***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 . The st and ard recommendation for treatment of young , febrile children with urinary tract infection has been hospitalization for intravenous antimicrobials . The availability of potent , oral , third-generation cephalosporins as well as interest in cost containment and avoidance of nosocomial risks prompted evaluation of the safety and efficacy of outpatient therapy . Methods . In a multicenter , r and omized clinical trial , we evaluated the efficacy of oral versus initial intravenous therapy in 306 children 1 to 24 months old with fever and urinary tract infection , in terms of short-term clinical outcomes ( sterilization of the urine and defervescence ) and long-term morbidity ( incidence of reinfection and incidence and extent of renal scarring documented at 6 months by99mTc-dimercaptosuccinic acid renal scans ) . Children received either oral cefixime for 14 days ( double dose on day 1 ) or initial intravenous cefotaxime for 3 days followed by oral cefixime for 11 days . Results . Treatment groups were comparable regarding demographic , clinical , and laboratory characteristics . Bacteremia was present in 3.4 % of children treated orally and 5.3 % of children treated intravenously . Of the short-term outcomes , 1 ) repeat urine cultures were sterile within 24 hours in all children , and 2 ) mean time to defervescence was 25 and 24 hours for children treated orally and intravenously , respectively . Of the long-term outcomes , 1 ) symptomatic reinfections occurred in 4.6 % of children treated orally and 7.2 % of children treated intravenously , 2 ) renal scarring at 6 months was noted in 9.8 % children treated orally versus 7.2 % of children treated intravenously , and 3 ) mean extent of scarring was ∼8 % in both treatment groups . Mean costs were at least twofold higher for children treated intravenously ( $ 3577 vs $ 1473 ) compared with those treated orally . Conclusions . Oral cefixime can be recommended as a safe and effective treatment for children with fever and urinary tract infection . Use of cefixime will result in substantial reductions of health care expenditures Percutaneous endoscopic gastrostomy ( PEG ) provides a non-surgical alternative to long-term enteral feeding . The gastrostomy tube , however , may deteriorate , malfunction , or be accidentally expelled , requiring replacement . A commercial gastrostomy tube is commonly used for replacement . However , a commercial replacement gastrostomy tube is many times more expensive than a Foley catheter , and the two have never been compared . We compared the efficacy and safety of an all-silicone Foley catheter used as a replacement feeding gastrostomy tube with the effectiveness of a commercial replacement gastrostomy tube in 46 patients undergoing long-term enteral feedings per gastrostomy . Twenty-four patients were r and omized to the Foley group and 22 patients to the commercial replacement gastrostomy tube group . The Foley catheter functioned well without need for replacement in 16 ( 66 % ) patients for 27.4 + /- 14.8 ( mean + /- SD ) weeks ; the commercial replacement gastrostomy tube functioned in 13 ( 59 % ) patients for 24.5 + /- 13.6 weeks ( p > 0.05 , NS ) . The Foley catheter  needed to be replaced because of malfunction in 8 ( 34 % ) patients and the commercial replacement gastrostomy tube in 9 ( 41 % ) patients after 21.6 + /- 11.5 weeks and 19.3 + /- 9.3 weeks , respectively ( p > 0.05 , NS ) . Neither the Foley catheter  nor the commercial replacement gastrostomy tube migrated ; this was the most striking finding , in contrast to case reports in the literature . Our data suggest that the Foley catheter can be safely used as a replacement gastrostomy tube ; it is considerably cheaper than the commercial replacement gastrostomy tube , and its efficacy and complication rates are similar to those of the commercial replacement gastrostomy tube A r and omised clinical trial of antiseptic nasal carrier cream ( Naseptin ) and silver nitrate cautery in the treatment of epistaxis in children was carried out . Fifty-four percent responded to cautery with silver nitrate and 50 % to treatment with Naseptin antiseptic carrier cream . There were 24 patients in each group . No statistically significant difference was observed between the groups when tested with the chi 2 test . We believe that the first line treatment of epistaxis in children should be the use of antiseptic nasal cream OBJECTIVES The purpose of this study was to test the hypothesis that topically applied 3 % diclofenac in 2.5 % hyaluronan reduces aphthous ulcer pain .  STUDY DESIGN A r and omized , double-blind , single dose study of 60 healthy adults with aphthous ulcers in three treatment groups--3 % diclofenac in 2.5 % hyaluronan , 2.5 % hyaluronan , 3 % viscous lidocaine -- was undertaken . Visual analogue scale pain scores were obtained before and after gel application and hourly , for up to 8 hours after gel application . Statistical analysis was performed with repeated measures ANOVA with square root transformation and Bonferroni correction . RESULTS A 48 % overall reduction in pain ( p < 0.01 ) was observed 10 minutes after gel application ; however , no significant difference was found between the three topical agents . A 35 % to 52 % pain reduction ( p < 0.01 ) was reported 2 to 6 hours after the application of diclofenac in hyaluronan , whereas hyaluronan gel alone and viscous lidocaine failed to produce significant VAS reductions . CONCLUSIONS A dose of 3 % diclofenac in 2.5 % hyaluronan is an effective and novel treatment for this common , painful disorder We performed a r and omized , prospect i ve study to compare the results of two methods for the operative fixation of fractures of the tibial plafond . Surgeons were assigned to a group on the basis of the operation that they preferred ( r and omized-surgeon design ) . In the first group , which consisted of eighteen patients ,  open reduction and internal fixation of both the tibia and the fibula  was performed through two separate incisions . An additional patient , who had an intact fibula , had fixation of the tibia only through an anteromedial incision . The second group consisted of twenty patients who were managed with external fixation with or without limited internal fixation ( a fibular plate or tibial interfragmentary screws ) .  Ten ( 26 per cent ) of the thirty-nine fractures were open , and seventeen ( 44 per cent ) were type III according to the classification of Rüedi and Allgöwer . There were fifteen operative complications in seven patients who had been managed with  open reduction  and internal fixation and four complications in four patients who had been managed with external fixation . All but four of the complications were infection or dehiscence of the wound that had developed within four months after the initial operation . The complications after open reduction and internal fixation tended to be more severe , and amputation was eventually done in three patients in this group . At a minimum of two years postoperatively ( average , thirty-nine months ; range , twenty-five to fifty-one months ) , the average clinical score was lower for the patients who had had a type-II or III fracture , regardless of the type of treatment . With the numbers available , no significant difference was found between the average clinical scores for the two groups . All of the patients , in both groups , who had had a type-II or III fracture had some degree of osteoarthrosis on plain radiographs at the time of the latest follow-up . With the numbers available , there was no significant difference between the two groups with regard to the osteoarthrotic changes . We concluded that external fixation is a satisfactory method of treatment for fractures of the tibial plafond and is associated with fewer complications than internal fixation The aetiology of acute epididymitis presenting to a surgical unit in a District General Hospital is presented . Patients over 45 years old frequently have a coliform urinary tract infection which may be associated with bladder neck obstruction . These patients require treatment with a suitable antibiotic ( Co‐trimoxazole ) and further investigation . This condition occurs more commonly in patients under 45 years old in whom it is not associated with urinary tract infection . We have not demonstrated significant chlamydial infection and in a double blind study the antibiotic Co‐trimoxazole did not hasten recovery . In this group the aetiology remains obscure From 1985 to 1988 , 90 closed tibial fractures were prospect ively studied to assess the morbidity of such injuries to sports people and how this can be influenced by treatment regimens . All fractures were sustained during rugby or football matches . After r and om selection , 45 fractures were openly reduced and internally fixed ( group A ) , and 45 fractures were manipulated under general anaesthesia and a long-leg plaster applied ( group B ) . For patients in group A , below-knee plasters were used for 3 to 4 weeks , with immediate weight-bearing when tolerated . A total of 44 ( 98 % ) tibiae united clinical ly and radiologically within 14 - 18 weeks . Within 4 months of surgery 28 ( 62 % ) patients had returned to work and were able to play again by the following season . By 6 months 17 ( 38 % ) patients had resumed normal activities . In group B , only 24 ( 53 % ) tibiae united in a mean time of 16 weeks ( range 12 - 40 weeks ) . Six ( 13 % ) patients required bone grafting for non-union , and one patient subsequently developed osteomyelitis . Only ten ( 22 % ) patients were back to work and playing sport again within 6 months of initial injury . It is concluded that internal fixation of closed tibial fractures as a primary procedure following low velocity sports injuries can be safely performed . It leads to a faster return to normal activities with fewer complications than does conservative treatment in plaster using contemporary methods AIM Controversy exists regarding the evidence base of medicine . Estimates range from 20 % to 80 % in various specialties , but there have been no studies in paediatrics . The aim of this study was to ascertain the evidence base for community paediatrics . METHODS Twelve community paediatricians working in clinics and schools in Yorkshire , Manchester , Teesside , and Cheshire carried out a prospect i ve review of consecutive clinical contacts . Evidence for diagnostic processes , prescribing , referrals , counselling/advice , and child health promotion was found by search ing electronic data bases . This information was critically appraised and a consensus was obtained regarding quality and whether it supported actions taken . RESULTS Two hundred and forty seven consultations and 1149 clinical actions were performed . Good evidence was found from a r and omised controlled trial or other appropriate study for 39.9 % of the 629 actions studied ; convincing non-experimental evidence for 7 % ; inconclusive evidence for 25.4 % ; evidence of ineffectiveness for 0.2 % ; and no evidence for 27.5 % . Prescribing and child health promotion activities had the highest levels of quality evidence , and counselling/advice had the lowest . CONCLUSIONS An encouraging amount of evidence was found to support much of community paediatric practice . This study improved on previous research in other specialties because actions other than medications and surgery were included Objective . To compare supination at the wrist followed by flexion at the elbow ( the traditional reduction technique ) to hyperpronation at the wrist in the reduction of radial head subluxations ( nursemaid 's elbow ) . Material s and Methods . This prospect i ve , r and omized study involved a consecutive sampling of children younger than 6 years of age who presented to one of two urban pediatric emergency departments and two suburban pediatric ambulatory care centers with a clinical diagnosis of radial head subluxation . Patients were r and omized to undergo reduction by one of the two methods and were followed every 5 minutes for return of elbow function . The initial procedure was repeated if baseline functioning did not return 15 minutes after the initial reduction attempt . Failure of that technique 30 minutes after the initial reduction attempt result ed in a cross-over to the alternate method of reduction . The alternate procedure was repeated if baseline functioning did not return 15 minutes after the alternate procedure was attempted . If the patient failed both techniques , radio-graphy of the elbow was performed . Results . A total of 90 patients were enrolled in the study . Five patients were removed from further analysis secondary to a final diagnosis of fracture , 84 were reduced successfully , and 1 failed both techniques . Demographic characteristics of each group were similar . Thirty-nine of 41 patients ( 95 % ) r and omized to hyper-pronation were reduced successfully on the first attempt versus 34 of 44 patients ( 77 % ) r and omized to supination . Two patients in the hyperpronation group required two attempts versus 10 patients in the supination group . Hyperpronation was more successful ; 40 of 41 patients ( 97.5 % ) in the hyperpronation group were reduced successfully versus 38 of 44 patients ( 86 % ) in the supination group . Of the 6 patients who crossed over from supination to hyperpronation , 5 were reduced on the first attempt and 1 was reduced on the second attempt . Conclusions . In the reduction of radial head subluxations , the hyperpronation technique required fewer attempts at reduction compared with supination , was successful more often than supination , and was often successful when supination failed Abstract It has been assumed that only 10 % of medical interventions are supported by solid scientific evidence . The aim of this study was to determine the type of research evidence supporting operations in a tertiary referral paediatric surgical unit . All patients admitted over a 4 
    Output:
    
Conclusion Our study demonstrates that a substantial proportion of PED treatment decisions are evidence -based , with most based on studies in pediatric patients .
Also , a large number of patients seen in the PED receive no intervention