***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 : Practice guidelines suggest that all patients hospitalised with community-acquired pneumonia ( CAP ) should receive antibiotics within 4 h of admission . An audit at our hospital during 1999–2000 showed that this target was achieved in less than two thirds of patients with severe CAP . Methods : An experienced multidisciplinary steering group design ed a management pathway to improve the early delivery of appropriate antibiotics to patients with CAP . This was implemented using a multifaceted strategy . The effect of implementation was evaluated using a controlled before- and -after study design over two winter seasons ( November – April 2001–2 and 2002–3 ) . Cost-effectiveness analyses were performed from the hospital ’s perspective . Results : The proportion of patients receiving appropriate antibiotics within 4 h of admission to hospital increased from 33 % to 56 % at the intervention site , and from 32 % to 36 % at the control site ( absolute change adjusted for differences in severity of illness 17 % , p = 0.035 ) . The cost per additional patient receiving appropriate antibiotics within 4 h was £ 132 with no post-implementation evaluation , and £ 456 for a limited post-implementation evaluation . Simple modelling from the results of a large observational study suggests that the cost per death prevented could be £ 3003 with no post-implementation evaluation , or £ 16 632 with a limited post-implementation evaluation . Conclusions : The intervention markedly improved door-to-antibiotic time , albeit at considerable cost . It might still be a cost-effective strategy , however , to reduce mortality in CAP . Uncertainty about the cost effectiveness of such interventions is likely to be resolved only by a well- design ed , cluster r and omised trial OBJECTIVE To implement and evaluate the effect of a computerized decision support tool on  antibiotic use in an intensive care unit ( ICU ) . DESIGN Prospect i ve before- and -after cohort study . SETTING Twenty-four bed tertiary hospital adult medical/surgical ICU . PARTICIPANTS All consecutive patients from May 2001 to November 2001 ( N = 524 ) and March 2002 to September 2002 ( N = 536 ) . INTERVENTION A real-time microbiology browser and computerized decision support system for isolate directed antibiotic prescription . MAIN OUTCOME MEASURES Number of courses of antibiotic prescribed , antibiotic utilization ( defined daily doses (DDDs)/100 ICU bed-days ) , antibiotic susceptibility mismatches , and system uptake . RESULTS There was a significant reduction in the proportion of patients prescribed carbapenems [ odds ratio ( OR ) = 0.61 , 95 % confidence interval ( CI ) = 0.39 - 0.97 , P = 0.04 ] , third-generation cephalosporins ( OR = 0.58 , 95 % CI = 0.42 - 0.79 , P = 0.001 ) , and vancomycin ( OR = 0.67 , 95 % CI = 0.45 - 1.00 , P = 0.05 ) after adjustment for risk factors including Apache II score , suspected infection , positive microbiology , intubation , and length of stay . The decision support tool was associated with a 10.5 % reduction in both total antibiotic utilization ( 166 - 149 DDDs/100 ICU bed days ) and the highest volume broad-spectrum antibiotics . There were fewer susceptibility mismatches for initial antibiotic therapy ( OR = 0.63 , 95 % CI = 0.39 - 0.98 , P = 0.02 ) and increased de-escalation to narrower spectrum antibiotics . Uptake of the program was high with 6028 access episodes during the 6-month evaluation period . CONCLUSIONS This tool streamlined collation and clinical use of microbiology results and integrated into the daily ICU workflow . Its introduction was accompanied by a reduction in both total and broad-spectrum antibiotic use and an increase in the number of switches to narrower spectrum antibiotics During the past decade , a variety of instrument-assisted bacterial identification and antimicrobial susceptibility test systems have been developed which permit provision of test results in a matter of hours rather than days , as has been the case with traditional overnight procedures . These newer rapid techniques are much more expensive than older methods . It has been presumed but not proven that the clinical benefits of rapid testing to patients with infection offset the added cost . The intent of this study was to objective ly define the clinical impact of rapid bacterial identification and antimicrobial susceptibility testing . A 1-year study was performed in which infected , hospitalized patients in a tertiary-care , teaching , medical center were r and omly assigned to one of two groups : patients for whom identification and susceptibility testing was performed by using a semi-automated , rapid , same-day procedure and those for whom testing was accomplished by using traditional overnight techniques . The two groups were compared with respect to numerous demographic descriptors , and then patients were monitored prospect ively through the end of their hospitalization with the aim of determining whether there existed objective ly defineable differences in management and outcome between the two groups . The mean lengths of time to provision of susceptibility and identification test results in the rapid test group were 11.3 and 9.6 h , respectively . In the overnight test group , these values were 19.6 and 25.9 h , respectively ( P < 0.0005 ) . There were 273 evaluable patients in the first group and 300 in the second group . Other than the length of time required to provide susceptibility and identification test results , no significant differences were noted between the two groups with respect to > 100 demographic descriptors . With regard to measures of outcome , the mean lengths of hospitalization were also the same in both groups . Mortality rates were however , lower in the rapid test group ( i.e. , 8.8 % versus 15.3 % ) . Similarly , statistically significantly fewer laboratory studies , imaging procedures , days of intubation , and days in an intensive or intermediate-care area were observed with patients in the rapid test group . Rapid testing was also associated with significantly shortened lengths of elapsed time prior to alterations in antimicrobial therapy . Lastly , patient costs for hospitalization were significantly lower in the rapid test group . The results of this study indicate the rapid same-day bacterial identification and susceptibility testing in the microbiology laboratory can have a major impact on the care and outcome of hospitalized patients with infection OBJECTIVES Misuse of antibiotics in surgical prophylaxis is still quite common . The objectives of this study were to reduce the quantity and improve the quality of surgical prophylaxis and to reduce costs . METHODS Prospect i ve multi-site study of elective procedures in 13 Dutch hospitals . The quality of prophylaxis was audited before and after an intervention consisting of performance feedback and implementation of national clinical practice guidelines . Process outcome parameters were  antibiotic choice , duration , timing , antibiotic volume and costs . Segmented regression analysis was used to estimate the effect size of the intervention . Patient outcome was documented by the incidence of surgical site infections ( SSI ) . RESULTS Before the intervention , 1763 procedures were recorded and 2050 thereafter .  Antimicrobial use decreased from 121 to 79 DDD ( defined daily doses)/100 procedures and costs reduced by 25 % per procedure . After the intervention , antibiotic choice was inappropriate in only 37.5 % of the cases instead of in 93.5 % expected cases had the intervention not occurred . Prolonged prophylaxis was observed in 31.4 % instead of 46.8 % expected cases and inappropriate timing in 39.4 % instead of the expected 51.8 % . Time series analysis showed that all improvements were statistically significant ( P < 0.01 ) and that they could be fully attributed to the intervention . The overall SSI rates before and after intervention were 5.4 % ( 95 % CI : 4.3 - 6.5 ) and 4.6 % ( 95 % CI : 3.6 - 5.4 ) , respectively . CONCLUSIONS The intervention led to improved quality of surgical prophylaxis and to reduced antibiotic use and costs without impairment of patient outcome Abstract Objective To evaluate the effectiveness of an educational visit to help obstetricians and midwives select and use evidence from a Cochrane data base containing 600 systematic review s. Design R and omised single blind controlled trial with obstetric units allocated to an educational visit or control group . Setting 25 of the 26 district general obstetric units in two former NHS regions . Subjects The senior obstetrician and midwife from each intervention unit participated in educational visits . Clinical practice s of all staff were assessed in 4508 pregnancies . Intervention Single informal educational visit by a respected obstetrician including discussion of evidence based obstetrics , guidance on implementation , and donation of Cochrane data base and other material s. Main outcome measures Rates of perineal suturing with polyglycolic acid , ventouse delivery , prophylactic antibiotics in caesarean section , and steroids in preterm delivery , before and 9 months after visits , and concordance of guidelines with review evidence for same marker practice s before and after visits . Results Rates varied greatly , but the overall baseline mean of 43 % ( 986/2312 ) increased to 54 % ( 1189/2196 ) 9 months later . Rates of ventouse delivery increased significantly in intervention units but not in control units ; there was no difference between the two types of units in uptake of other practice s. Pooling rates from all 25 units , use of antibiotics in caesarean section and use of polyglycolic acid sutures increased significantly over the period , but use of steroids in preterm delivery was unchanged . Labour ward guidelines seldom agreed with evidence at baseline ; this hardly improved after visits . Educational visits cost 860 $ each ( at 1995 prices ) . Conclusions There was considerable uptake of evidence into practice in both control and intervention units between 1994 and 1995 . Our educational visits added little to this , despite the informal setting , targeting of senior staff from two disciplines , and donation of educational material s. Further work is needed to define cost effective methods to enhance the uptake of evidence from systematic review s and to clarify leadership and roles of senior obstetric staff in implementing the evidence OBJECTIVE To evaluate the impact that the implementation of therapeutic guidelines has on the empirical treatment of nosocomial pneumonia . METHODS A clinical trial , using historical controls and involving current ICU patients who had acquired nosocomial pneumonia , was carried out from June of 2002 to June of 2003 . All were treated according to therapeutic guidelines developed by the Commission for Nosocomial Infection Control of the institution ( group with intervention ) . As controls , the medical charts of the patients who acquired nosocomial pneumonia between June of 2000 and June of 2001 ( group without intervention ) were analyzed . Mortality and mean treatment period , as well as the length of hospital and ICU stays , were determined for the patients who acquired nosocomial pneumonia . RESULTS Mortality associated with pneumonia was lower in the group treated according to the therapeutic guidelines ( 26 vs. 53.6 % ; p = 0.00 ) . As for overall mortality , there was no statistically significant difference between the two periods ( 51 vs. 57.9 % ; p = 0.37 ) . There was also no difference in the type of microorganisms isolated , treatment period , length of hospital stay or length of ICU stay . CONCLUSION The implementation of therapeutic guidelines for the treatment of nosocomial pneumonia acquired in the ICU can be efficacious in decreasing mortality rates OBJECTIVE To determine whether a computerized decision support system could increase the proportion of oral quinolone antibiotic  orders placed for hospitalized patients . DESIGN Prospect i ve , interrupted time-series analysis . SETTING University hospital in the south-eastern United States . SUBJECTS Inpatient quinolone orders placed from 1 February 2001 to 31 January 2003 . INTERVENTION A web-based intervention was deployed as part of an existing order entry system at a university hospital on 5 February 2002 . Based on an automated query of active medication and diet orders , some users ordering intravenous quinolones  were presented with a suggestion to consider choosing an oral formulation . MAIN OUTCOME MEASURE The proportion of inpatient quinolone orders placed for oral formulations before and after deployment of the intervention . RESULTS There were a total of 15 194 quinolone orders during the study period , of which 8962 ( 59 % ) were for oral forms . Orders for oral quinolones increased from 4202 ( 56 % ) before the intervention to 4760 ( 62 % ) after , without a change in total orders . In the time-series analysis , there was an overall 5.6 % increase ( 95 % CI 2.8 - 8.4 % ; P < 0.001 ) in weekly oral quinolone orders due to the intervention , with the greatest effect on nonintensive care medical units . CONCLUSIONS A web-based intervention was able to increase oral quinolone orders in hospitalized patients . This is one of the first studies to demonstrate a significant effect of a computerized intervention on dosing route within an antibiotic class . This model could be applied to other antibiotics or other drug classes with good oral bioavailability OBJECTIVES This study investigated the impact of a combined intervention strategy to improve antimicrobial prescribing at University Hospital Groningen . For the intervention , the antimicrobial treatment guidelines were up date d and disseminated in paperback and electronic format . The credibility 
    Output:
    
The results show that interventions to improve antibiotic prescribing to hospital in patients are successful , and can reduce antimicrobial resistance or hospital acquired infections