
  METHODS
  Pragmatic trial with Zelen's randomisation before consent to minimise distortion of existing practice.
  
  
  METHODS
  23 hospitals in the United Kingdom. In six hospitals, nurses undertook both upper and lower gastrointestinal endoscopy, yielding a total of 29 centres.
  
  
  METHODS
  67 doctors and 30 nurses. Of 4964 potentially eligible patients, we randomised 4128 (83%) and recruited 1888 (38%) from July 2002 to June 2003.
  
  
  METHODS
  Diagnostic upper gastrointestinal endoscopy and flexible sigmoidoscopy, undertaken with or without sedation, with the standard preparation, techniques, and protocols of participating hospitals. After referral for either procedure, patients were randomised between doctors and nurses.
  
  
  METHODS
  Gastrointestinal symptom rating questionnaire (primary outcome), gastrointestinal endoscopy satisfaction questionnaire and state-trait anxiety inventory (all analysed by intention to treat); immediate and delayed complications; quality of examination and corresponding report; patients' preferences for operator; and new diagnoses at one year (all analysed according to who carried out the procedure).
  
  
  RESULTS
  There was no significant difference between groups in outcome at one day, one month, or one year after endoscopy, except that patients were more satisfied with nurses after one day. Nurses were also more thorough than doctors in examining the stomach and oesophagus. While quality of life scores were slightly better in patients the doctor group, this was not statistically significant.
  
  
  CONCLUSIONS
  Diagnostic endoscopy can be undertaken safely and effectively by nurses.
  
  
  BACKGROUND
  International standard RCT 82765705.
authors.affiliation: Centre for Health Information, Research and Evaluation, School of Medicine, Swansea University, Swansea SA2 8PP.
authors.forename: John
authors.initials: J
authors.lastname: Williams
authors.forename: Ian
authors.initials: I
authors.lastname: Russell
authors.forename: Dharmaraj
authors.initials: D
authors.lastname: Durai
authors.forename: Wai Yee
authors.initials: WY
authors.lastname: Cheung
authors.forename: Amanda
authors.initials: A
authors.lastname: Farrin
authors.forename: Karen
authors.initials: K
authors.lastname: Bloor
authors.forename: Simon
authors.initials: S
authors.lastname: Coulton
authors.forename: Gerry
authors.initials: G
authors.lastname: Richardson
mesh_terms: D001007:Anxiety / Q000209:etiology; D003362:Cost-Benefit Analysis; D016099:Endoscopy, Gastrointestinal / Q000379:methods / Q000451:nursing*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000451:nursing; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D006113:United Kingdom; D014741:Video Recording