***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 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 Background A global antimicrobial resistance ( AMR ) awareness intervention targeting the general public has been prioritized . Objectives To evaluate the effectiveness of interventions that aim to change AMR awareness and subsequent stewardship behaviours amongst the public . Methods Five data bases were search ed between 2000 and 2016 for interventions to change the public 's AMR awareness and /or antimicrobial stewardship behaviours . Study design s meeting the Cochrane Effective Practice and Organization of Care ( EPOC ) criteria , non-controlled before- and -after studies and prospect i ve cohort studies were considered eligible . Participants recruited from healthcare setting s and studies measuring stewardship behaviours of healthcare professionals were excluded .  Quality of studies was assessed using EPOC risk of bias criteria . Data were extracted and synthesized narratively . Registration : PROSPERO international prospect i ve register of systematic review s ( PROSPERO 2016 : CRD42016050343 ) . Results Twenty studies were included in the review with nine meeting the EPOC criteria . The overall risk of bias was high . Nineteen studies were conducted in high-income countries .  Mass media interventions were most common ( n = 7 ) , followed by school-based ( n = 6 ) and printed material interventions ( n = 6 ) . Seventeen studies demonstrated a significant effect on changing knowledge , attitudes or the public 's antimicrobial stewardship behaviours . Analysis showed that interventions targeting schoolchildren and parents have notable potential , but for the general public the picture is less clear . Conclusions Our work provides an in-depth examination of the effectiveness of AMR interventions for the public . However , the studies were heterogeneous and the quality of evidence was poor . Well- design ed , experimental studies on behavioural outcomes of such interventions are required Background The evidence gained from effective self-management interventions is often criticised for the ambiguity of its active components , and consequently the obstruction of their implementation into daily practice .Our aim is to report how an intervention development model aids the careful selection of active components in an intervention for people with dysglycaemia . Methods The first three phases of the UK Medical Research Council 's model for developing complex interventions in primary care were used to develop a self-management intervention targeting people with screen-detected dysglycaemia . In the pre clinical phase , the expected needs of the target group were assessed by review of empirical literature and theories . In phase I , a preliminary intervention was modelled and in phase II , the preliminary intervention was pilot tested . Results In the pre clinical phase the achievement of health-related action competence was defined as the overall intervention goal and four learning objectives were identified : motivation , informed decision-making , action experience and social involvement . In Phase I , the educational activities were defined and the pedagogical tools tested . In phase II , the intervention was tested in two different primary healthcare setting s and adjusted accordingly . The 18-hour intervention " Ready to Act " ran for 3 months and consisted of two motivational one-to-one sessions conducted by nurses and eight group meetings conducted by multidisciplinary teams . Conclusions An intervention aim ed at health-related action competence was successfully developed for people with screen-detected dysglycaemia . The systematic and transparent developmental process is expected to facilitate future clinical research . The MRC model provides the necessary steps to inform intervention development but should be prioritised according to existing evidence in order to save time OBJECTIVES Intervention Modeling Experiments ( IMEs ) are a way of developing and testing behavior change interventions before a trial . We aim ed to test this methodology in a Web-based IME that replicated the trial component of an earlier , paper-based IME . STUDY DESIGN AND SETTING Three-arm , Web-based r and omized evaluation of two interventions ( persuasive communication and action plan ) and a " no intervention " comparator . The interventions were design ed to reduce the number of antibiotic prescriptions in the management of uncomplicated upper respiratory tract infection . General practitioners ( GPs ) were invited to complete an online question naire and eight clinical scenarios where an antibiotic might be considered . RESULTS One hundred twenty-nine GPs completed the question naire . GPs receiving the persuasive communication did not prescribe an antibiotic in 0.70 more scenarios ( 95 % confidence interval [ CI ] = 0.17 - 1.24 ) than those in the control arm . For the action plan , GPs did not prescribe an antibiotic in 0.63 ( 95 % CI = 0.11 - 1.15 ) more scenarios than those in the control arm . Unlike the earlier IME , behavioral intention was unaffected by the interventions ; this may be due to a smaller sample size than intended . CONCLUSIONS A Web-based IME largely replicated the findings of an earlier paper-based study , providing some grounds for confidence in the IME methodology Background Behavioural theory can be used to better underst and the effects of behaviour change interventions targeting healthcare professional behaviour to improve quality of care . However , the explicit use of theory is rarely reported despite interventions inevitably involving at least an implicit idea of what factors to target to implement change . There is a quality of care gap in the post-fracture investigation ( bone mineral density ( BMD ) scanning ) and management ( bisphosphonate prescription ) of patients at risk of osteoporosis . We aim ed to use the Theoretical Domains Framework ( TDF ) within a systematic review of interventions to improve quality of care in post-fracture investigation . Our objectives were to explore which theoretical factors the interventions in the review may have been targeting and how this might be related to the size of the effect on rates of BMD scanning and osteoporosis treatment with bisphosphonate medication . Methods A behavioural scientist and a clinician independently coded TDF domains in intervention and control groups . Quantitative analyses explored the relationship between intervention effect size and total number of domains targeted , and as number of different domains targeted . Results Nine r and omised controlled trials ( RCTs ) ( 10 interventions ) were analysed . The five theoretical domains most frequently coded as being targeted by the interventions in the review included “ memory , attention and decision processes ” , “ knowledge ” , “ environmental context and re sources ” , “ social influences ” and “ beliefs about consequences ” . Each intervention targeted a combination of at least four of these five domains . Analyses identified an inverse relationship between both number of times and number of different domains coded and the effect size for BMD scanning but not for bisphosphonate prescription , suggesting that the more domains the intervention targeted , the lower the observed effect size . Conclusions When explicit use of theory to inform interventions is absent , it is possible to retrospectively identify the likely targeted factors using theoretical frameworks such as the TDF . In osteoporosis management , this suggested that several likely determinants of healthcare professional behaviour appear not yet to have been considered in implementation interventions . This approach may serve as a useful basis for using theory-based frameworks such as the TDF to retrospectively identify targeted factors within systematic review s of implementation interventions in other implementation context Objectives To test the hypothesis that a multifaceted , local public campaign could be feasible and influence antibiotic prescribing for out patients . Design Community level , controlled , non-r and omised trial . Setting Provinces of Modena and Parma in Emilia-Romagna , northern Italy , November 2011 to February 2012 . Population 1 150 000 residents of Modena and Parma ( intervention group ) and 3 250 000 residents in provinces in the same region but where no campaign had been implemented ( control group ) . Interventions Campaign material s ( mainly posters , brochures , and advertisements on local media , plus a newsletter on local antibiotic resistance targeted at doctors and pharmacists ) . General practitioners and paediatricians in the intervention area participated in design ing the campaign messages . Main outcomes measures Primary outcome was the average change in prescribing rates of antibiotics for outpatient in five months , measured as defined daily doses per 1000 inhabitants/day , using health districts as the unit of analysis . Results Antibiotic prescribing was reduced in the intervention area compared with control area ( −4.3 % , 95 % confidence interval −7.1 % to −1.5 % ) . This result was robust to “ sensitivity analysis ” modifying the baseline period from two months ( main analysis ) to one month . A higher decrease was observed for penicillins resistant to β lactamase and a lower decrease for penicillins susceptible to β lactamase , consistent with the content of the newsletter on antibiotic resistance directed at health professionals . The decrease in expenditure on antibiotics was not statistically significant in a district level analysis with a two month baseline period ( main analysis ) , but was statistically significant in sensitivity analyses using either a one month baseline period or a more powered doctor level analysis . Knowledge and attitudes of the target population about the correct use of antibiotics did not differ between the intervention and control areas . Conclusions A local low cost information campaign targeted at citizens , combined with a newsletter on local antibiotic resistance targeted at doctors and pharmacists , was associated with significantly decreased total rates of antibiotic prescribing but did not affect the population ’s knowledge and attitudes about antibiotic resistance . Trial registration Clinical Trials.gov NCT01604096 Background Method ological guidelines for intervention reporting emphasise describing intervention content in detail . Despite this , systematic review s of quality improvement ( QI ) implementation interventions continue to be limited by a lack of clarity and detail regarding the intervention content being evaluated . We aim ed to apply the recently developed Behaviour Change Techniques Taxonomy version 1 ( BCTTv1 ) to trials of implementation interventions for managing diabetes to assess the capacity and utility of this taxonomy for characterising active ingredients . Methods Three psychologists independently coded a r and om sample of 23 trials of healthcare system , provider- and /or patient-focused implementation interventions from a systematic review that included 142 such studies . Intervention content was coded using the BCTTv1 , which describes 93 behaviour change techniques ( BCTs ) grouped within 16 categories . We supplemented the generic coding instructions within the BCTTv1 with decision rules and examples from this literature . Results Less than a quarter of possible BCTs within the BCTTv1 were identified . For implementation interventions targeting providers , the most commonly identified BCTs included the following : adding objects to the environment , prompts/cues , instruction on how to perform the behaviour , credible source , goal setting ( outcome ) , feedback on outcome of behaviour , and social support ( practical ) . For implementation interventions also targeting patients , the most commonly identified BCTs included the following : prompts/cues , instruction on how to perform the behaviour , information about health consequences , restructuring the social environment , adding objects to the environment , social support ( practical ) , and goal setting ( behaviour ) . The BCTTv1 mapped well onto implementation interventions directly targeting clinicians and patients and could also be used to examine the impact of system-level interventions on clinician and patient behaviour . Conclusions The BCTTv1 can be used to characterise the active ingredients in trials of implementation interventions and provides specificity of content beyond what is given by broader intervention labels . Identification of BCTs may provide a more helpful means of accumulating knowledge on the content used in trials of implementation interventions , which may help to better inform replication efforts . In addition , prospect i ve use of a behaviour change techniques taxonomy for developing and reporting intervention content would further aid in building a cumulative science of effective implementation interventions Context : Large-scale strategies are needed to reduce overuse of antibiotics in US communities . Objectives : To evaluate the impact of a mass media campaign—“Get Smart Colorado”—on public exposure to campaign , antibiotic use , and office visit rates . Design : Nonr and omized controlled trial . Setting : Two metropolitan communities in Colorado , United States . Subject 
    Output:
    
Only 15 % of BCTs have been applied in AMR interventions thus providing a clear opportunity for the development of novel interventions in this context .
Evidence of the effectiveness of interventions that target the public to engage them with AMR is mixed ; the public continue to show poor knowledge and misperceptions of AMR .
Little is known about the common , active ingredients of AMR interventions targeting the public and information on explicit theoretical content is sparse .
The analysis shows very few studies reported any explicit theoretical basis to the interventions they described .
Many interventions share common components , including core mechanisms of action and behaviour change techniques .
The analysis suggests components of future interventions to engage the public with AMR