***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: The priority of the National Health System in South Africa is primary health care ( PHC ) . The approach involves a health system led by PHC services and includes personal and curative services for acute minor ailments  delivered by PHC nurses . The nurses are also responsible for the treatment of these ailments with essential drugs according to protocol s as proposed in the Essential Drugs List . A before-after experimental research design was used to evaluate the effect of a competency-based primary care drug therapy ( PCDT ) training programme for PHC nurses in the treatment of acute minor ailments . An experimental group ( n = 35 ) and control group ( n = 31 ) consisting of registered nurses undergoing training in PHC at Gold Fields Nursing College were r and omly selected . The results showed a significant increase in prescribing outcomes and medicine utilisation OBJECTIVE The study was carried out to evaluate short term effects of one to one educational intervention approach , conducted with 40 drug sellers in order to improve the private sector 's practice s , compliance and performance in using the national treatment guidelines for malaria and other common childhood ( diarrhoea , acute respiratory tract infection-ARI ) illnesses in Kibaha district-Tanzania . METHODS The training took place one month after baseline data collection . Data collection was undertaken eight months after training and the effects of training was evaluated . The 40 drug stores were divided into 20 intervention and 20 control facilities . Trained  nurses  were used as clients who posed as caretakers of sick under-five children needing medication . The drug dispensers/sellers knowledge of anti-malarials and other drugs and their dispensing practice s was assessed . RESULTS The intervention seemed to have had a significant impact on knowledge pattern for prescribing and dispensing practice s of drug stores for some common childhood illnesses but not in other control drug stores/shops . About 90 % ( n=18 ) of shops prescribed to clients , the approved first-line anti-malarial drug for uncomplicated malaria ( sulfadoxine-pyrimethamine ) , as compared to only 55 % ( n=11 ) of the control shops . CONCLUSION Changing the private sectors ' knowledge , behaviour and practice s/performance may be a slow and difficult process . The intervention approach applied in this study seems to be feasible at district-level . This strategy can be applied in all districts of Tanzania with the aim of achieving significant improvements in knowledge , behaviour , compliance , improving performance and practice s of drug sellers in drug stores/shops . However , other alternative strategies are needed to influence drug sellers'/dispensers ' compliance and performance . Thus , the overall impact on performance and practice s in these facilities will remain at moderate level for quite sometime unless national policies , other programs and stakeholders are involved actively WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Medication errors , and particularly prescribing errors , are common in UK hospitals . Junior doctors make the majority of prescribing errors . Deficiencies in prescribing education and training have been closely linked to the high frequency of medication errors . WHAT THIS STUDY ADDS Focussed prescribing teaching can lead to an improvement in prescribing ability . Prescribing confidence can be significantly improved through education . Education is insufficient alone in eradicating prescribing errors . AIM To assess the impact of prescribing teaching on final year medical students . METHODS Students r and omly allocated to two hospitals completed a prescribing assessment . Prescribing teaching was delivered to the intervention group while no additional teaching was provided for the control group . All students then completed a second prescribing assessment . RESULTS Teaching improved the assessment score : mean assessment 2 vs. 1 , 70 % vs. 62 % , P= 0.007 ; allergy documentation : 98 % vs. 74 % , P= 0.0001 ; and confidence . However , 30 % of prescriptions continued to include prescribing errors . CONCLUSION Medical students make significant errors in prescribing . Teaching improves ability and confidence but is insufficient alone in eradicating errors OBJECTIVE To identify and analyse factors underlying intern prescribing errors to inform development of specific medication-safety interventions . DESIGN A prospect i ve qualitative study that involved face-to-face interviews and human-factor analysis . SETTING A tertiary referral teaching hospital , Brisbane , Queensl and , February-June , 2004 . PARTICIPANTS Fourteen intern prescribers involved in 21 errors . METHOD A structured question naire was used to identify factors causing the errors . Transcripts were analysed on the basis of human-error theory to identify underlying themes . MAIN OUTCOME MEASURES Factors underlying prescribing errors . RESULTS Errors were multifactorial , with a median of 4 ( range , 2 - 5 ) different types of performance-influencing factors per error . Lack of drug knowledge was not the single causative factor in any incident . The factors in new-prescribing errors included team , individual , patient and task factors . Factors associated with errors in represcribing were environment , task and number of weeks into the term . Defences against error , such as other clinicians and guidelines , were porous , and supervision was inadequate or not tailored to the patient , task , intern or environment . Factors were underpinned by an underlying culture in which prescribing is seen as a repetitive low-risk chore . CONCLUSION To reduce the risk of prescribing errors , a range of strategies addressing patient , task , individual , team and environment factors must be introduced OBJECTIVE To evaluate the effect of an educational intervention on rational drug use  amongst Primary Health Care workers in two Local Government Areas ( LGAs ) , Mushin and Ikeja , in Lagos State . METHODS Mushin was r and omly selected as the intervention LGA while Ikeja was selected as the control L.G.A. A structured educational intervention design ed to improve prescribing practice s was carried in Mushin LGA for four weeks . Drug use indicators were measured before , at two weeks and three months post intervention . RESULTS At baseline , most of the drug-use indicators in the intervention LGA were significantly worse ( p < 0.05 ) than the control LGA . However , at the two-week evaluation , the educational programme achieved a significant reduction in the average number of drugs in the intervention LGA from 7.3 + 2.8 to 6.3 + 2.3 ( p=0.000 ) compared to the control LGA where there was no significant change ( from 4.9 + to 4.8 + 2.2 , p=0.647 ) . There was also a significant increase in the percentage of patients rationally managed from 18 % to 30 % ( p=0.0005 ) in the intervention LGA unlike the control LGA ( from 33 % to 31%,p=0.693 . ) . The rate of change in the average number of drugs prescribed was significantly higher in the intervention LGA ( + 14 % ) compared to the control LGA ( + 2%,p=0.0000 ) . The improvements were not sustained at the three-month evaluation , as most of the indicators were similar to values obtained at the baseline . CONCLUSION The intervention programme significantly improved rational drug use in the short-term period only . Other cost effective and sustainable intervention models for improving prescribing practice s should be developed OBJECTIVE : To study the effectiveness of an intensive small group education and peer review programme aim ed at implementing national guidelines on asthma/chronic obstructive pulmonary disease ( COPD ) on care provision by general practitioners ( GPs ) and on patient outcomes . DESIGN : A r and omised experimental study with pre-measurement and post-measurement ( after one year ) in an experimental group and a control group in Dutch general practice . SUBJECTS AND INTERVENTION : Two groups of GPs were formed and r and omised . The education and peer review group ( 17 GPs with 210 patients ) had an intervention consisting of an interactive group education and peer review programme ( four sessions each lasting two hours ) . The control group consisted of 17 GPs with 223 patients ( no intervention ) . MAIN OUTCOME MEASURES : Knowledge , skills , opinion about asthma and COPD care , presence of equipment in practice ; actual performance about peakflow measurement , non-pharmacological and pharmacological treatment ; asthma symptoms ( Dutch Medical Research Council ) , smoking habits , exacerbation ratio , and disease specific quality of life ( QOL-RIQ ) . Data were collected by a written question naire for GPs , by self recording of consultations by GPs , and by a written self administered question naire for adult patients with asthma/ COPD . RESULTS : Data from 34 GP question naires , 433 patient question naires , and recordings from 934 consultations/visits and 350 repeat prescriptions were available . Compared with the control group there were only significant changes for self estimated skills ( + 16 % , 95 % confidence interval 4 % to 26 % ) and presence of peakflow meters in practice ( + 18 % , p < 0.05 ) . No significant changes were found for provided care and patient outcomes compared with the control group . In the subgroup of more severe patients , the group of older patients , and in the group of patients not using anti-inflammatory medication at baseline , no significant changes compared with the control group were seen in patient outcomes . CONCLUSION : Except for two aspects , intensive small group education and peer review in asthma and COPD care do not seem to be effective in changing relevant aspects of the provided care by GPs in accordance with guidelines , nor in changing patients ' health status Objective Medication errors are common , with junior doctors accounting for the majority in acute healthcare . Paediatrics is uniquely challenging , but the evidence base to guide prescribing education is limited . The authors set out to develop a short , educationally sound , low cost e-learning re source for paediatric prescribing to improve junior doctors ' prescribing skills and to evaluate its effectiveness . Design A non-blinded r and omised controlled trial . Setting North Western Deanery Foundation School , UK . Participants 162 volunteer foundation ( junior ) doctors r and omised into control ( 86 ) and intervention ( 76 ) groups . Interventions On study entry , participants were assessed on prescribing skill , prescribing habits and confidence . The intervention group completed the e-learning course design ed for the study , which took 1–2 h. At 1 and 3 months after the intervention , both groups were assessed on similar prescribing assessment s , habits and confidence . Main outcome measures Total score ( expressed as a percentage ) on prescribing assessment s , confidence and satisfaction scores . Results There were no preintervention differences in prescribing assessment s ( 67 % vs 67 % , p=0.56 ) . Postintervention , the e-learning group scored significantly higher than the control group ( 63 % vs 79 % , p<0.0001 ) . At 3 months , the e-learning group still scored significantly higher ( 69 % vs 79 % , p<0.0001 ) , with improved confidence scores ( p<0.0001 ) . Conclusions This short e-learning re source significantly improved the paediatric prescribing skills of junior doctors . Outcomes were maintained at 3 months , suggesting the utility of low cost , low fidelity , educationally sound e-learning interventions . However , the direct impact on patient outcomes following this intervention has yet to be determined BACKGROUND Antibiotics are a medication class for which inappropriate prescribing is frequently described . We sought to assess the effectiveness of a mailed intervention combining confidential prescribing feedback with targeted educational bulletins in increasing the use of less expensive , first-line antibiotics by practising physicians . METHODS The participants were 251 r and omly selected primary care physicians from southern Ontario who consented to participate ( 135 in the feedback group and 116 in the control group ) . Prescribing data were obtained from the cl aims data base of the Ontario Drug Benefit program , which covers all Ontarians over age 65 years for drugs selected from a minimally restrictive formulary . Confidentially prepared profiles of antibiotic prescriptions coupled with guidelines -based educational bulletins were mailed to the intervention group every 2 months for 6 months . The control group received no intervention until after completion of the study . The main outcome measures were change from baseline in physician 's median antibiotic cost and proportion of episodes of care in which a prespecified first-line antibiotic was used first . RESULTS The median prescription cost of about $ 11 remained constant in the feedback group but rose in the control group ( change of $ 0.05 v. $ 3.37 , p < 0.002 ) . First-line drug use increased in the feedback group but decreased in the control group ( change of 2.6 % v. -1.7 % , p < 0.01 ) . In a mailed survey of 100 feedback recipients ( response rate 76 % ) , 82 % indicated that they would participate readily in another , similar program . INTERPRETATION A simple program of confidential feedback and educational material s blunted cost increases , increased the use of first-line antibiotics and was highly acceptable to Ontario primary care physicians BACKGROUND Different methods have previously been tested to affect GPs ' prescribing habits . Attention has been drawn to benzodiazepines and antipsychotic drugs that are associated with several adverse effects in the elderly . OBJECTIVE To evaluate if educational outreach visits to GP practice s can affect the prescribing of  benzodiazepines and antipsychotic drugs to the elderly and to evaluate the opinions of the participating GPs on such education . METHODS In the county of Skåne , Sweden , 41 GP practice s were invited to participate in educational outreach visits .  Fifteen GP practice s accepted the invitation . Practice s were r and omised to active ( 8 practice s , 23 physicians ) and  control group ( 7 practice s , 31 physicians ) . After the educational outreach visits prescribing of benzodiazepines and antipsychotic drugs to patients 65 
    Output:
    
A broad range of educational interventions have been conducted to improve prescribing competency .
The WHO Guide to Good Prescribing has the largest body of evidence to support its use and is a promising model for the design of targeted prescribing courses .