***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 test the hypothesis that educating parents about use of their primary care provider and providing information about common pediatric illnesses will reduce visits to the pediatric emergency department ( PED ) . DESIGN Prospect i ve , r and omized , controlled trial conducted from September 1 , 1993 , to October 31 , 1994 . SETTING Pediatric emergency department of an urban university hospital . PARTICIPANTS Parents of 130 patients seen in the PED for minor illness . INTERVENTIONS Subjects were r and omized to intervention or control groups . Parents in both groups were interviewed about their child 's health and use of health care services . The intervention group received education on pediatric health care issues ; the control group received usual PED discharge instructions . Use of the PED by all subjects was tracked for 6 months by telephone follow-up and medical record review . MAIN OUTCOME MEASURES Differences between the two groups in total number of return visits to the PED and return visits to the PED for minor illness . RESULTS Sixty-seven ( 97 % ) of the 69 patients in the intervention group and 56 ( 92 % ) of the 61 patients in the control group identified a primary care provider . At 6-month follow-up , 21 patients ( 30 % ) from the intervention group and 16 ( 26 % ) from the control group had returned to the PED ( P = .68 , chi 2 ) . Seventeen ( 81 % ) of intervention group returnees to the PED had minor illness , as did 11 ( 69 % ) of control group returnees . CONCLUSIONS A one-time educational intervention in the PED does not alter long-term emergency department utilization habits . More extensive education and greater availability of primary care providers may be needed to decrease use of the PED  for minor illness Background Effective communication between physician and patient is essential to optimize care after discharge from the emergency department ( ED ) . Written discharge care instructions ( DCI ) complement verbal instructions and have been shown to improve communication and patient management . In 2012 , Centers for Medicare and Medicaid Services proposed a quality measure ( OP-19 ) that assesses compliance with key elements considered essential for high- quality written DCI . Objective To evaluate the impact of a QI intervention on improving quality of written DCI in a pediatric emergency department ( PED ) . Methods A QI initiative was conducted at a tertiary PED with greater than 60,000 annual visits . Based on Centers for Medicare and Medicaid Services OP-19 measure and group consensus , 8 elements were defined a priori as requisites for good quality DCI . These elements are : Customized noteExplanation of presenting complaint/diagnosisTest(s ) performedTest(s ) results New medication(s)Reason for medication(s ) Reasons to follow-upFollow-up physician's/specialty name Providers review ed a r and om sample of DCI of patients . Proportion of DCI that had each element documented was compared between preintervention phase ( PRE ) and postintervention phase ( POST ) . Results Three hundred twenty-nine DCI ( PRE ) and 1434 DCI ( POST ) were review ed . The POST DCI showed statistically significant improvement for each of the 8 elements . The bundle measure ( proportion containing all 8 elements ) increased from 23 % ( PRE ) to 79 % ( POST ) ( P < 0.001 ) . Conclusions The ED DCI improved in all 8 elements after a QI intervention . A detailed DCI at ED discharge enhances the patient 's ability to comply with postdischarge treatment plan . Further studies are needed to evaluate the impact of improving DCI on ED return rates and other outcomes OBJECTIVE Suicide is the third leading cause of death among adolescents . Many suicidal youths treated in emergency departments do not receive follow-up treatment as advocated by the National Strategy for Suicide Prevention . Two strategies for improving rates of follow-up treatment were compared . METHODS In a r and omized controlled trial , suicidal youths at two emergency departments ( N=181 ; ages ten to 18 ) were individually assigned between April 2003 and August 2005 to one of two conditions : an enhanced mental health intervention involving a family-based cognitive-behavioral therapy session design ed to increase motivation for follow-up treatment and safety , supplemented by care linkage telephone contacts after emergency department discharge , or usual emergency department care enhanced by provider education . Assessment s were conducted at baseline and approximately two months after discharge from the emergency department or hospital . The primary outcome measure was rates of outpatient mental health treatment after discharge . RESULTS Intervention patients were significantly more likely than usual care patients to attend outpatient treatment ( 92 % versus 76 % ; p=.004 ) . The intervention group also had significantly higher rates of  psychotherapy  ( 76 % versus 49 % ; p=.001 ) , combined psychotherapy and medication  ( 58 % versus 37 % ; p=.003 ) , and  psychotherapy visits ( mean 5.3 versus 3.1 ; p=.003 ) . Neither the emergency department intervention nor community outpatient treatment ( in exploratory analyses ) was significantly associated with improved clinical or functioning outcomes . CONCLUSIONS Results support efficacy of the enhanced emergency department intervention for improving linkage to outpatient mental health treatment but underscore the need for improved community outpatient treatment to prevent suicide , suicide attempts , and poor clinical and functioning outcomes for suicidal youths treated in emergency departments BACKGROUND Efforts to enroll inner-city asthmatic children into continuity care after a pediatric emergency department ( PED ) visit are frequently unsuccessful . Providing parents with documentation of their child 's allergic status and how this can be used to tailor an asthma management plan may improve adherence to scheduled continuity appointments . OBJECTIVE To determine whether skin testing children during PED visits for wheezing and providing parents with skin test results improves adherence to follow-up visits . METHODS A convenience sample of children aged 2 to 12 years with asthma who presented to the PED with wheezing were eligible . Enrolled children were r and omized to group 1 ( no skin test ) or group 2  ( skin test ) . At discharge , both groups scheduled asthma clinic appointments for within 1 week . Children in group 2 underwent skin testing with st and ard allergens , and parents were given documentation of skin test results . Adherence was assessed by computer confirmation of the patient 's asthma clinic visit . RESULTS Seventy-seven children were enrolled : 39 in group 1 and 38 in group 2 . The mean age was 7 years ; 69 % had mild intermittent asthma .  Twenty-four percent of children ( 9 of 38 ) in group 1 vs 46 % ( 17 of 37 ) in group 2 were followed up in the asthma clinic ( P < .05 ) . Children in group 2 were 2.6 ( 95 % confidence interval , 1.02 - 6.65 ) times more likely to keep appointments compared with children in group 1 . CONCLUSIONS Parents who receive evidence in the PED of their child 's allergic status and probable relationship to the child 's asthma are more likely to adhere to scheduled continuity visits Objective : The objective of the study was to compare change in asthma knowledge among parents with low or adequate health literacy after video or written asthma education  delivered during their child 's asthma-related emergency department ( ED ) visit . Methods : We recruited a convenience sample of parents presenting to the ED with their asthmatic child 2 to 14 years old . Parents were r and omized to receive video ( intervention ) or written ( active-control ) asthma education material s.  Health literacy levels were determined using the Rapid Estimate of Adult Literacy in Medicine tool . Asthma knowledge was evaluated at enrollment and 6-week telephone follow-up . Differences in knowledge scores were analyzed using Wilcoxon signed rank tests ; & khgr;2 tests were used for comparisons of categorical variables . Results : Of 150 eligible parents , 129 participated ( 86 % ) , and 117 were eligible for follow-up . Telephone follow-up was completed with 86 parents ( 74 % ) . Health literacy levels were low in 31 % of the parents . High asthma knowledge scores at enrollment were achieved by 33 % of low-literacy and 59 % of adequate-health-literacy parents ( P = 0.025 ) . Improvement in knowledge was realized for low-literacy parents regardless of the type of education ( P < 0.001 ) . Parents with adequate health literacy showed increased knowledge scores only after viewing the video . Conclusions : Asthma education material s distributed at the time of an ED visit increase parental knowledge about the disease . Video-based asthma education appears promising as a tool for increasing asthma knowledge in both low- and adequate-health-literacy parents Background Mild traumatic brain injury is a frequent cause of presentation to emergency departments . Despite the availability of clinical practice guidelines in this area , there is variation in practice . One of the aims of the Neurotrauma Evidence Translation program is to develop and evaluate a targeted , theory- and evidence -informed intervention to improve the management of mild traumatic brain injury in Australian emergency departments . This study is the first step in the intervention development process and uses the Theoretical Domains Framework to explore the factors perceived to influence the uptake of four key evidence -based recommended practice s for managing mild traumatic brain injury . Methods Semi-structured interviews were conducted with emergency staff in the Australian state of Victoria . The interview guide was developed using the Theoretical Domains Framework to explore current practice and to identify the factors perceived to influence practice . Two research ers coded the interview transcripts using thematic content analysis . Results A total of 42 participants ( 9 Directors , 20 doctors and 13 nurses ) were interviewed over a seven-month period . The results suggested that ( i ) the prospect i ve assessment of post-traumatic amnesia was influenced by : knowledge ; beliefs about consequences ; environmental context and re sources ; skills ; social/professional role and identity ; and beliefs about capabilities ; ( ii ) the use of guideline -developed criteria or decision rules to inform the appropriate use of a CT scan was influenced by : knowledge ; beliefs about consequences ; environmental context and re sources ; memory , attention and decision processes ; beliefs about capabilities ; social influences ; skills and behavioral regulation ; ( iii ) providing verbal and written patient information on discharge was influenced by : beliefs about consequences ; environmental context and re sources ; memory , attention and decision processes ; social/professional role and identity ; and knowledge ; ( iv ) the practice of providing brief , routine follow-up on discharge was influenced by : environmental context and re sources ; social/professional role and identity ; knowledge ; beliefs about consequences ; and motivation and goals . Conclusions Using the Theoretical Domains Framework , factors thought to influence the management of mild traumatic brain injury in the emergency department were identified . These factors present theoretically based targets for a future intervention OBJECTIVE . Many children are brought to the pediatric emergency department ( ED ) with acute asthma symptoms . Emergency asthma care is costly , and many ED visits may be preventable . Families often do not have written asthma action plans and lack asthma self-managment skills . This study tests a tailored self-managment intervention delivered in the ED for families of children with asthma . The primary hypotheses were that the intervention group would have greater confidence to manage asthma 14 days postintervention and more well-asthma visits and fewer urgent care/ED visits at 9 and 12 months . METHODS . This r and omized intervention/usual-care study was part of a larger ED asthma surveillance project in 4 urban pediatric ED sites . Asthma educators used a computer-based re source to tailor the intervention messages and provide a customized asthma action plan and educational summary . Children with acute asthma were enrolled during an ED visit , and follow-up telephone interviews were conducted during the next 9 months . The ED clinician classified the child ’s acute and chronic severity . RESULTS . To date , 464 subjects aged 1 to 18 years have been enrolled . The ED clinicians reported that 46 % had intermittent and 54 % had persistent chronic severity with 51 % having mild acute severity episodes . The confidence level to prevent asthma episodes and keep them from getting worse was significantly higher in the intervention group at 14 days postintervention . More subjects in the intervention group reported well-asthma visits by 9 months . Return ED visits were significantly lower in the intervention group in those with intermittent asthma . Twelve-month follow-up is in process . CONCLUSIONS . The tailored ED self-management intervention demonstrates significant effects on caregiver self-confidence and well-visit follow-up . Additional evaluation is needed to determine what impact this intervention has long-term Objective The aims of the study were to determine the following : 1 ) if a fever education program ( interactive or written ) reduces parent fever anxiety ; 2 ) if an interactive fever program was more effective as a teaching style than st and ard written material alone ; and 3 ) if a fever program increases parent fever home management and reduces return emergency department ( ED ) visits . Method A quasiexperimental , pretest and post-test pilot study examining parental fever anxiety was conducted at The Children ’s Hospital of Philadelphia . Eligible participants consisted of 87 parents and their children , aged 3 months to 5 years presenting with fever > 38.4 ° C , and without coexisting serious illness . Results Both the interactive fever education program and the st and ard written fever pamphlet were equally effective as teaching methods . Data revealed a 30 % reduction in fever anxiety rated as moderate-severe on arrival to none-low post-fever education , increased parent fever home management skills with correct use of thermometer and antipyretics 
    Output:
    
Education was the most common intervention and the majority of studies targeted parent knowledge or behavior .
Few interventions attempted to change healthcare provider knowledge or behavior .
Assessing barriers to implementation , identifying relevant ED context ual factors , and underst and ing provider and patient attitudes and beliefs about discharge communication were identified as important factors for improving discharge communication practice .
Strengthening discharge communication in a pediatric emergency context presents a significant opportunity for improving parent comprehension and health outcomes for children .