***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: A recent federal law has exp and ed the eligibility for multidisciplinary evaluation and assessment of infants suspected of developmental delay . At the same time , modern neonatal care has increased infant survival . These two developments have created a need for family education regarding the need for health and developmental intervention , as well as counseling to maintain family participation in these services . This study compares the education and counseling services of a hospital-based case management team with the traditional discharge and follow-up services of a neonatal intensive care unit ( NICU ) .  Subjects were the 10 % most medically severe infants discharged from a neonatal intensive care unit over a 16-month period . Preliminary data suggests a significantly greater number of families accessed community-based , coordinated , comprehensive health and developmental services when they received case management services . The data suggest that hospital professionals generally refer the most medically severe 3 % of this group for services under a traditional model . However , the additional 7 % referred under the transition model showed greater developmental benefits from the services during the first 6 months of life . These data support current federal initiatives for early intervention services which are family-centered , community-based and coordinated This week , a series of four articles considers the place of the r and omised controlled trial as we approach the second century of experience with the concept . Its basic principle is genuine uncertainty as to which treatment arm of the trial it would be in a patient 's best interests to enter . This is not necessarily an easy concept to transmit , Care of asthmatic children is often episodic and more therapeutic than preventive . A 2-year r and omized , controlled trial involving 95 children measured the impact of a comprehensive home and ambulatory program for pediatric asthma management using objective outcome measures . Interventions for the study group during the first year included 3-month clinic visits , education , and home visits by a specially trained research nurse . Control subjects continued to receive regular care from a family physician or pediatrician .  Eight-nine subjects ( 93 % ) completed the study . Study subjects had less school absenteeism than control subjects ( 10.7 vs. 16.0 days , P = .04 ) and showed significantly better small airway function after 1 year . Asthma severity improved in 13 study subjects and worsened in 5 . The reverse was true for control subjects . Study subjects exhibited better metered aerosol technique than control subjects ( P = .0005 ) . Fewer days were spent in hospital by the study subjects admitted compared with control subjects ( 3.67 vs 11.2 days , P = .02 ) . After 1 year , more study than control families ( 72.1 % vs 33.1 % , P = .006 ) reported that their asthmatic child took responsibility for the asthma management . The intervention failed to reduce exposure to secondh and smoke or to household pets . There were no significant differences in medical visits , theophylline levels , or records of asthma symptoms . One year after discontinuing the intervention , a marked " washout " effect was observed . Comprehensive ambulatory programs of childhood asthma management can improve objective measures of illness severity but must be sustained A r and omised controlled study of an educational programme for children with asthma and their families was carried out by community child health nurses . Three hundred and sixty eight children aged 2 to 14 years were enrolled in the study after admission to hospital for asthma . The intervention group was visited monthly by a nurse for six months . The subjects were assessed six months later by a postal , self administered question naire . European children in the intervention group were taking significantly more drugs for the treatment of asthma six months after the index admission to hospital than those in the control group ( mean ( SD ) intake 2.7 ( 1.1 ) v 2.1 ( 1.0 ) , respectively ) . In particular , they were using more  theophylline  ( 56.6 % v 37.0 % ) and  inhaled steroids  ( 34.9 % v 21.0 % ) . There was no difference between the groups for parental reports of improvement , of missed schooling , and in severe attacks of asthma of not responding to the usual treatment at home . European children in the intervention group used the hospital services for severe attacks of asthma more than controls ( 34.2 % v 10.5 % ) . There were more re-admissions in the European intervention group in the subsequent six months after the index admission than in the control group ( mean ( SD ) 0.51 ( 0.97 ) v 0.29 ( 0.65 ) . Re-admission continued to be higher in the 12 months after the nurse had stopped visiting ( 0.81 ( 1.65 ) v 0.25 ( 0.65 ] . There was no difference in the duration of hospital stay between the intervention and control groups . For Polynesian children there was no difference between the groups for any outcome measures Aims : To assess the clinical effectiveness of a  paediatric hospital at home service compared to conventional hospital care . Methods : A total of 399 children suffering from breathing difficulty ( n = 202 ) , diarrhoea and vomiting ( n = 125 ) , or fever ( n = 72 ) were r and omised to Hospital at Home or in-patient paediatric care .  Main outcome measures were : comparative clinical effectiveness as measured by readmission rate within three months ( used as a proxy for parental coping with illness ) ; and length of stay/care and comparative satisfaction of both patients and carers . Results : Clinical effectiveness of both services was not significantly different . Length of care was one day longer in the Hospital at Home group ; however , most parents and children preferred home care . Conclusions : Hospital at Home is a clinical ly acceptable form of care for these groups of acute paediatric illness . Readmission rates within three months failed to show any advantage in terms of parental coping . Parents and patients expressed a strong preference for hospital at home OBJECTIVES : To evaluate the effectiveness of different forms of organisation ( delivery ) of asthma care . METHODS : A systematic review of the published evidence of effectiveness organisational methods of asthma management . Search es on computerised data bases including Medline , CINAHL , and HELMIS , and relevant citations and letters to experts were used to identify relevant studies . RESULTS : 27 studies were identified that evaluated different organisational methods of delivery across both primary and secondary sectors , such as shared care , general practice asthma clinics , outpatient programmes , inpatient admissions policies , and the use of specialists . Only one third of the studies used a r and omised controlled trial and many had small sample sizes . No conclusive evidence was found to favour any particular organisational form , although limited evidence would suggest that specialist care is better than general care and that shared care can be as effective as hospital led care . CONCLUSIONS : There is little good published research evaluating different ways of organising the delivery of asthma care . There is need for quality research on organisational methods of delivery of asthma care that could be used to inform policy makers , in particular examining whether patients treated by healthcare professional with expertise and interest in asthma will experience better outcomes This mainly qualitative study compared 40 families ' experience of hospital and home care .  This is one aspect of a r and omised , controlled trial , which aim ed to evaluate the clinical and cost effectiveness of a paediatric hospital at home service ( HAH ) for acute illness in children . This paper builds upon previous work that has aim ed to examine parents ' and children 's views as service users . Forty families from a larger sample population took part in structured interviews . Eleven children aged 5 to 12 years took part in semistructured interviews . A drawing technique was the chosen method of augmentation in the children 's interviews . Research findings showed that HAH is an acceptable alternative to hospital care where there are essentially nursing needs . Thirty-six ( 90 % ) parents and seven children stated a clear preference for HAH . The parents ' preference was based on a perception that their child 's illness was n't serious or life threatening and therefore could be managed at home with appropriate support from health professionals . The social and financial costs of hospital care compared with HAH were the other main drivers , rather than a comparison of the quality of nursing care of their child OBJECTIVE To establish whether an intervention given by child psychiatric social workers to the families of children and adolescents who had attempted suicide by taking an overdose reduced the patients ' suicidal feelings and improved family functioning . METHOD One hundred sixty-two patients , aged 16 or younger , who had deliberately poisoned themselves were r and omly allocated to routine care ( n = 77 ) or routine care plus the intervention ( n = 85 ) . The intervention consisted of an assessment session and four home visits by the social workers to conduct family problem-solving sessions . The control group received no visits . Both groups were assessed at the time of recruitment and 2 and 6 months later . The primary outcome measures were the Suicidal Ideation Question naire , the Hopelessness Scale , and the Family Assessment Device . RESULTS There were no significant differences in the primary outcomes between the intervention and control groups at either of the outcome assessment s. Parents in the intervention group were more satisfied with treatment ( mean difference 1.4 [ 95 % confidence interval 0.6 to 2.1 ] ) . A subgroup without major depression had much less suicidal ideation at both outcome assessment s ( analysis of covariance p < .01 ) compared with controls . CONCLUSIONS The home-based family intervention result ed in reduced suicidal ideation only for patients without major depression Hospitalization and out-of-home placement data for 113 youth participating in a r and omized trial comparing home-based multisystemic therapy ( MST ; n = 57 ) with hospitalization(n = 56 ) for psychiatric crisis stabilization were analyzed following the completion of MST treatment — approximately 4 months post approval for emergency psychiatric hospitalization . Analyses showed that MST prevented any hospitalization for 57 % of the participants in the MST condition and reduced the overall number of days hospitalized by 72 % . Importantly , the reduction in use and length of hospitalization was not offset by increased use of other placement options , as MST reduced days in other out-of-home placements by 49 % . The cost implication s for the viability of MST as an alternative to hospitalization for youth presenting psychiatric emergencies are discussed OBJECTIVE The primary purpose of this study was to determine whether multisystemic therapy ( MST ) , modified for use with youths presenting psychiatric emergencies , can serve as a clinical ly viable alternative to inpatient psychiatric hospitalization . METHOD One hundred sixteen children and adolescents approved for emergency psychiatric hospitalization were r and omly assigned to home-based MST or inpatient hospitalization . Assessment s examining symptomatology , antisocial behavior , self-esteem , family relations , peer relations , school attendance , and consumer satisfaction were conducted at 3 times : within 24 hours of recruitment into the project , shortly after the hospitalized youth was released from the hospital ( 1 - 2 weeks after recruitment ) , and at the completion of MST home-based services ( average of 4 months postrecruitment ) . RESULTS  MST  was more effective than emergency hospitalization at decreasing youths ' externalizing symptoms and improving their family functioning and school attendance . Hospitalization was more effective than  MST  at improving youths ' self-esteem . Consumer satisfaction scores were higher in the MST condition . CONCLUSIONS The findings support the view that an intensive , well-specified , and empirically supported treatment model , with judicious access to placement , can effectively serve as a family- and community-based alternative to the emergency psychiatric hospitalization of children and adolescents The ongoing care needed by children with chronic physical illness is a topic of national concern . The Pediatric Ambulatory Care Treatment Study ( PACTS ) is a classic pretest-posttest r and omized experiment design ed to evaluate a Pediatric Home Care ( PHC ) program in which an interdisciplinary team provides comprehensive primary health care , support , coordination , patient advocacy , and education to chronically ill children and their families . Home interviews were conducted by an independent research team with the 219 families at enrollment , 6 months , and 1 year ; 80 % completed all three interviews . Analyses indicate that pediatric home care is effective in improving the satisfaction of the family with care , in improving the child 's psychological adjustment , and in lessening the psychiatric symptoms of the mother . The functional status of the children was equally well maintained in both groups , and there was no significant difference in the impact of the illness on the family between the two groups . There are indications that there may be a dose-related effect with respect to the child 's psychological adjustment with those in the program for the longest period of time showing the greatest benefit . Such a home care program can be an effective intervention for minimizing the social and psychological consequences of chronic illness OBJECTIVE To evaluate factors contributing to optimal medical outcomes during the first year following discharge of very low birth weight infants from tertiary neonatal intensive care units . STUDY DESIGN This was a prospect i ve investigation of the health and development of 81 very low birth weight infants following discharge from two tertiary neonatal intensive care units in Los Angeles . Infants were assigned to four groups receiving a variety of after care services in their homes .  Analyses of variance were computed to examine differences between groups for a variety of outcomes . RESULTS No statistically significant differences were seen between after care groups on use of hospital emergency rooms ( ER ) rehospitalization rates , or child abuse and neglect . Highest overall rates of optimal outcomes were seen in the group receiving the highest intensity of after care services . Those groups receiving long-term home visiting services had significantly higher rates of up-to- date immunizations . CONCLUSION There was no significant impact on infant mortality and morbidity of early discharge , regardless of the system of after care used . However , those infants who received the highest level of after care services had the most optimal health outcomes and were most likely to be receiving well-baby care . It is likely that the comprehensive , clinic-based system of health care available to all study infants was a significant factor in low rates of morbidity Background . Newly diagnosed insulin-dependent diabetic children are most often admitted to hospital for education and insulin management and 
    Output:
    
Paediatric home care may enhance physical and mental development for very low birth weight infants and may be cheaper but the evidence is not strong .
Home care for diabetes or asthma may reduce parents ' costs with some clinical but no social differences noticeable .
Home care for mental health may increase parental satisfaction with services and reduce some health service and residential care costs .
Generic home care showed no clinical effects at early follow-up .
Partial follow-up after five years suggested improved psychological adjustment .