***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: AIMS AND OBJECTIVES This study examined effectiveness of a theoretically based education programme in reducing inappropriate antipyretic use in fever management . BACKGROUND Paediatric nurses ' inconsistent , ritualistic antipyretic use in fever management is influenced by many factors including inconsistent beliefs and parental requests . Determinants of antipyretic administration , identified by the theory of planned behaviour , were belief-based attitudes and subjective norms . DESIGN A quasi-experiment explored group effects of a peer education programme , based on the theory of planned behaviour , on factors influencing paediatric nurses ' antipyretic administration . Surveys and chart audits collected data from medical wards at experimental and control hospitals one month pre and one and four months postpeer education programme .  METHODS All nurses employed in targeted wards were eligible to participate in surveys and all eligible charts were audited . The peer education programme consisted of four one-hour sessions targeting evidence -based knowledge , myths and misconceptions , normative , attitudinal and control influences over and rehearsal of evidence -based fever management .  All nurses in experimental hospital targeted wards were eligible to attend .  Peer education and support facilitated session information reaching those unable to attend sessions . RESULTS Two-way univariate anovas explored between subject , experimental and control group and within subject factors , pre , post and latency data . Significant interactions in normative influence ( p = 0.01 ) and intentions ( p = 0.01 ) , a significant main group effect in control influence ( p = 0.01 ) and a significant main effect between audit data across time points ( p = 0.03 ) highlight peer education programme effectiveness in behaviour change . Normative , control and intention changes postpeer education programme were maintained in latency data ; mean temperature was not . CONCLUSION The peer education programme , based on a behaviour change theory , initiated and maintained evidence -based intentions for antipyretics use in fever management . RELEVANCE TO CLINICAL PRACTICE The promotion of evidence -based change in organizational unit intentions and behaviour highlights the crucial role peer support and education can play in continuing educational programmes OBJECTIVE To compare the effectiveness of tepid sponging and antipyretic drug versus only antipyretic drug among febrile children . DESIGN R and omized controlled trial . SETTING Tertiary care hospital . PARTICIPANTS 150 children 6 mo - 12 yr age with axillary temperature 101F . INTERVENTION Tepid sponging and antipyretic drug ( Paracetamol ) ( n=73 ) or only antipyretic drug ( Paracetamol ) ( n=77 ) . MAIN OUTCOME MEASURES Reduction of body temperature and level of comfort . RESULTS The reduction of body temperature in the tepid sponging and antipyretic drug group was significantly faster than only antipyretic group ; however , by the end of 2 hours both groups had reached the same degree of temperature . The children in tepid sponging and antipyretic drug had significantly higher discomfort than only antipyretic group , but the discomfort was mostly mild . CONCLUSION Apart from the initial rapid temperature reduction , addition of tepid sponging to antipyretic administration does not offer any advantage in ultimate reduction of temperature ; moreover it may result in additional discomfort A controlled clinical study compared the antipyretic effectiveness of acetaminophen administered at regular 4 h intervals ( group 1,n=53 ) versus sproadic usage contingent upon a body temperature above 37.9 ° C ( group 2,n=51 ) in 104 children presenting with simple febrile convulsions .  The incidence of febrile episodes or temperature values were similar in spite of significantly larger amounts of acetaminophen administered to patients in group 1 . Four and 4 children in groups 1 and 2 , respectively , had a second episode of febrile seizures , in all of them within the first 24 h of admission . We conclude that the prophylactic administration of acetaminophen in children with  febrile seizures  is not effective in the prevention of fever , the reduction of its degree , or in preventing the early recurrence of febrile seizures A controlled clinical study compared the effectiveness of sponging with tepid water , ice water , and equal parts of 70 per cent isopropyl alcohol and water in addition to orally administered acetaminophen to reduce  fever in children . More rapid reduction of fever was demonstrated when sponging was combined with the oral antipyretic drug . Sponging with ice water or with alcohol in water  were equally effective and significantly superior to sponging with tepid water ; however , sponging with tepid water  afforded significantly better comfort during the sponging procedure OBJECTIVES --To compare the acceptability and effects on temperature of advice to  unwrap children  and give paracetamol or warm sponging treatments in the management of feverish illness at home . DESIGN --A r and omised , open , parallel group study using factorial design comparison of unwrapping , warm sponging plus unwrapping , paracetamol plus unwrapping , and paracetamol and warm sponging plus unwrapping . SETTING --Homes of willing families with a feverish child recruited after consulting one of 21 participating general practitioners in Southampton . SUBJECTS--52 children aged from 3 months to 5 years with axillary temperatures before treatment of > or = 37.8 degrees C and < 40 degrees C. MAIN OUTCOME MEASURES --Response to advice assessed over four hours ; temperature assessed by continuous data logging from an axillary thermistor ; acceptability of treatment to child and parent scored on Likert scales immediately after treatment and on return to health . RESULTS --Response to treatment advice varied ; unwrapping alone had little effect on temperature . Paracetamol  increased the time below 37.2 degrees C in four hours by 109 ( 95 % confidence interval 74 to 145 ) minutes compared with unwrapping ; warm sponging caused the fastest reduction in temperature . Parents discriminated between treatments , preferring paracetamol . CONCLUSION --Advice to give paracetamol is more effective than sponging or unwrapping in controlling temperature in children at home and is more acceptable to parents . Warm sponging has an additive effect and reduces fever more quickly than paracetamol BACKGROUND Routine antipyretic therapy in children with infectious diseases has long been the source of controversy . Each year , in addition to antimalarial medication , millions of children with Plasmodium falciparum malaria receive paracetamol to reduce fever . However , the usefulness of this practice has not been proven . METHODS In a r and omised trial in Lambaréné , Gabon , 50 children with P falciparum malaria were treated with intravenous quinine , and received either mechanical antipyresis alone , or in combination with paracetamol .  Rectal body temperature and parasitaemia were recorded every 6 h for 4 days . Plasma concentrations and inducible concentrations of tumour necrosis factor ( TNF ) and interleukin-6 were measured every 24 h. In addition , production of oxygen radicals was measured in both groups . FINDINGS The mean fever clearance time was 32 h for children treated with paracetamol and 43 h for those who received mechanical antipyresis alone ; however , this 11 h difference was not significant ( 95 % CI -2 to 24 h ; p = 0.176 ) . Parasite clearance time was significantly prolonged in patients who received paracetamol with a difference of 16 h ( 8 - 24 h ; p = 0.004 ) . Plasma concentrations of TNF and interleukin-6 were similar in both groups during the study . However , the induced concentrations of TNF , and the production of oxygen radicals , were significantly lower in children treated with paracetamol than those who received mechanical antipyresis alone . INTERPRETATION These data suggest that paracetamol has no antipyretic benefits over mechanical antipyresis alone in P falciparum malaria . Moreover , paracetamol prolongs parasite clearance time , possibly by decreased production of TNF and oxygen radicals CONTEXT AND OBJECTIVE The role of tepid sponging to promote fever control in children is controversial . We did not find any studies reporting on the effectiveness of tepid sponging in addition to dipyrone . The aim of this study was to compare the effects of tepid sponging plus dipyrone with dipyrone alone for reducing fever . DESIGN AND SETTING A r and omized clinical trial was undertaken at Instituto Materno-Infantil Professor Fern and o Figueira , Recife , Pernambuco . METHODS Children from six months to five years old with axillary temperature greater than 38 masculineC in the emergency ward between January and July 2006 were eligible . One hundred and twenty children were r and omly assigned to receive oral dipyrone ( 20 mg/kg ) or oral dipyrone and tepid sponging for 15 minutes . The primary outcome was mean temperature reduction after 15 , 30 , 60 , 90 and 120 minutes . Secondary outcomes were crying and irritability . RESULTS 106 children finished the study . After the first 15 minutes , the fall in axillary temperature was significantly greater in the sponged group than in the control group ( p < 0.001 ) . From 30 to 120 minutes , better fever control was observed in the control group . Crying and irritability were observed respectively in 52 % and 36 % of the sponged children and in none and only two of the controls . CONCLUSIONS Tepid sponging plus dipyrone  cooled faster during the first 15 minutes , but dipyrone alone presented better fever control over the two-hour period . Tepid sponging caused mild discomfort , crying and irritability for most of the children . CLINICAL TRIAL REGISTRATION NUMBER ACTRN12608000083392 Tepid sponge baths distress febrile children , and their efficacy at reducing fever has not been established . This study compared fever reduction and with ( 1 ) acetaminophen alone and ( 2 ) acetaminophen plus a 15-minute tepid sponge bath .  Twenty children , ages 5 to 68 months , who presented to the emergency department or urgent care center with fever of > or = 38.9 degrees C were r and omized to receive ( 1 ) acetaminophen alone or ( 2 ) acetaminophen plus a 15-minute tepid sponge bath . All subjects received a 15-mg/kg dose of acetaminophen .  Tympanic temperature was monitored every 30 minutes for 2 hours . Subjects were monitored for signs of discomfort ( crying , shivering , goosebumps ) . Sponge-bathed subjects cooled faster during the first hour but there was no significant temperature difference between the groups over the 2-hour study period ( P = .871 ) . Subjects in the sponge bath group had significantly higher discomfort scores ( P = .009 ) Two hundred and twenty-four children aged 6 months to 5 years , with rectal temperatures greater than or equal to 30 degrees ( 104 degrees F ) , were r and omly treated with sponging alone or with medication including a single oral dose of aspirin 15 mg/kg , or paracetamol 15 mg/kg , or ibuprofen 8 mg/kg . Twenty-three children were excluded from the final analysis because they did not complete the study . Demographic characteristics of the patients were found to be comparable in all groups . Rectal temperatures were recorded every 30 min for a 3 h period . During the first 30 min of intervention ,  sponging  was found to be more effective than all of the three medications . After 60 min , the effects of each medication became superior to sponging with tepid water in reducing body temperature .  Twenty-three children were excluded from the final analysis because they did not complete the study . Comparing the effect of the three different medications , it was seen that the antipyretic efficacy of  aspirin  and ibuprofen were significantly more than paracetamol 3 h after intervention ( P < 0.05 ) . For the management of fever over 39 degrees C , it is therefore recommended to give children an antipyretic drug , preferably ibuprofen , and at the same time to begin sponging to provide a rapid and sustained Several commonly used antipyretic therapies were compared in a series of 67 children . All regimens were more effective than exposure alone . Paracetamol and aspirin were comparable in antipyretic effect and superior to tepid sponging alone . The addition of tepid sponging to paracetamol therapy did not further improve the antipyretic response A block r and omized clinical trial to compare the efficacy of tepid sponging with the use of paracetamol in febrile children was undertaken at the Queen Elizabeth Central Hospital , Blantyre . Eighty children aged between 6 and 54 months with axillary temperatures of between > or = 38.5 degrees C and < or = 40 degrees C and a clinical diagnosis consistent with upper respiratory tract infection and /or malaria were block r and omized to receive either oral paracetamol ( 15 mg/kg ) or tepid sponging . Children receiving tepid sponging were sponged from head to toe ( except the scalp ) by leaving a thin layer of water on the body . If the body became dry it was repeated and continued until the axillary temperature fell to < 38.5 degrees C. Axillary temperature and assessment of discomfort ( convulsions , crying , irritability , vomiting and shivering ) were recorded every 30 minutes for 2 hours . A significantly greater and more 
    Output:
    
RESULTS This study review ed mainly the effect of tepid massage on temperature compared with the use of  antipyretics  , along with other adverse effects in relation with fever management .
The results revealed no significant effect of tepid massage on temperature in febrile children .
In addition , incidence rates of adverse effects including chills , goose pimples , and discomfort were higher in tepid massage groups .