***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: Background The current health care reform in China launched in 2009 tackles the problem of access to appropriate medicines for its 1.3 billion people by focusing on providing essential medicines to all . To provide evidence for the reform process , we investigated the manufacturing , purchasing , and prescribing of essential medicines in two provinces . Methods We conducted surveys in 2007 of all manufacturers ( n = 253 ) and of 59 purposively selected retail and 63 hospital pharmacies in Sh and ong and Gansu provinces to assess production and supply of products on the 2004 National Essential Medicines List ( NEML ) , as well as factors underlying decision making about production and supply . We also review ed prescriptions ( n = 5456 ) in health facilities to calculate st and ard indicators of appropriate medicines use . Results Overall , manufacturers in Sh and ong and Gansu produced only 62 % and 50 % , respectively , of the essential medicines they were licensed to produce . Of a r and omly selected 10 % of NEML products , retail pharmacies stocked up to 60 % of Western products . Median availability in hospital pharmacies ranged from 19 % to 69 % . Manufacturer and retail pharmacy managers based decisions on medicines production and stocking on economic considerations , while hospital pharmacy managers cited clinical need . Between 64 % and 86 % of prescriptions contained an essential medicine . However , overprescribing of antibiotics ( 34%-77 % of prescriptions ) and injectables ( 22%-61 % ) for adult non-infectious outpatient consultations was common . Conclusions We found that manufacturers , retail pharmacies , and hospital pharmacies paid limited attention to China 's 2004 NEML in their decisions to manufacture , purchase , and stock essential medicines . We also found that prescribing of essential medicines was frequently inappropriate . These results should inform strategies to improve affordable access to essential medicines under the current health care reform BACKGROUND Despite efforts to ensure more accurate prescribing of antibiotics for respiratory tract infections , inappropriate selection of antibiotic treatment remains a big issue . We tried to ascertain which factors best predict the nature of fluoroquinolone prescribing for acute cough in primary care . METHODS R and om effects logistic regression models were applied to the baseline prescription data taken from a cluster-r and omized controlled trial based on 104 general practitioners ( GPs ) and 2745 patients . RESULTS Significant predictors for the prescription of fluoroquinolones from both patient and GP data were identified . Predictors from a patient 's perspective were the severity of illness { odds ratio ( OR ) 3.56 [ 95 % confidence interval ( CI ) 2.45 - 5.19 ] P < 0.001 } , the duration of illness before seeing the GP [ OR 1.09 ( 95 % CI 1.04 - 1.14 ) P < 0.020 ] and the individual patient 's age [ OR 1.01 ( 95 % CI 1.00 - 1.01 ) P < 0.015 ] . Predictors from the GP 's perspective were extent/lack of specific vocational training [ OR 3.10 ( 95 % CI 1.54 - 6.22 ) P < 0.001 ] , status as a general internist [ OR 2.00 ( 95 % CI 1.10 - 3.70 ) P < 0.002 ] , the physician 's overall antibiotic prescription rate for acute cough [ OR 1.02 ( 95 % CI 1.01 - 1.04 ) P < 0.001 ] , the duration of illness before contact with patient [ OR 0.81 ( 95 % CI 0.69 - 0.95 ) P < 0.010 ] and the severity of illness [ OR 0.27 ( 95 % CI 0.12 - 0.63 ) P < 0.002 ] . DISCUSSION Whether a fluoroquinolone is prescribed by a GP seems to be determined not only by the patient 's characteristics but also by the GP 's vocational training and overall antibiotic prescribing rate . As the prescription of fluoroquinolones for the treatment of acute coughing can rarely be justified , such prescriptions may serve as a quality indicator for antibiotic prescribing in primary care IMPORTANCE Antimicrobial stewardship programs have been effective for in patients , often through prescribing audit and feedback . However , most antimicrobial use occurs in out patients with acute respiratory tract infections ( ARTIs ) . OBJECTIVE To evaluate the effect of an antimicrobial stewardship intervention on antibiotic prescribing for pediatric out patients . DESIGN Cluster r and omized trial of outpatient antimicrobial stewardship comparing prescribing between intervention and control practice s using a common electronic health record . After excluding children with chronic medical conditions , antibiotic allergies , and prior antibiotic use , we estimated prescribing rates for targeted ARTIs st and ardized for age , sex , race , and insurance from 20 months before the intervention to 12 months afterward ( October 2008-June 2011 ) . SETTING AND PARTICIPANTS A network of 25 pediatric primary care practice s in Pennsylvania and New Jersey ; 18 practice s ( 162 clinicians ) participated . INTERVENTIONS One 1-hour on-site clinician education session ( June 2010 ) followed by 1 year of personalized , quarterly audit and feedback of prescribing for bacterial and viral ARTIs or usual practice . MAIN OUTCOMES AND MEASURES Rates of broad-spectrum ( off- guideline ) antibiotic prescribing for bacterial ARTIs and antibiotics for viral ARTIs for 1 year after the intervention . RESULTS Broad-spectrum antibiotic prescribing decreased from 26.8 % to 14.3 % ( absolute difference , 12.5 % ) among intervention practice s vs from 28.4 % to 22.6 % ( absolute difference , 5.8 % ) in controls ( difference of differences [ DOD ] , 6.7 % ; P = .01 for differences in trajectories ) . Off- guideline prescribing for children with pneumonia decreased from 15.7 % to 4.2 % among intervention practice s compared with 17.1 % to 16.3 % in controls ( DOD , 10.7 % ; P < .001 ) and for acute sinusitis from 38.9 % to 18.8 % in intervention practice s and from 40.0 % to 33.9 % in controls ( DOD , 14.0 % ; P = .12 ) . Off- guideline prescribing was uncommon at baseline and changed little for streptococcal pharyngitis ( intervention , from 4.4 % to 3.4 % ; control , from 5.6 % to 3.5 % ; DOD , -1.1 % ; P = .82 ) and for viral infections ( intervention , from 7.9 % to 7.7 % ; control , from 6.4 % to 4.5 % ; DOD , -1.7 % ; P = .93 ) . CONCLUSIONS AND RELEVANCE In this large pediatric primary care network , clinician education coupled with audit and feedback , compared with usual practice , improved adherence to prescribing guidelines for common bacterial ARTIs , and the intervention did not affect antibiotic prescribing for viral infections . Future studies should examine the drivers of these effects , as well as the generalizability , sustainability , and clinical outcomes of outpatient antimicrobial stewardship . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01806103 Background To promote rational drug use in developing countries , it is important to assess drug use pattern using the World Health Organization ( WHO ) drug use indicators . The aim of this study was to assess the drug prescription patterns at the Medical Outpatient Pharmacy of Hawassa University Teaching and Referral Hospital , using some of the WHO core drug use indicators . Methods A descriptive , quantitative , and cross-sectional survey was conducted to determine the current prescribing practice s at Hawassa University Teaching and Referral Hospital . The sample was selected using systematic r and om sampling . 1290 patient encounters were review ed retrospectively for a 2-year period from September 2007 to September 2009 . Data were collected from prescriptions and Prescription registration books retained in the pharmacy . Result The average number of drugs prescribed per encounter or mean was 1.9 ( SD 0.91 ) with a range between 1 and 4 . The percentage of encounters in which an antibiotic or injection was prescribed was 58.1 % ( n = 749 ) and 38.1 % ( n = 491 ) , respectively . The Percentage of drugs prescribed by generic name and from an essential drug list was 98.7 % ( n=2419 ) and 96.6 % ( n=2367 ) , respectively . The most commonly prescribed forms of antibiotics were amoxicillin ( 16.4 % ) , ampicillin ( 15 % ) , gentamicin ( 14.9 % ) and chloramphenicol ( 11.6 % ) . On the other h and , the most commonly prescribed injections were ampicillin ( 21.4 % ) , cloxacillin ( 13.4 % ) , crystalline penicillin ( 12.4 % ) , ceftriaxon ( 9.8 % ) gentamicin ( 9.8 % ) , diclofenac ( 9.4 % ) , chloramphenicol 41 ( 8.4 % ) and furosemide 25 ( 5.1 % ) . Conclusion On the basis of the finding of this study , the prescribing practice s for antibiotic and injection shows deviation from the st and ard recommended by WHO . These two commonly overused and costly forms of drug therapy need to be regulated closely . Drug use evaluation should be done for some of the antibiotics to check whether they were appropriately prescribed or not . On the other h and , polypharmacy , generic prescribing and prescribing from EDL were not found to be a problem in this study . Teaching hospitals have a special responsibility to society to promote rational prescribing by their staff and , through them , the future generations of doctors The aim of this study was to analyse drug prescribing practice s in primary health care centres in Bahrain . We retrospectively evaluated 600 prescriptions selected r and omly from all primary health care centres in Bahrain ( n = 20 ) in 2004 . Analysis followed WHO recommended prescribing core indicators . The mean number of drugs prescribed at each encounter was 3.3 ( SD 0.7 ) . A single drug was prescribed on 6.3 % of prescriptions and drugs were prescribed by generic name on 10.2 % . The percentage of total prescriptions for antibiotics  was 45.8 % , for injections was 9.3 % and for vitamins was 12.5 % . The prescribing pattern in primary health care centres in Bahrain is associated with polypharmacy , over-prescribing of antibiotics and an under-prescribing of drugs by generic names OBJECTIVES Outpatient parenteral antibiotic therapy ( OPAT ) is an effective treatment strategy for a wide variety of infections as long as clinical risk is minimized by conforming to practice guidelines . However , its cost-effectiveness has not been established in the setting of the UK National Health Service . We examined the clinical efficacy and cost-effectiveness of an  OPAT service based in a large UK teaching hospital , predominantly using the outpatient ' infusion centre ' and patient/carer administration models of service delivery . PATIENTS AND METHODS Data on clinical activity and outcomes were collected prospect ively on 334 episodes of treatment administered by the Sheffield OPAT service between January 2006 and January 2008 .  Cost-effectiveness was calculated by comparing real costs of OPAT with estimated inpatient costs for these patient episodes incorporating two additional sensitivity analyses . RESULTS Of the OPAT episodes , 87 % result ed in cure or improvement on completion of intravenous therapy . The readmission rate was 6.3 % , and patient satisfaction was high . OPAT cost 41 % of equivalent inpatient costs for an Infectious Diseases Unit , 47 % of equivalent inpatient costs using national average costs and 61 % of inpatient costs using minimum inpatient costs for each diagnosis . CONCLUSIONS Using this service model , OPAT is safe and clinical ly effective , with low rates of complications/readmissions and high levels of patient satisfaction .  OPAT is cost-effective when compared with equivalent inpatient care in the UK healthcare setting Background : The introduction of m and atory or quasim and atory certification processes for general/family doctors has become common in many countries , including Australia . Whether certification effects the care provided is rarely investigated . Objectives : The objective of this study was to determine whether certification of general/family physicians is associated with clinical performance . Research Design : We conducted a secondary comparative analysis of data from an Australian national cross-sectional survey ( April 2000–March 2002 ) . Subjects : Subjects consisted of a r and om sample of 1982 general practitioners ( GPs ) Methods : Each participant provided demographic details and information about 100 consecutive patient encounters ( total 197,500 ) . We compared characteristics of certified and uncertified  general practitioners ( GPs ) , their patients , encounters , problems , management actions , and tested 34 performance indicators . We investigated whether differences identified in descriptive analyses were explained by other factors . 
    Output:
    
These QIs can be used to identify targets for improvement and to evaluate the effects of antibiotic stewardship interventions