***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: OBJECTIVES to evaluate the effect of two interventions on reducing antibiotic prescription in pharyngitis . METHODS a prospect i ve , non-r and omized , before-after controlled study was carried out in primary care centres throughout Spain . General practitioners ( GPs ) registered all cases of pharyngitis during a 3 week period before and after two types of intervention in 2008 and 2009 , respectively . Full intervention consisted of discussion sessions of the results of the first registry , courses for GPs , guidelines , patient information leaflets , workshops on rapid tests and the use of rapid antigen detection tests ( RADTs ) in their consulting offices . The physicians in the partial intervention group underwent all the above intervention except for the workshop , and RADTs were not provided . A control group was also included in 2009 . Multilevel logistic regression was performed considering the prescription of antibiotics as the dependent variable . RESULTS a total of 280 GPs registered cases with pharyngitis ( 70 partial intervention and 210 full intervention ) . Fifty-nine new physicians were included as a control group . A total of 6849 episodes of pharyngitis were registered .  Antibiotic prescription was significantly lower after intervention for the full intervention group , but not for the partial intervention group . According to the multivariate model , in comparison with the control group , the odds ratio of antibiotic prescription after the intervention was 0.52 [ 95 % confidence interval ( 95 % CI ) 0.23 - 1.18 ] in the partial intervention group and 0.23 ( 95 % CI 0.11 - 0.47 ) in the full intervention group . CONCLUSIONS intervention was beneficial for reducing the prescription of antibiotics , but was only statistically significant when the GPs were provided with RADTs BACKGROUND A multiple intervention targeted to reduce antibiotic prescribing with an educational outreach programme had proven to be effective in a r and omized controlled trial in 12 peer review groups , demonstrating 12 % less prescriptions for respiratory tract infections . OBJECTIVE To assess the effectiveness of a multiple intervention in primary care at a large scale . METHODS A controlled before and after study in 2006 and 2007 was design ed . Participants were from general practice s within a geographically defined area in the middle region of The Netherl and s. Participants were GPs in 141 practice s in 25 peer review groups . A control group of GP practice s from the same region , matched for type of practice and mean volume of antibiotic prescribing . The multiple intervention consisted of the following elements : ( i ) group education meeting and communication training ; ( ii ) monitoring and feedback on prescribing behaviour ; ( iii ) group education for GPs and pharmacists assistants and ( iv ) patient education material . The main outcome measures are as follows : ( i ) number of antibiotic prescriptions per 1000 patients per GP and ( ii ) number of second-choice antibiotics , obtained from cl aims data from the regional health insurance company . The associations between predictors and outcome measurements were assessed by means of a multiple regression analyses . RESULTS At baseline , the number of antibiotic prescriptions per 1000 patients was slightly higher in the intervention group than in the control group ( 184 versus 176 ) . In 2007 , the number of prescriptions had increased to 232 and 227 , respectively , and not differed between intervention and control group . CONCLUSIONS The implementation of an already proven effective multiple intervention strategy at a larger scale showed no reduction of antibiotic prescription rates . The failure might be attributed to a less tight monitoring of intervention and audit . Inserting practical tools in the intervention might be more successful and should be studied OBJECTIVE This study assessed the effect of a h and held computer-based decision support system ( DSS ) on  antibiotic use and patient outcomes in a critical care unit . DESIGN A DSS containing four types of evidence ( patient microbiology reports , local antibiotic guidelines , unit-specific antibiotic susceptibility data for common bacterial pathogens , and a clinical pulmonary infection score calculator ) was developed and implemented on a  h and held computer  for use in the intensive care unit at a tertiary referral hospital . System impact was assessed in a prospect i ve " before/after " cohort trial lasting 12 months . Outcome measures were defined daily doses ( DDDs ) of antibiotics per 1,000 patient-days , patient length of stay , and mortality . RESULTS The number of admissions , APACHE ( Acute Physiology , Age , and Chronic Health Evaluation ) II and SAPS ( Simplified Acute Physiology Score ) II for patients in preintervention , and intervention ( DSS use ) periods were statistically comparable . The mean patient length of stay and the use of antibiotics in the unit during six months of the DSS use decreased from 7.15 to 6.22 bed-days ( p = 0.02 ) and from 1,767 DDD to 1,458 DDD per 1,000 patient-days ( p = 0.04 ) , respectively , with no change in mortality . The DSS was accessed 674 times during 168 days of the trial . Microbiology reports and antibiotic guidelines were the two most commonly used ( 53 % and 22.5 % , respectively ) types of evidence . The greatest reduction was observed in the use of beta-lactamase-resistant penicillins and vancomycin . CONCLUSION H and held computer-based decision support contributed to a significant reduction in patient length of stay and antibiotic prescribing in a critical care unit Background Acute respiratory tract infections ( ARTI ) are among the most frequent reasons for consultations in primary care . Although predominantly viral in origin , ARTI often lead to the prescription of antibiotics for ambulatory patients , mainly because it is difficult to distinguish between viral and bacterial infections . Unnecessary antibiotic use , however , is associated with increased drug expenditure , side effects and antibiotic resistance . A novel approach is to guide antibiotic therapy by procalcitonin ( ProCT ) , since serum levels of ProCT are elevated in bacterial infections but remain lower in viral infections and inflammatory diseases . The aim of this trial is to compare a ProCT-guided antibiotic therapy with a st and ard approach based on evidence -based guidelines for patients with ARTI in primary care . Methods / Design This is a r and omised controlled trial in primary care with an open intervention . Adult patients judged by their general practitioner ( GP ) to need antibiotics for ARTI are r and omised in equal numbers either to st and ard antibiotic therapy or to ProCT-guided antibiotic therapy . Patients are followed-up after 1 week by their GP and after 2 and 4 weeks by phone interviews carried out by medical students blinded to the goal of the trial . Exclusion criteria for patients are antibiotic use in the previous 28 days , psychiatric disorders or inability to give written informed consent , not being fluent in German , severe immunosuppression , intravenous drug use , cystic fibrosis , active tuberculosis , or need for immediate hospitalisation . The primary endpoint is days with restrictions from ARTI within 14 days after r and omisation . Secondary outcomes are antibiotic use in terms of antibiotic prescription rate and duration of antibiotic treatment in days , days off work and days with side-effects from medication within 14 days , and relapse rate from the infection within 28 days after r and omisation . Discussion We aim to include 600 patients from 50 general practice s in the Northwest of Switzerl and . Data from the registry of the Swiss Medical Association suggests that our recruited GPs are representative of all eligible GPs with respect to age , proportion of female physicians , specialisation , years of postgraduate training and years in private practice 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 BACKGROUND Antibiotic misuse is common and costly and may promote antibiotic resistance . We tested the efficacy of a targeted one-on-one educational program ( " academic detailing " ) design ed to improve the appropriateness of broad-spectrum antibiotic use . METHODS A r and omized controlled trial was conducted in a large US teaching hospital . During an 18-week study period , 17 general medical , oncology , and cardiology services either received academic detailing or did not . The intervention was prompted by an order for either levofloxacin or ceftazidime that led to a computer-based review of data for that patient . Orders for the 2 target antibiotics deemed unnecessary by a priori criteria were included in the study . The primary outcome examined was the number of days that unnecessary levofloxacin or ceftazidime was administered in intervention and control groups . RESULTS Before the trial , intervention and control services had similar prescribing patterns for the target antibiotics ; the drugs were used for similar indications throughout the study period . During the intervention , there was a reduction of 37 % in days of unnecessary levofloxacin or ceftazidime use per 2-week interval on services r and omized to the educational intervention vs control services ( P < .001 ) . In multivariable analyses controlling for baseline prescribing and study interval , the rate of unnecessary use of the 2 target antibiotics was reduced by 41 % on the intervention services compared with controls ( 95 % confidence interval , 44%-78 % ; P < .001 ) . Length of stay , intensive care unit transfers , readmission rates , and in-hospital death rates were similar in both groups ( P > or = .10 for all ) . CONCLUSION Targeted one-on-one education is a practical , effective , and safe method for reducing excessive broad-spectrum antibiotic use From 1998 to 2000 , 13 rural Alaskan villages ( population , 3326 ) were surveyed annually by nasopharyngeal cultures for Streptococcus pneumoniae carriage . Data regarding antibiotic use for the entire population was abstract ed from clinic records . In 1999 , education of medical providers and the community about appropriate antibiotic use began in 4 villages ; this program was exp and ed to include all villages in 2000 .  Antibiotic courses per person decreased by 31 % in the initial intervention villages and by 35 % in the remaining villages after education ( P<.01 for each ) . Sample s were obtained for culture from a mean of 31 % of the population each year ; 31 % carried pneumococcus . No sustained decrease in carriage of penicillin-nonsusceptible strains was observed . When linear regression was used , serotype accounted for 81 % of the variance in pneumococcal minimum inhibitory concentrations after the intervention , compared with 7 % for antibiotic use . This suggests that reducing the carriage of serotypes associated with antibiotic resistance by use of pneumococcal conjugate vaccines may have a greater short-term impact than does decreasing antibiotic use Objective The study objective was to evaluate the effectiveness of an operational multidisciplinary antibiotic team , including an infectious disease physician and a clinical pharmacist , in reducing the hospital antimicrobial consumption and costs . Setting The 1800-bed University Hospitals of Nancy ( France ) . Method A cluster controlled ‘ before-after ’ study was performed . The intervention group comprised 11 medical and surgical wards in setting s where the operational antibiotic team was implemented  , and the  control group comprised 6 wards without this operational team .  The ‘ before ’ period ( 2005 ) preceded the implementation of the operational team in the intervention group and ‘ after ’ ( July 2007 to June 2008 ) followed its full implementation . Main outcome measure We compared consumption of antibiotics overall and by therapeutic class ( in defined daily doses per 1,000 patient days ) and cost savings ( in € ) between ‘ before ’ and ‘ after ’ in both groups ( control and intervention ) , using a mixed effect linear model . Results 
    Output:
    
Conclusion The results show that antibiotic use could be improved by educational interventions , being mostly used multifaceted interventions