***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: Physician behavior and caregiver retention of nutrition advice were examined as potential mediating factors in the success of a nutrition counseling efficacy trial in Pelotas , Brazil , which reduced growth faltering in children 12 - 24 mo old . After pair-matching on socioeconomic status and nutrition indicators , municipal health centers were r and omly assigned to an intervention group , in which physicians were trained with an IMCI-derived ( Integrated Management of Childhood Illness ) nutrition counseling protocol , or to a control group , without continuing education in nutrition . In a sub study of the larger trial , direct observation of consultations , followed by home interviews with mothers , provided data on physician counseling behavior and mothers ' retention of nutrition advice . Trained providers were more likely to engage in nutrition counseling ( P < 0.013 ) and to deliver more extensive advice ( P < 0.02 ) . They also used communication skills design ed to improve rapport and ensure that mothers understood the advice ( P < 0.01 ) . Mothers who received advice from trained providers had high rates of recalling the messages on specific foods ( 95 vs.27 % ; P < 0.01 ) and feeding practice and food preparation recommendations ( 90 vs. 20 % ; P < 0.01 ) , whereas the proportions of the messages recalled on breast-feeding ( 60 % vs. 30 % ) did not differ significantly ( P < 0.20 ) . The training course contained several elements that may explain why intervention group mothers were better able to recall nutrition advice . These include locally appropriate messages , tools for assessing individual problems , and counseling skills Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To evaluate the effectiveness of an educational intervention on pediatric residents ' resuscitation fund of knowledge , technical skills , confidence , and overall performance . DESIGN Prospect i ve , nonconcurrent , controlled interventional trial . SETTING Urban pediatric tertiary care hospital . PARTICIPANTS An intervention group ( IG ) of 28 pediatric residents graduating in 1997 , and a control group ( CG ) of 30 pediatric residents graduating in 1996 . INTERVENTIONS Resuscitation course with didactic lectures and skills practice stations , as well as a minimum of 3 practice mock resuscitations with immediate feedback throughout postgraduate year 3 . MAIN OUTCOME MEASURES Fund of knowledge , using the Pediatric Advanced Life Support test and short answer test ; technical skills , using the Airway and Vascular Access Skills Assessment ; experience and confidence , using an anonymous survey ; and overall performance , evaluated using a videotaped mock resuscitation test . RESULTS The IG scored better on the short answer test ( P<.001 ) . A larger number of IG residents were successful in the completion of ancillary airway maneuvers and femoral vascular access ( P = .02 ) , as well as endotracheal intubation ( P = .004 ) and intraosseous access ( P = .002 ) . The IG was more confident in their leadership role ( P = .0001 ) and technical skills ( P = .05 ) . Trends toward improved overall performance were noted for the IG mock resuscitations . Residents in the IG were more likely to assess the airway in fewer than 2 minutes ( P = .02 ) , recognize the threat to life in fewer than 5 minutes ( P = .02 ) , and complete the primary survey in a timely fashion ( P = .05 ) . They required fewer prompts ( P = .04 ) and made fewer mistakes ( P = .07 ) . CONCLUSIONS A structured , formal curriculum can improve the necessary fund of knowledge , skills , confidence , and leadership required for resuscitation OBJECTIVE The objective of this study was to assess the effect of Integrated Management of Childhood Illness ( IMCI ) case management training on the use of antimicrobial drugs among health-care workers treating young children at first-level facilities . Antimicrobial drugs are an essential child-survival intervention . Ensuring that children younger than five who need these drugs receive them promptly and correctly can save their lives . Prescribing these drugs only when necessary and ensuring that those who receive them complete the full course can slow the development of antimicrobial resistance . METHODS Data collected through observation-based surveys in r and omly selected first-level health facilities in Brazil , Ug and a and the United Republic of Tanzania were statistically analysed . The surveys were carried out as part of the multi-country evaluation of IMCI effectiveness , cost and impact ( MCE ) . FINDINGS Results from three MCE sites show that children receiving care from health workers trained in IMCI are significantly more likely to receive correct prescriptions for antimicrobial drugs than those receiving care from workers not trained in IMCI . They are also more likely to receive the first dose of the drug before leaving the health facility , to have their caregiver advised how to administer the drug , and to have caregivers who are able to describe correctly how to give the drug at home as they leave the health facility . CONCLUSIONS IMCI case management training is an effective intervention to improve the rational use of antimicrobial drugs for sick children visiting first-level health facilities in low-income and middle-income countries OBJECTIVE : This study evaluated the effectiveness of Helping Babies Breathe ( HBB ) newborn care and resuscitation training for birth attendants in reducing stillbirth ( SB ) , and predischarge and neonatal mortality ( NMR ) . India contributes to a large proportion of the worlds annual 3.1 million neonatal deaths and 2.6 million SBs . METHODS : This prospect i ve study included 4187 births at > 28 weeks ’ gestation before and 5411 births after HBB training in Karnataka . A total of 599 birth attendants from rural primary health centers and district and urban hospitals received HBB training developed by the American Academy of Pediatrics , using a train-the-trainer cascade . Pre-post written trainee knowledge , posttraining provider performance and skills , SB , predischarge mortality , and NMR before and after HBB training were assessed by using χ2 and t-tests for categorical and continuous variables , respectively . Backward stepwise logistic regression analysis adjusted for potential confounding . RESULTS : Provider knowledge and performance systematic ally improved with HBB training . HBB training  reduced resuscitation but increased assisted bag and mask ventilation incidence . SB declined from 3.0 % to 2.3 % ( odds ratio [ OR ] 0.76 , 95 % confidence interval [ CI ] 0.59–0.98 ) and fresh SB from 1.7 % to 0.9 % ( OR 0.54 , 95 % CI 0.37–0.78 ) after HBB training . Predischarge mortality was 0.1 % in both periods . NMR was 1.8 % before and 1.9 % after HBB training ( OR 1.09 , 95 % CI 0.80–1.47 , P = .59 ) but unknown status at 28 days was 2 % greater after HBB training ( P = .007 ) . CONCLUSIONS : HBB training  reduced SB without increasing NMR , indicating that resuscitated infants survived the neonatal period . Monitoring and community-based assessment are recommended OBJECTIVE : The goal was to determine the effect of training in newborn care and resuscitation on 7-day ( early ) neonatal mortality rates for very low birth weight ( VLBW ) infants . The study was design ed to test the hypothesis that these training programs would reduce neonatal mortality rates for VLBW infants . METHODS : Local instructors trained birth attendants from 96 rural communities in 6 developing countries in protocol and data collection , the World Health Organization Essential Newborn Care ( ENC ) course , and a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program ( NRP ) , by using a train-the-trainer model . To test the impact of ENC training , data on infants of 500 to 1499 g were collected by using a before/after , active baseline , controlled study design . A cluster-r and omized , controlled trial design was used to test the impact of the NRP . RESULTS : A total of 1096 VLBW ( 500–1499 g ) infants were enrolled , and 98.5 % of live-born infants were monitored to 7 days . All-cause , 7-day neonatal mortality , stillbirth , and perinatal mortality rates were not affected by ENC or NRP training . CONCLUSIONS : Neither ENC nor NRP training of birth attendants decreased 7-day neonatal , stillbirth , or perinatal mortality rates for VLBW infants born at home or at first-level facilities . Encouragement of delivery in a facility where a higher level of care is available may be preferable when delivery of a VLBW infant is expected Abstract Objectives To determine how well antibiotic treatment is targeted by simple clinical syndromes and to what extent drug resistance threatens affordable antibiotics . Design Observational study involving a priori definition of a hierarchy of syndromic indications for antibiotic therapy derived from World Health Organization integrated management of childhood illness and inpatient guidelines and application of these rules to a prospect ively collected data set . Setting Kilifi District Hospital , Kenya . Participants 11 847 acute paediatric admissions . Main outcome measures Presence of invasive bacterial infection ( bacteraemia or meningitis ) or Plasmodium falciparum parasitaemia ; antimicrobial sensitivities of isolated bacteria . Results 6254 ( 53 % ) admissions met criteria for syndromes requiring antibiotics ( sick young infants ; meningitis/encephalopathy ; severe malnutrition ; very severe , severe , or mild pneumonia ; skin or soft tissue infection ) : 672 ( 11 % ) had an invasive bacterial infection ( 80 % of all invasive bacterial infections identified ) , and 753 ( 12 % ) died ( 93 % of all inpatient deaths ) . Among P falciparum infected children with a syndromic indication for parenteral antibiotics , an invasive bacterial infection was detected in 4.0 - 8.8 % . For the syndrome of meningitis/encephalopathy , 96/123 ( 76 % ) isolates were fully sensitive in vitro to penicillin or chloramphenicol . Conclusions Simple clinical syndromes effectively target children admitted with invasive bacterial infection and those at risk of death . Malaria parasitaemia does not justify withholding empirical parenteral antibiotics . Lumbar puncture is critical to the rational use of antibiotics Background Birth asphyxia kills 0.7 to 1.6 million newborns a year globally with 99 % of deaths in developing countries . Effective newborn resuscitation could reduce this burden of disease but the training of health-care providers in low income setting s is often out date d. Our aim was to determine if a simple one day newborn resuscitation training ( NRT ) alters health worker resuscitation practice s in a public hospital setting in Kenya . Methods /Principal Findings We conducted a r and omised , controlled trial with health workers receiving early training with NRT ( n = 28 ) or late training ( the control group , n = 55 ) . The training was adapted locally from the approach of the UK Resuscitation Council . The primary outcome was the proportion of appropriate initial resuscitation steps with the frequency of inappropriate practice s as a secondary outcome . Data were collected on 97 and 115 resuscitation episodes over 7 weeks after early training in the intervention and control groups respectively . Trained providers demonstrated a higher proportion of adequate initial resuscitation steps compared to the control group ( trained 66 % vs control 27 % ; risk ratio 2.45 , [ 95 % CI 1.75–3.42 ] , p<0.001 , adjusted for clustering ) . In addition , there was a statistically significant reduction in the frequency of inappropriate and potentially harmful practice s per resuscitation in the trained group ( trained 0.53 vs control 0.92 ; mean difference 0.40 , [ 95 % CI 0.13–0.66 ] , p = 0.004 ) . Conclusions / Significance Implementation of a simple , one day newborn resuscitation training can be followed immediately by significant improvement in health workers ' practice s. However , evidence of the effects on long term performance or clinical outcomes can only be established by larger cluster r and omised trials . Trial Registration Controlled-Trials.com IS RCT Objective To determine whether training  traditional birth attendants  to manage several common perinatal conditions could reduce  neonatal mortality in the setting of a re source poor country with limited access to healthcare . Design Prospect i ve , cluster r and omised and controlled effectiveness study . Setting Lufwanyama , an agrarian , poorly developed district located in the Copperbelt province , Zambia . All births carried out by study birth attendants occurred at mothers ’ homes , in rural village setting s. Participants 127 traditional birth attendants and mothers and their newborns ( 3559 infants delivered regardless of vital status ) from Lufwanyama district . Interventions Using an unblinded design , birth attendants were cluster r and omised to intervention or control groups . The intervention had two components : training in a modified version of the neonatal resuscitation protocol , and single dose amoxicillin coupled with facilitated referral of infants to a health centre . Control birth attendants continued their existing st and ard of care ( basic obstetric skills and use of clean delivery kits ) . Main outcome measures The primary outcome was the proportion of liveborn infants who died by day 28 after birth , with rate ratios statistically adjusted for clustering . Secondary outcomes 
    Output:
    
Authors ' conclusions In-service neonatal emergency care courses probably improve health professionals ' treatment of seriously ill babies in the short term .
This is the first up date of the original Cochrane review , whose objective was to find out whether additional emergency care training programmes can improve the ability of health workers in poor countries to care for seriously ill newborns and children admitted to hospitals .
The review authors suggest that giving health professionals in poor countries additional training in emergency care probably improves their ability to care for seriously ill newborns .
Health workers in poor countries often do not have these skills , and these babies are likely to die .
Babies can also be harmed if the health worker does not resuscitate the baby correctly .
This course was adapted from the World Health Organization ( WHO ) Training Modules on Essential Newborn Care and Breastfeeding , and included lectures , demonstrations , h and s-on training and small group discussion s. This study suggests that after these training courses : health professionals probably are more likely to be well prepared to resuscitate newborn babies ( moderate certainty of the evidence ) .
The review authors found no studies that looked at the effects of training programmes on the care of older children .