***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: OBJECTIVE To assess the quality of antibiotic prescribing by Victorian general practitioners , and the effectiveness of educational intervention techniques in improving prescribing . DESIGN A r and omised , controlled , parallel group trial . SETTING AND PARTICIPANTS In rural and metropolitan Victoria , 182 general practitioners ( 78 control , 104 intervention ) began and 103 ( 41 control , 62 intervention ) completed the study . INTERVENTION Participants recorded their  antibiotic prescribing for tonsillitis .  The intervention group received an educational mailing campaign . A project pharmacist visited each doctor to discuss campaign messages . MAIN OUTCOME MEASURE The percentages of prescriptions of antibiotics for tonsillitis complying with those recommended in Antibiotic guidelines . RESULTS In the intervention group , prescriptions consistent with recommendations in the guidelines increased from 60.5 % before the campaign to 87.7 % afterwards . Improvement also occurred in the control group , from 52.9 % to 71.7 % of prescriptions . The improvement within the intervention group was significantly greater than that within the control group . CONCLUSIONS The educational campaign significantly improved the prescribing of appropriate antibiotics for tonsillitis by general practitioners Background : The effect of regular and expected printed educational material s on physician prescribing behaviour has not been studied . We sought to measure the impact of a series of evidence -based drug therapy letters mailed to physicians in British Columbia on prescribing to newly treated patients . Methods : A paired , cluster r and omized community design was used . The study population included 499 physicians from 24 local health areas in British Columbia . Local health areas were paired by number of physicians , and 1 of each pair was r and omly selected and its physicians assigned to an intervention group or a control group . The intervention was 12 issues of an evidence -based series called Therapeutics Letter . Physicians in the control group ( n = 241 ) received the letters 3–8 months after physicians in the intervention group ( n = 258 ) . The impact on prescribing to newly treated patients  ( defined as patients who had not previously made a cl aim for any medication from the class of drugs profiled in the letter ) was analyzed using the drug cl aims data base of BC Pharmacare , a publicly funded drug benefits program that covered all seniors and people receiving social assistance . Results : The probability of prescribing a drug recommended in the Therapeutics Letter rather than another drug in the same class increased by 30 % in the 3 months after the mailing of the letter relative to the preceding 3 months , adjusted for any before – after changes in the control group ( relative risk 1.30 ; 95 % confidence interval 1.13–1.52 ) . No letter achieved statistical significance on its own . However , 11 of the 12 letters produced prescribing changes in the predicted direction such that the overall result was significant when their effect was combined . Interpretation : The combined effect of an ongoing series of printed letters distributed from a credible and trusted source can have a clinical ly significant effect on prescribing to newly treated patients The rate of recovery of  oropharyngeal penicillin-resistant Streptococcus pneumoniae and aerobic and anaerobic beta-lactamase-producing bacteria ( BLPB ) from children who received a 4- to 6-month course of prophylaxis with amoxicillin or sulfisoxazole for otitis media was investigated monthly over 9 months . The BLPB recovered were Haemophilus influenzae , Moraxella catarrhalis , Staphylococcus aureus , pigmented Prevotella species , and Fusobacterium species . The recovery rate for all penicillin-resistant S. pneumoniae isolates and BLPB increased only after administration of amoxicillin . Before amoxicillin was administered , six BLPB isolates were recovered from four of the children who were to be given this drug ( 20 % ) . The number of BLPB recovered increased gradually until all of these patients were found to be colonized with BLPB ; five ( 25 % ) of these patients were found to be colonized with penicillin-resistant S. pneumoniae after 5 months of prophylaxis . Three to five months after amoxicillin prophylaxis was discontinued , the number of BLPB recovered gradually declined ; only three children ( 15 % ) remained colonized with BLPB , and none remained colonized with penicillin-resistant S. pneumoniae . These data illustrate that amoxicillin prophylaxis induces an increase in the number of penicillin-resistant bacteria in the oropharynx Two hundred fifty-eight isolates of Streptococcus pneumoniae obtained from 232 infants and children at Children 's Medical Center , Dallas , from November 1 , 1981 , to March 31 , 1983 , were screened for susceptibility to penicillin . On 1-μg oxacillin disks 21 strains ( 8 % ) had zones of inhibition of 17 mm or less , and the tubedilution minimal inhibitory concentrations of penicillin were from 0.125 to 0.5 μg/ml . These strains were design ated as relatively resistant S. pneumoniae ( RRSP ) . Prior therapy with a beta-lactam agent had occurred in 56 % of patients with RRSP disease compared with 14 % of r and omly selected children with infections due to susceptible strains of S. pneumoniae ( P = 0.009 ) . Fifteen children ( 6 % ) had diseases due to RRSP ranging from sepsis or meningitis to otitis media or conjunctivitis .  Four children , including the two patients with meningitis , had unsatisfactory responses to therapy with a betalactam antibiotic . Vancomycin or chloramphenicol is preferred for therapy of disease due to RRSP 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 Education on rational prescribing is receiving increased emphasis but the effectiveness of this education is not well research ed . This study used a r and omised trial to evaluate a seminar for general practice trainees on rational prescribing of antibiotics and benzodiazepines , two important areas of general practice prescribing . Results show a decrease in prescribing of antibiotics by the group of trainees attending the seminar but no effect on an already low level of benzodiazepine prescribing . The study provides evidence that group educational approaches to influencing prescribing behaviour can be effective 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 BACKGROUND The extent of use of antibiotics for upper respiratory tract infection ( URTI ) prompted a previous study of an educational intervention based on prescriber feedback and management guidelines . This study demonstrated a reduction in antibiotic prescribing for URTI and a more appropriate choice of antibiotic for tonsillitis/streptococcal pharyngitis . There are few long-term follow-up studies of educational programmes of this kind . OBJECTIVES This follow-up study aim ed to examine if the reduction in antibiotic prescribing observed in the intervention group of the original study remained present after 5 years , and how the prescribing behaviour of the GPs involved in the follow-up differed from a large national survey of GP prescribing . METHODS Attempts were made to contact the 157 GPs involved in the original study . Of these , 121 were both located and currently working in general practice . Ninety-six consented to take part and , of these , 79 completed a morbidity and treatment survey of 100 patient encounters ( response rate 65.3 % ) . RESULTS The intervention group ( n = 37 ) maintained their pattern of prescribing of antibiotics for URTI and choice of antibiotic for tonsillitis/streptococcal pharyngitis , with no significant change between the completion of the original study and the 5-year follow-up . The control  group ( n = 42 ) showed a downward trend in  antibiotic prescribing for URTI , with the effect that no significant differences remained between groups at the 5-year follow-up . At the 5-year follow-up , both groups prescribed significantly fewer antibiotics for URTI and showed greater adherence to prescribing guidelines for tonsillitis/streptococcal pharyngitis than participants in a large national GP survey ( n = 984 ) . CONCLUSION This study demonstrated maintenance of prescribing behaviour in the intervention group in the long term . However , the changes in prescribing observed in the control group and the power limitations of the study make it uncertain whether this was the result of a sustained effect of the educational intervention . The differences in both groups from the large national GP survey suggest that other influences on prescribing ( such as participation in vocational training for general practice ) were also having an important effect BACKGROUND In response to the dramatic emergence of resistant pneumococci , more judicious use of antibiotics has been advocated . Physician beliefs , their prescribing practice s , and the attitudes of patients have been evaluated previously in separate studies . METHODS This 3-part study included a statewide mailed survey , office chart review s , and parent telephone interviews . We compared survey responses of 366 licensed pediatricians and family physicians in Georgia to recently published recommendations on diagnosis and treatment of upper respiratory infections ( URIs ) . We further evaluated 25 r and omly selected pediatricians from 119 surveyed in the Atlanta metropolitan area . For each , charts from the first 30 patients between the ages of 12 and 72 months seen on a r and omly selected date were review ed for encounters during the preceding year . A sample of parents from each practice were interviewed by telephone . RESULTS In the survey , physicians agreed that overuse of antibiotics is a major factor contributing to the development of antibiotic resistance ( 97 % ) , and that they should consider selective pressure for resistance in their decisions on providing antibiotic treatment for URIs in children in their practice s ( 83 % ) . However , many reported practice s do not conform to the recently published principles for judicious antibiotic use . For example , 69 % of physicians considered purulent rhinitis a diagnostic finding for sinusitis ; 86 % prescribed antibiotics for bronchitis regardless of the duration of cough ; and 42 % prescribed antibiotics for the common cold . Reported practice s by family physicians were more often at odds with the published principles : they were significantly more likely than pediatricians to omit 
    Output:
    
Use of printed educational material s or audit and feedback alone result ed in no or only small changes in prescribing .
Interactive educational meetings appeared to be more effective than didactic lectures .
Educational outreach visits and physician reminders produced mixed results .
Patient-based interventions , particularly the use of delayed prescriptions for infections for which antibiotics were not immediately indicated effectively reduced antibiotic use by patients and did not result in excess morbidity .
Multi-faceted interventions combining physician , patient and public education in a variety of venues and formats were the most successful in reducing antibiotic prescribing for inappropriate indications .
The effectiveness of an intervention on antibiotic prescribing depends to a large degree on the particular prescribing behaviour and the barriers to change in the particular community .
No single intervention can be recommended for all behaviours in any setting .
Multi-faceted interventions where educational interventions occur on many levels may be successfully applied to communities after addressing local barriers to change .
These were the only interventions with effect sizes of sufficient magnitude to potentially reduce the incidence of antibiotic-resistant bacteria .