***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: CONTEXT The emergence and spread of antibiotic-resistant Streptococcus pneumoniae in US communities is due , in part , to the excessive use of antibiotics for acute respiratory tract infections . OBJECTIVE To decrease total antibiotic use for uncomplicated acute bronchitis in adults . DESIGN Prospect i ve , nonr and omized controlled trial , including baseline ( November 1996-February 1997 ) and study ( November 1997-February 1998 ) periods . SETTING Four selected primary care practice s belonging to a group-model health maintenance organization in the Denver , Colo , metropolitan area . PARTICIPANTS Consecutive adults diagnosed as having uncomplicated acute bronchitis . A total of 2462 adults were included at baseline and 2027 adults were included in the study . Clinicians included 56 physicians , 28 physician assistants or nurse practitioners , and 9 registered nurses . INTERVENTION The full intervention site received household and office-based patient educational material s , as well as a clinician intervention consisting of education , practice -profiling , and academic detailing . A limited intervention site received only office-based educational material s , and control sites provided usual care . MAIN OUTCOME MEASURE Antibiotic prescriptions for uncomplicated acute bronchitis during baseline and study periods . RESULTS Antibiotic prescription rates for uncomplicated acute bronchitis were similar at all 4 sites during the baseline period . During the study period , there was a substantial decline in antibiotic prescription rates at the full intervention site ( from 74 % to 48 % [ P = .003 ] ) , but not at the control and limited intervention sites ( 78 % to 76 % [ P = .81 ] and 82 % to 77 % [ P = .68 ] , respectively ) . Compared with control sites , changes in nonantibiotic prescriptions ( inhaled bronchodilators , cough suppressants , and analgesics ) were not significantly different for intervention sites . Return office visits ( within 30 days of the incident visit ) for bronchitis or pneumonia did not change significantly for any of the sites . CONCLUSIONS Antibiotic treatment of adults diagnosed as having uncomplicated acute bronchitis can be safely reduced using a combination of patient and clinician interventions BACKGROUND Overuse of antibiotics for children 's upper respiratory infections is widespread and contributes to the emergence of antibiotic-resistant bacteria . OBJECTIVE To assess changes in knowledge and awareness regarding antibiotic resistance and appropriate antibiotic use after community-wide educational interventions to reduce inappropriate antibiotic use . DESIGN Baseline survey conducted during June through July 1997 and postintervention survey of baseline participants during June through August 1998 . SETTING Communities in northern Wisconsin . PARTICIPANTS Parents of 729 r and omly selected children < 4 years of age were called until 215 in each of the intervention and control areas were reached . Of the 430 baseline participants , 365 ( 85 % ) participated in the postintervention survey . INTERVENTION Parent-oriented activities included distribution of material s and presentations . Physician-oriented activities included formal presentations and small group meetings . OUTCOME MEASURE Change in awareness about antibiotic resistance and knowledge about antibiotic indications . RESULTS A higher proportion of parents in the intervention area ( 53 % ) were exposed to 2 or more local educational messages , compared with the control area ( 23 % ) . From the baseline to the postintervention survey , the percentage of parents with a high degree of antibiotic resistance awareness increased more in the intervention area ( 58 % to 73 % ) than in the control area ( 60 % to 65 % ) . In the intervention area , there was also a larger increase in knowledge regarding appropriate indications for antibiotic use , compared with the control area . The proportion of parents who expected an antibiotic for their child and did not receive one declined in the intervention area ( 14 % to 9 % ) , while it increased in the control area ( 7 % to 10 % ) . In addition , the percentage of parents in the intervention area who brought their child to another physician because they did not receive an antibiotic decreased ( 5 % to 2 % ) , while it increased in the control area ( 2 % to 4 % ) . CONCLUSION Parental knowledge and awareness about antibiotic indications and antibiotic resistance can be changed with educational interventions directed at parents and clinicians From 1998 to 2000 , 13 rural Alaskan villages ( population , 3326 ) were surveyed annually by nasopharyngeal cultures for Streptococcus pneumoniae carriage . Data regarding antibiotic use for the entire population was abstract ed from clinic records . In 1999 , education of medical providers and the community about appropriate antibiotic use began in 4 villages ; this program was exp and ed to include all villages in 2000 .  Antibiotic courses per person decreased by 31 % in the initial intervention villages and by 35 % in the remaining villages after education ( P<.01 for each ) . Sample s were obtained for culture from a mean of 31 % of the population each year ; 31 % carried pneumococcus . No sustained decrease in carriage of penicillin-nonsusceptible strains was observed . When linear regression was used , serotype accounted for 81 % of the variance in pneumococcal minimum inhibitory concentrations after the intervention , compared with 7 % for antibiotic use . This suggests that reducing the carriage of serotypes associated with antibiotic resistance by use of pneumococcal conjugate vaccines may have a greater short-term impact than does decreasing antibiotic use CONTEXT The impact of clinical decision support systems ( CDSS ) on antimicrobial prescribing in ambulatory setting s has not previously been evaluated . OBJECTIVE To measure the added value of CDSS when coupled with a community intervention to reduce inappropriate prescribing of antimicrobial drugs for acute respiratory tract infections . DESIGN , PARTICIPANTS AND SETTING Cluster r and omized trial that included 407,460 inhabitants and 334 primary care clinicians in 12 rural communities in Utah and Idaho ( 6 with 1 shared characteristic and 6 with another ) , and a third group of 6 communities that served as non study controls . The preintervention period was January to December 2001 and the postintervention period was January 2002 to September 2003 . Acute respiratory tract infection diagnoses were classified into groups based on indication for antimicrobial use . Multilevel regression methods were applied to account for the clustered design . INTERVENTION Six communities received a community intervention alone and 6 communities received community intervention plus CDSS that were targeted toward primary care clinicians . The CDSS comprised decision support tools on paper and a h and held computer to guide diagnosis and management of acute respiratory tract infection . MAIN OUTCOME MEASURE Community-wide antimicrobial usage was assessed using retail pharmacy data . Diagnosis-specific antimicrobial use was compared by chart review . RESULTS Within CDSS communities , 71 % of primary care clinicians participated in the use of CDSS . The prescribing rate decreased from 84.1 to 75.3 per 100 person-years in the CDSS arm vs 84.3 to 85.2 in community intervention alone , and remained stable in the other communities ( P = .03 ) . A total of 13,081 acute respiratory tract infection visits were abstract ed . The relative decrease in antimicrobial prescribing for visits in the antibiotics " never-indicated " category during the post-intervention period was 32 % in CDSS communities and 5 % in community intervention-alone communities ( P = .03 ) . Use of macrolides decreased significantly in CDSS communities but not in community intervention-alone communities . CONCLUSION CDSS implemented in rural primary care setting s reduced overall antimicrobial use and improved appropriateness of antimicrobial selection for acute respiratory tract infections . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT00235703 INTRODUCTION Antibiotic overuse promotes resistant strains of bacteria and puts patients at risk for adverse reactions . Given the use of educational posters in government-sponsored public health campaigns , this study examined the effectiveness of a waiting room poster in reducing excessive antibiotic use in clinical practice . METHODS Investigators conducted a 1-month trial of an educational poster with historical controls using three private pediatric group practice s in Westchester County , New York . Children between the ages of 6 months and 10 years at the time of a visit to diagnose and treat symptoms of respiratory illness were enrolled as subjects .  Antibiotic prescriptions for children with respiratory illnesses seen during the poster month were compared with prescriptions written during three 1-month historical control periods . The proportion of visits that result ed in a prescription for an antibiotic served as the outcome measure . RESULTS Overall , 326 of the 720 patients ( 45.2 % ) enrolled in the study were treated with an antibiotic . Multiple logistic regression analysis revealed no statistically significant difference in the proportion of visits result ing in an antibiotic prescription among the 4 study months ( P = .79 ) , indicating that the educational poster had no effect on antibiotic use . DISCUSSION Public education in the form of a waiting room poster was not sufficient to decrease antibiotic prescriptions . This finding has implication s for current large-scale programs and for health care providers as they continue to attempt to educate patients on the appropriate use of antibiotics OBJECTIVE To determine whether an educational video could improve  parent knowledge , beliefs , and behaviors about the appropriate use of oral antibiotics . STUDY DESIGN A r and omized , controlled trial was conducted in an urban primary care clinic and a suburban pediatric practice . Parents were r and omly assigned to the intervention or control groups . Parents in the intervention group were asked to view a 20-minute video , specifically developed for this project , over a 2-month period , and given a brochure about antibiotics .  Parent knowledge , beliefs , and behaviors were assessed at the time of enrollment and then by telephone 2 months later . RESULTS A total of 193 ( 94 % ) of 206 parents completed the study . The groups were equivalent with respect to all important baseline characteristics . No differences were found for adjusted posttest means between the intervention and control groups for knowledge , beliefs , or behavior . For example , the intervention group scored 8.04 on the knowledge question naire ( 11 true-false questions ) , compared with 7.82 for the control group . Subgroup analysis , based on site of enrollment , indicated that families in the intervention group from the primary care urban clinic improved their knowledge score ( 6.03 to 6.92 ) and were more likely to report that there were problems with children receiving too many antibiotics ( intervention 67 % vs control 34 % ) . CONCLUSION Overall , this video had only a modest effect on parent knowledge , beliefs , and self-reported behaviors regarding oral antibiotics . We believe that any campaign promoting the judicious use of oral antibiotics must use a multifaceted approach and target both parents and physicians BACKGROUND The rapid increase of antibiotic resistance poses a significant threat to human health . Overuse of antibiotics has been linked to rates of antibiotic resistance . This study assessed the utility of two common interventions --1 ) practice profiling and feedback and 2 ) patient education material s -- implemented to decrease antibiotic prescribing for pediatric upper respiratory infections ( URIs ) . METHODS Based on Medicaid regions in Kentucky , primary care physicians managing pediatric respiratory infections in Medicaid were r and omized into four groups . Groups received either 1 ) performance feedback only , 2 ) patient education material s only , 3 ) both feedback and education material s , or 4 ) no intervention .  Participating physicians had their antibiotic prescribing assessed for the period of July 1 , 1996 , to November 30 , 1997 , with an intervention in June 1997 . The study included 216 physicians and 124,092 episodes of care . RESULTS All groups increased in proportion of episodes with antibiotics between the pre-intervention and post-intervention periods . Prescribing in the patient education group and the patient education and feedback group increased at a significantly lower rate than in the control group . Physicians did not change their coding of illness to justify antibiotics after the intervention , and there was no significant generalization of effect of the pediatric intervention on prescribing for adult URIs . CONCLUSIONS These interventions demonstrate little if any impact on promoting appropriate antibiotic prescribing . Antibiotic prescribing for viral respiratory infections continues to increase , suggesting concomitant increases in antibiotic resistance OBJECTIVES Nonadherence to prescribed medications impairs therapeutic benefits . The authors measured the ability of an automated text messaging ( short message service [ SMS ] ) system to improve adherence to postdischarge antibiotic prescriptions . METHODS This was a r and omized controlled trial in an urban emergency department ( ED ) with an annual census of 65,000 . A convenience sample of adult patients being discharged with a prescription for oral antibiotics was enrolled . Participants received either a daily SMS query about prescription pickup , and then dosage taken , with educational feedback based on their responses ( intervention ) , or the usual printed discharge instructions ( control ) . A st and ardized phone follow-up interview was used on the day after the intended completion date to determine antibiotic adherence : 1 ) the participant filled prescription within 24 hours of 
    Output:
    
Patient interventions that did not include clinician education were successful to increase KAB but were not shown to decrease antibiotic prescribing .
These interventions can change patient perspectives regarding antibiotic use , though it is unclear if clinician education is also necessary to reduce antibiotic prescribing .