***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 Research -Based Education and Quality Improvement ( ReBEQI ) European partnership aims to establish a framework and provide practical tools for the selection , implementation , and evaluation of quality improvement ( QI ) interventions . We describe the development and preliminary evaluation of the software tool NorthStar , a major product of the ReBEQI project . Methods We focused the content of NorthStar on the design and evaluation of QI interventions . A lead individual from the ReBEQI group drafted each section , and at least two other group members review ed it . The content is based on published literature , as well as material developed by the ReBEQI group . We developed the software in both a Microsoft Windows HTML help system version and a web-based version . In a preliminary evaluation , we surveyed 33 potential users about the acceptability and perceived utility of NorthStar . Results NorthStar consists of 18 sections covering the design and evaluation of QI interventions . The major focus of the intervention design sections is on how to identify determinants of practice ( factors affecting practice patterns ) , while the major focus of the intervention evaluation sections is on how to design a cluster r and omised trial . The two versions of the software can be transferred by email or CD , and are available for download from the internet . The software offers easy navigation and various functions to access the content . Potential users ( 55 % response rate ) reported above-moderate levels of confidence in carrying out QI research related tasks if using NorthStar , particularly when developing a protocol for a cluster r and omised trial Conclusion NorthStar is an integrated , accessible , practical , and acceptable tool to assist developers and evaluators of QI interventions Physician behavior and caregiver retention of nutrition advice were examined as potential mediating factors in the success of a nutrition counseling efficacy trial in Pelotas , Brazil , which reduced growth faltering in children 12 - 24 mo old . After pair-matching on socioeconomic status and nutrition indicators , municipal health centers were r and omly assigned to an intervention group , in which physicians were trained with an IMCI-derived ( Integrated Management of Childhood Illness ) nutrition counseling protocol , or to a control group , without continuing education in nutrition . In a sub study of the larger trial , direct observation of consultations , followed by home interviews with mothers , provided data on physician counseling behavior and mothers ' retention of nutrition advice . Trained providers were more likely to engage in nutrition counseling ( P < 0.013 ) and to deliver more extensive advice ( P < 0.02 ) . They also used communication skills design ed to improve rapport and ensure that mothers understood the advice ( P < 0.01 ) . Mothers who received advice from trained providers had high rates of recalling the messages on specific foods ( 95 vs.27 % ; P < 0.01 ) and feeding practice and food preparation recommendations ( 90 vs. 20 % ; P < 0.01 ) , whereas the proportions of the messages recalled on breast-feeding ( 60 % vs. 30 % ) did not differ significantly ( P < 0.20 ) . The training course contained several elements that may explain why intervention group mothers were better able to recall nutrition advice . These include locally appropriate messages , tools for assessing individual problems , and counseling skills OBJECTIVE To evaluate the effectiveness of an educational intervention on pediatric residents ' resuscitation fund of knowledge , technical skills , confidence , and overall performance . DESIGN Prospect i ve , nonconcurrent , controlled interventional trial . SETTING Urban pediatric tertiary care hospital . PARTICIPANTS An intervention group ( IG ) of 28 pediatric residents graduating in 1997 , and a control group ( CG ) of 30 pediatric residents graduating in 1996 . INTERVENTIONS Resuscitation course with didactic lectures and skills practice stations , as well as a minimum of 3 practice mock resuscitations with immediate feedback throughout postgraduate year 3 . MAIN OUTCOME MEASURES Fund of knowledge , using the Pediatric Advanced Life Support test and short answer test ; technical skills , using the Airway and Vascular Access Skills Assessment ; experience and confidence , using an anonymous survey ; and overall performance , evaluated using a videotaped mock resuscitation test . RESULTS The IG scored better on the short answer test ( P<.001 ) . A larger number of IG residents were successful in the completion of ancillary airway maneuvers and femoral vascular access ( P = .02 ) , as well as endotracheal intubation ( P = .004 ) and intraosseous access ( P = .002 ) . The IG was more confident in their leadership role ( P = .0001 ) and technical skills ( P = .05 ) . Trends toward improved overall performance were noted for the IG mock resuscitations . Residents in the IG were more likely to assess the airway in fewer than 2 minutes ( P = .02 ) , recognize the threat to life in fewer than 5 minutes ( P = .02 ) , and complete the primary survey in a timely fashion ( P = .05 ) . They required fewer prompts ( P = .04 ) and made fewer mistakes ( P = .07 ) . CONCLUSIONS A structured , formal curriculum can improve the necessary fund of knowledge , skills , confidence , and leadership required for resuscitation OBJECTIVE The objective of this study was to assess the effect of Integrated Management of Childhood Illness ( IMCI ) case management training on the use of antimicrobial drugs among health-care workers treating young children at first-level facilities . Antimicrobial drugs are an essential child-survival intervention . Ensuring that children younger than five who need these drugs receive them promptly and correctly can save their lives . Prescribing these drugs only when necessary and ensuring that those who receive them complete the full course can slow the development of antimicrobial resistance . METHODS Data collected through observation-based surveys in r and omly selected first-level health facilities in Brazil , Ug and a and the United Republic of Tanzania were statistically analysed . The surveys were carried out as part of the multi-country evaluation of IMCI effectiveness , cost and impact ( MCE ) . FINDINGS Results from three MCE sites show that children receiving care from health workers trained in IMCI are significantly more likely to receive correct prescriptions for antimicrobial drugs than those receiving care from workers not trained in IMCI . They are also more likely to receive the first dose of the drug before leaving the health facility , to have their caregiver advised how to administer the drug , and to have caregivers who are able to describe correctly how to give the drug at home as they leave the health facility . CONCLUSIONS IMCI case management training is an effective intervention to improve the rational use of antimicrobial drugs for sick children visiting first-level health facilities in low-income and middle-income countries Abstract Objectives To determine how well antibiotic treatment is targeted by simple clinical syndromes and to what extent drug resistance threatens affordable antibiotics . Design Observational study involving a priori definition of a hierarchy of syndromic indications for antibiotic therapy derived from World Health Organization integrated management of childhood illness and inpatient guidelines and application of these rules to a prospect ively collected data set . Setting Kilifi District Hospital , Kenya . Participants 11 847 acute paediatric admissions . Main outcome measures Presence of invasive bacterial infection ( bacteraemia or meningitis ) or Plasmodium falciparum parasitaemia ; antimicrobial sensitivities of isolated bacteria . Results 6254 ( 53 % ) admissions met criteria for syndromes requiring antibiotics ( sick young infants ; meningitis/encephalopathy ; severe malnutrition ; very severe , severe , or mild pneumonia ; skin or soft tissue infection ) : 672 ( 11 % ) had an invasive bacterial infection ( 80 % of all invasive bacterial infections identified ) , and 753 ( 12 % ) died ( 93 % of all inpatient deaths ) . Among P falciparum infected children with a syndromic indication for parenteral antibiotics , an invasive bacterial infection was detected in 4.0 - 8.8 % . For the syndrome of meningitis/encephalopathy , 96/123 ( 76 % ) isolates were fully sensitive in vitro to penicillin or chloramphenicol . Conclusions Simple clinical syndromes effectively target children admitted with invasive bacterial infection and those at risk of death . Malaria parasitaemia does not justify withholding empirical parenteral antibiotics . Lumbar puncture is critical to the rational use of antibiotics Background Birth asphyxia kills 0.7 to 1.6 million newborns a year globally with 99 % of deaths in developing countries . Effective newborn resuscitation could reduce this burden of disease but the training of health-care providers in low income setting s is often out date d. Our aim was to determine if a simple one day newborn resuscitation training ( NRT ) alters health worker resuscitation practice s in a public hospital setting in Kenya . Methods /Principal Findings We conducted a r and omised , controlled trial with health workers receiving early training with NRT ( n = 28 ) or late training ( the control group , n = 55 ) . The training was adapted locally from the approach of the UK Resuscitation Council . The primary outcome was the proportion of appropriate initial resuscitation steps with the frequency of inappropriate practice s as a secondary outcome . Data were collected on 97 and 115 resuscitation episodes over 7 weeks after early training in the intervention and control groups respectively . Trained providers demonstrated a higher proportion of adequate initial resuscitation steps compared to the control group ( trained 66 % vs control 27 % ; risk ratio 2.45 , [ 95 % CI 1.75–3.42 ] , p<0.001 , adjusted for clustering ) . In addition , there was a statistically significant reduction in the frequency of inappropriate and potentially harmful practice s per resuscitation in the trained group ( trained 0.53 vs control 0.92 ; mean difference 0.40 , [ 95 % CI 0.13–0.66 ] , p = 0.004 ) . Conclusions / Significance Implementation of a simple , one day newborn resuscitation training can be followed immediately by significant improvement in health workers ' practice s. However , evidence of the effects on long term performance or clinical outcomes can only be established by larger cluster r and omised trials . Trial Registration Controlled-Trials.com IS RCT OBJECTIVES To assess the effect of Integrated Management of Childhood Illness ( IMCI ) relative to routine care on the quality and efficiency of providing care for sick children in first-level health facilities in Tanzania , and to disseminate the results for use in health sector decision-making . DESIGN Non-r and omized controlled trial to compare child health care quality and economic costs in two intervention ( > 90 % of health care workers trained in IMCI ) and two comparison districts in rural Tanzania . PARTICIPANTS For quality measures , all sick children presenting for care at r and om sample s of first-level health facilities ; for costs , all national , district , facility and household costs associated with child health care , taking a societal perspective . RESULTS IMCI training is associated with significantly better child health care in facilities at no additional cost to districts . The cost per child visit managed correctly was lower in IMCI than in routine care setting s : $ 4.02 versus $ 25.70 , respectively , in 1999 US dollars and after st and ardization for variations in population size . CONCLUSION IMCI improved the quality and efficiency of child health care relative to routine child health care in the study districts . Previous study results indicated that the introduction of IMCI in these Tanzanian districts was associated with mortality levels that were 13 % lower than in comparison districts . We can therefore conclude that IMCI is also more cost-effective than routine care for improving child health outcomes . The dissemination strategy for these results led to adoption of IMCI for nationwide implementation within 12 months of study completion BACKGROUND We report the preliminary findings from a continuing cluster r and omised evaluation of the Integrated Management of Childhood Illness ( IMCI ) strategy in Bangladesh . METHODS 20 first-level outpatient facilities in the Matlab sub-district and their catchment areas were r and omised to either IMCI or st and ard care . Surveys were done in households and in health facilities at baseline and were repeated about 2 years after implementation . Data on use of health facilities were recorded . IMCI implementation included health worker training , health systems support , and community level activities guided by formative research . FINDINGS 94 % of health workers in the intervention facilities were trained in IMCI . Health systems supports were generally available , but implementation of the community activities was slow . The mean index of correct treatment for sick children was 54 in IMCI facilities compared with 9 in comparison facilities ( range 0 - 100 ) . Use of the IMCI facilities increased from 0.6 visits per child per year at baseline to 1.9 visits per child per year about 21 months after IMCI introduction . 19 % of sick children in the IMCI area were taken to a health worker compared with 9 % in the non-IMCI area . INTERPRETATION 2 years into the assessment , the results show improvements in the quality of care in health facilities , increases in use of facilities , and gains in the proportion of sick children taken to an appropriate health care provider . These findings are being used to strengthen child health care nationwide . They suggest that low levels of use of health facilities could be improved by investing in quality of care and health systems support 
    Output:
    
There is limited evidence that in-service neonatal emergency care courses improve health-workers ' practice s when caring for a seriously ill newborn although there is some evidence of benefit .