***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: Managing children with influenza-like illness is associated with costly and painful interventions because , in order to distinguish viral from bacterial infections , diagnostic tests ( including routine blood examinations and chest radiographs ) are frequently performed,1,2 and the empirical use of antimicrobial agents is common.3 Various rapid diagnostic techniques for the detection of influenza viruses have been developed , but few data are available on their impact on child care.2,4,5 The aim of this study was to assess the effect of a rapid diagnosis of influenza infection on the management of children with influenza-like illness in an emergency department . All patients seen for influenza-like illness from 6 January to 27 February 2002 , at the paediatric emergency department of the University of Milan , Italy , were enrolled and blindly r and omly assigned in a 1:1 ratio to undergo a rapid test for the detection of influenza viruses or no rapid test . Influenza-like illness was defined as an axillary temperature of ⩾37.8 ° C and at least one symptom of acute upper or lower respiratory tract disease.6 The patients who underwent the test had their throats swabbed after vigorously rubbing both tonsillar surfaces and the posterior pharynx ; the swab was then immediately su bmi tted to the Quickvue influenza test ( Quidel , Milan , Italy ) for the rapid detection of influenza A and B viruses . The test , which has an overall sensitivity of 74–95 % and an overall specificity of 76–98%,5,7,8 was performed by a postgraduate student in accordance with the manufacturer ’s recommendations . The results were available after 10 OBJECTIVE Computerized medical decision support tools have been shown to improve the quality of care and have been cited by the Institute of Medicine as one method to reduce pharmaceutical errors . We evaluated the impact of an antiinfective decision support tool in a pediatric intensive care unit ( PICU ) . METHODS We enhanced an existing adult antiinfective management tool by adding and changing medical logic to make it appropriate for pediatric patients . Process and outcomes measures were monitored prospect ively during a 6-month control and a 6-month intervention period . M and atory use of the decision support tool was initiated for all antiinfective orders in a 26-bed PICU during the intervention period . Clinician opinions of the decision support tool were surveyed via question naire . RESULTS The rate of pharmacy interventions for erroneous drug doses declined by 59 % . The rate of anti-infective subtherapeutic patient days decreased by 36 % , and the rate of excessive-dose days declined by 28 % . The number of orders placed per antiinfective course decreased 11.5 % , and the robust estimate of the antiinfective costs per patient decreased 9 % . The type of anti-infectives ordered and the number of antiinfective doses per patient remained similar , as did the rates of adverse drug events and antibiotic-bacterial susceptibility mismatches . The surveyed clinicians reported that use of the program improved their antiinfective agent choices as well as their awareness of impairments in renal function and reduced the likelihood of adverse drug events . CONCLUSIONS Use of the pediatric antiinfective decision support tool in a PICU was considered beneficial to patient care by the clinicians and reduced the rates of erroneous drug orders , improved therapeutic dosage targets , and was associated with a decreased robust estimate of antiinfective costs per patient . antiinfective agents , decision support systems , drug therapy , medication errors , child , infant OBJECTIVE To determine the impact of the rapid diagnosis of influenza on physician decision-making and patient management , including laboratory tests and radiographs ordered , patient charges associated with these tests , antibiotics/antivirals prescribed , and length of time to patient discharge from the emergency department . METHODS Patients aged 2 months to 21 years presenting to an urban children 's teaching hospital emergency department were screened for fever and cough , coryza , myalgias , headache , and /or malaise . After obtaining informed consent , patients were r and omized to 1 of 2 groups : 1 ) physician receives ( physician aware of ) the rapid influenza test result ; or 2 ) physician does not receive ( physician unaware of ) the result . For patients in the physician aware group , nasopharyngeal swabs were obtained , immediately tested with the FluOIA test for influenza A and B , and the result was placed on the chart before patient evaluation by the attending physician . For the physician unaware group , nasopharyngeal swabs were obtained , stored according to manufacturer 's directions , and tested within 24 hours . Results for the physician unaware group were not disclosed to the treating physicians at any time . The 2 result ant influenza-positive groups ( aware and unaware ) were compared for laboratory and radiograph studies and their associated patient charges , antibiotic/antiviral prescriptions , and length of stay in the emergency department . RESULTS A total of 418 patients were enrolled , and 391 completed the study . Of these , 202 tested positive for influenza . Comparison of the 96 influenza-positive patients whose physician was aware of the result with the 106 influenza-positive patients whose physician was unaware of the result revealed significant reductions among the former group in : 1 ) numbers of complete blood counts , blood cultures , urinalyses , urine cultures , and chest radiographs performed ; 2 ) charges associated with these tests ; 3 ) antibiotics prescribed ; and 4 ) length of stay in the emergency department . The number of influenza-positive patients who received prescriptions for antiviral drugs  was significantly higher among those whose physician was aware of the result . CONCLUSIONS Physician awareness of a rapid diagnosis of influenza in the pediatric emergency department significantly reduced the number of laboratory tests and radiographs ordered and their associated charges , decreased antibiotic use , increased antiviral use , and decreased length of time to discharge BACKGROUND Although rapid viral tests are commonly used in children with lower respiratory tract infection , their effect on patient management has not been studied . OBJECTIVES To examine how physicians utilize an enzyme immunoassay for respiratory syncytial virus ( RSV EIA ) and a centrifugation-enhanced cellular immunofluorescence assay for multiple viral pathogens [ viral respiratory panel ( VRP ) ] in children hospitalized with respiratory illness ; to determine the effect of testing on length of stay , antibiotic use and costs ; and to determine physician attitudes toward RSV testing . DESIGN AND SETTING Prospect i ve study and survey at a large children 's hospital . PATIENTS Previously healthy children < 24 months of age consecutively admitted between January 1 and February 11 , 1995 , with symptoms of lower respiratory tract infection . RESULTS Of 200 patients 160 were tested by RSV EIA ; 92 were positive and 68 were negative . Tested children were younger , more tachypneic and more likely to require oxygen than those not tested . Overall the length of stay was similar in RSV-positive and -negative patients . Although equal proportions of each group were given antibiotic therapy , RSV-positive children received antibiotic therapy for fewer days than RSV-negative children ( median 2 vs. 3 days ; P = 0.0387 ) . However , a crude cost analysis did not support a strategy of testing all bronchiolitis patients for RSV . Sixty-five of the 68 RSV-negative children were tested for RSV and other pathogens by VRP . In 55 cases the results were not available until after patient discharge and could not have influenced their management . One hundred three physicians caring for children in the study were surveyed . Of 75 respondents almost all thought that RSV EIA results influenced their management of patients and were important to parents . CONCLUSIONS Most children hospitalized with symptoms of lower respiratory tract infection were tested for viral pathogens . The VRP provided little clinical ly useful information . In contrast RSV EIA results may have been used by clinicians to make antibiotic decisions . Physicians felt that rapid testing for RSV was important In an attempt to evaluate the efficacy of different methods of interventions to improve the appropriate use of drugs for acute diarrhoea , a controlled study has been carried out in 6 districts in Yogyakarta and Central Java provinces , Indonesia . This study was design ed to investigate the impacts of two different methods of educational intervention , i.e. a small group face-to-face intervention and a formal seminar for prescribers , on prescribing practice in acute diarrhoea . The districts were r and omly assigned into 3 groups and 15 health centers were selected from each district . Prescribers in Group 1 underwent a small group face-to-face intervention conducted in the respective health center . Those in Group 2 attended a formal seminar conducted at the district level .  Prescribers in Group 3 served as the control group . Both interventions were given on a single occasion without follow-up supervision or monitoring . Written information material s on the appropriate management of acute diarrhoea were developed and were provided to all prescribers in the intervention groups . Focus group discussion s ( FGDs ) involving prescribers and consumers in the 6 districts were carried out to identify various underlying motivations of drug use in acute diarrhoea . The findings of the FGDs were used as part of the intervention material s. To evaluate the impacts of these interventions on prescribing practice , a prescribing survey for patients under five years old with acute diarrhoea was carried out in health centers covering 3-month periods before and after the intervention . The results showed that both interventions were equally effective in improving the levels of knowledge of prescribers about the appropriate management of acute diarrhoea . They were also partially effective in improving the appropriate use of drugs , reducing the use of non-rehydration medications . There was a highly significant reduction of antimicrobial usage either after small-group face-to-face intervention ( 77.4 + /- 2.7 % to 60.4 + /- 2.9 % ; P < 0.001 ) or formal seminar ( 82.3 + /- 3.0 % to 72.3 + /- 3.6 % ; P < 0.001 ) , and the former caused significantly ( P < 0.001 ) greater reduction than the latter . There was also a significant ( P < 0.01 ) reduction in the usage of antidiarrhoeals after both interventions , i.e. from 20.3 + /- 3.7 % to 12.5 + /- 3.3 % ( P < 0.01 ) after face-to-face intervention and from 48.5 + /- 4.1 % to 27.0 + /- 4.3 % ( P < 0.01 ) after seminar . However , the formal seminar had a significantly ( P < 0.01 ) greater impact than the small group face-to-face intervention . There was also a trend toward increased  oral rehydration solution ( ORS ) usage after both interventions , but this did not achieve the level of statistical significance ( P > 0.05 ) . No changes were observed in the control group . Although the small group face-to-face intervention did not appear to offer greater impacts over large seminars in improving the appropriate use of drugs in acute diarrhoea , since the unit cost of training is far less costly than the seminar , it might be feasibly implemented in the existing supervisory structure of the health system OBJECTIVE To assess the marginal impact of patient education on antibiotic prescribing to children with pharyngitis and adults with acute bronchitis in private office practice s. DATA SOURCES / STUDY SETTING Antibiotic prescription rates based on cl aims data from four managed care organizations in Colorado during baseline ( winter 2000 ) and study ( winter 2001 ) periods . STUDY DESIGN A nonr and omized controlled trial of a household and office-based patient educational intervention was performed . During both periods , Colorado physicians were mailed antibiotic prescribing profiles and practice s guidelines as part of an ongoing quality improvement program .  Intervention practice s ( n=7 ) were compared with local and distant control practice s. DATA COLLECTION / EXTRACTION METHODS Office visits were extracted by managed care organizations using International Classification of Diseases-9- Clinical Modification codes for acute respiratory tract infections , and merged with pharmacy cl aims data based on visit and dispensing date s coinciding within 2 days . PRINCIPAL FINDINGS Adjusted antibiotic prescription rates during baseline and study periods increased from 38 to 39 percent for pediatric pharyngitis at the distant control practice s , and decreased from 39 to 37 percent at the local control practice s , and from 34 to 30 percent at the intervention practice s ( p=.18 compared with distant control practice s ) . Adjusted antibiotic prescription rates decreased from 50 to 44 percent for adult bronchitis at the distant control practice s , from 55 to 45 percent at the local control practice s , and from 60 to 36 percent at the intervention practice s ( p<.002 and p=.006 compared with distant and local control practice s , respectively ) . CONCLUSIONS In office practice s , there appears to be little room for improvement in antibiotic prescription rates for children with pharyngitis . In contrast , patient education helps reduce antibiotic use for adults with acute bronchitis beyond that achieved by physician-directed efforts OBJECTIVE To test whether a ceftazidime restriction policy in a pediatric intensive care unit ( ICU ) could decrease the endemic rate of colonization with ceftazidime-resistant gram-negative bacilli . DESIGN Prospect i ve , pre- vs. postintervention study . SETTING University hospital pediatric ICU . PATIENTS Consecutive children admitted to the pediatric ICU over a 19-mo period . INTERVENTIONS After an observation period in which ant 
    Output:
    
Prescriber education for a specific diagnosis ( eg , otitis media ) was the most effective intervention in the outpatient setting .
Ancillary laboratory tests ( eg , rapid diagnostic assays for viral pathogens ) were most effective in the inpatient setting .