***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 Overuse of antibiotics for children 's upper respiratory infections is widespread and contributes to the emergence of antibiotic-resistant bacteria . OBJECTIVE To assess changes in knowledge and awareness regarding antibiotic resistance and appropriate antibiotic use after community-wide educational interventions to reduce inappropriate antibiotic use . DESIGN Baseline survey conducted during June through July 1997 and postintervention survey of baseline participants during June through August 1998 . SETTING Communities in northern Wisconsin . PARTICIPANTS Parents of 729 r and omly selected children < 4 years of age were called until 215 in each of the intervention and control areas were reached . Of the 430 baseline participants , 365 ( 85 % ) participated in the postintervention survey . INTERVENTION Parent-oriented activities included distribution of material s and presentations . Physician-oriented activities included formal presentations and small group meetings . OUTCOME MEASURE Change in awareness about antibiotic resistance and knowledge about antibiotic indications . RESULTS A higher proportion of parents in the intervention area ( 53 % ) were exposed to 2 or more local educational messages , compared with the control area ( 23 % ) . From the baseline to the postintervention survey , the percentage of parents with a high degree of antibiotic resistance awareness increased more in the intervention area ( 58 % to 73 % ) than in the control area ( 60 % to 65 % ) . In the intervention area , there was also a larger increase in knowledge regarding appropriate indications for antibiotic use , compared with the control area . The proportion of parents who expected an antibiotic for their child and did not receive one declined in the intervention area ( 14 % to 9 % ) , while it increased in the control area ( 7 % to 10 % ) . In addition , the percentage of parents in the intervention area who brought their child to another physician because they did not receive an antibiotic decreased ( 5 % to 2 % ) , while it increased in the control area ( 2 % to 4 % ) . CONCLUSION Parental knowledge and awareness about antibiotic indications and antibiotic resistance can be changed with educational interventions directed at parents and clinicians BACKGROUND Sore throat is one of the commonest presenting symptoms in general practice in Australia , and results in the prescription of an antibiotic in 50 - 90 % of cases , despite the finding of bacterial throat infection in around 30 % of cases or fewer . AIM This study set out to examine whether inaccurate knowledge about the pathophysiological features and management of sore throat helps to explain the high level of inappropriate antibiotic prescribing for sore throat by general practitioners . METHOD A question naire with four case vignettes of sore throat presentations was sent to 400 r and omly selected general practitioners , practising in Victoria , Australia . Of 367 eligible respondents , 284 responded ( 77 % ) . RESULTS Of the respondents 97 % reported that they would prescribe an antibiotic for the case of tonsillitis , 70 % for the case of possible gl and ular fever , 29 % for the child with probable viral sore throat and 9 % for the adult with probable viral infection . There were no differences in prescribing rates between general practitioners of different sex , practice location , practice type or qualification . Overall , 25 % of the antibiotics which formed the respondents ' first choice were inappropriate  broad-spectrum antibiotics .  CONCLUSION General practitioners are generally accurate in their assessment of the features of sore throats , but less accurate in their knowledge of appropriate antibiotics BACKGROUND In response to the dramatic emergence of resistant pneumococci , more judicious use of antibiotics has been advocated . Physician beliefs , their prescribing practice s , and the attitudes of patients have been evaluated previously in separate studies . METHODS This 3-part study included a statewide mailed survey , office chart review s , and parent telephone interviews . We compared survey responses of 366 licensed pediatricians and family physicians in Georgia to recently published recommendations on diagnosis and treatment of upper respiratory infections ( URIs ) . We further evaluated 25 r and omly selected pediatricians from 119 surveyed in the Atlanta metropolitan area . For each , charts from the first 30 patients between the ages of 12 and 72 months seen on a r and omly selected date were review ed for encounters during the preceding year . A sample of parents from each practice were interviewed by telephone . RESULTS In the survey , physicians agreed that overuse of antibiotics is a major factor contributing to the development of antibiotic resistance ( 97 % ) , and that they should consider selective pressure for resistance in their decisions on providing antibiotic treatment for URIs in children in their practice s ( 83 % ) . However , many reported practice s do not conform to the recently published principles for judicious antibiotic use . For example , 69 % of physicians considered purulent rhinitis a diagnostic finding for sinusitis ; 86 % prescribed antibiotics for bronchitis regardless of the duration of cough ; and 42 % prescribed antibiotics for the common cold . Reported practice s by family physicians were more often at odds with the published principles : they were significantly more likely than pediatricians to omit pneumatic otoscopy ( 46 % vs 25 % ) ; to omit the requirement for prolonged symptoms to diagnose sinusitis ( median 4 vs 10 days ) ; and to omit laboratory testing for pharyngitis ( 27 % vs 14 % ) . Of the 7531 encounters analyzed in the chart review , 43 % result ed in an antibiotic prescription , including 11 % of checkups , 18 % of telephone calls , and 72 % of visits for URIs . There was wide variability in the overall antibiotic use rates among the 25 physicians ( 1 - 10 courses per child per year ) . There was an even wider variability in some diagnosis-specific rates ; bronchitis and sinusitis in particular . Those with the highest antibiotic prescribing rates had up to 30 % more return office visits . Physicians who prescribed antibiotics for purulent rhinitis were more likely to see parents who believed that their children should be evaluated for cold symptoms . CONCLUSIONS Physicians recognize the problem of antibiotic resistance but their reported practice s are not in line with recently published recommendations for most pediatric URIs . The actual prescribing practice s of pediatricians are often considerably different from their close colleagues . Patient beliefs are correlated with their own physician 's practice Abstract Objective : To assess whether sharing the uncertainty of the value of antibiotics for acute bronchitis in the form of written and verbal advice affects the likelihood of patients taking antibiotics .  Design : Nested , single blind , r and omised controlled trial . Setting : Three suburban general practice s in Nottingham . Participants : 259 previously well adults presenting with acute bronchitis . Intervention : In group A , 212 patients were judged by their general practitioner not to need antibiotics that day but were given a prescription to use if they got worse and st and ard verbal reassurance . Half of them ( 106 ) were also given an information leaflet . All patients in group B ( 47 ) were judged to need antibiotics and were given a prescription and encouraged to use it . Main outcome measures : Antibiotic use in the next two weeks . Reconsultation for the same symptoms in the next month . Results : In group A fewer patients who received the information leaflet  took antibiotics compared with those who did not receive the leaflet ( 49 v 63 , risk ratio 0.76 , 95 % confidence interval 0.59 to 0.97 , P=0.04 ) . Numbers reconsulting were similar ( 11 v 14 ) . In group B , 44 patients took the antibiotics . Conclusion : Most previously well adults with acute bronchitis were judged not to need antibiotics . Reassuring these patients and sharing the uncertainty about prescribing in a information leaflet supported by verbal advice is a safe strategy and reduces antibiotic use . What is already known on this topic Most adults with acute bronchitis who consult their general practitioner will receive antibiotics For most patients antibiotics do not modify the natural course of the symptoms The widespread belief among patients that infection is the problem and antibiotics the solution has considerable influence on prescribing by general practitioners , even when they judge that antibiotics are not definitely indicated What this study adds General practitioners judged that about four in five adults with acute bronchitis did not definitely need antibiotics on the day they consulted Antibiotic use was reduced by a quarter in such patients , who received verbal and written information and reassurance in addition to a prescription for antibiotics Sharing with the patient the uncertainty about the decision to prescribe seems safe and Abstract BACKGROUND : To reduce the prevalence of antibioticresistant bacteria in the community , physicians must optimize their use of antibiotics . However , optimal use from the perspective of the community ( reserving newer agents for future use ) is not always consistent with optimal use from the perspective of the individual patient ( prescribing newer , broader agents ) . OBJECTIVES : To identify preferred patterns of antibiotic prescribing for patients with community-acquired pneumonia ( CAP ) , measure explicit attitudes toward antibiotics and antibiotic resistance , and determine the relationship between these prescribing patterns and attitudes . DESIGN : Cross-sectional anonymous mail survey . PARTICIPANTS : National r and om sample of 400 generalist physicians ( general internal medicine and family practice ) and 429 infectious diseases specialists . MEASUREMENTS : Rank ordering of antibiotic preferences for a hypothetical outpatient with CAP and reasons for antibiotic selection . Endorsement of attitudes regarding antibiotic prescribing decisions and resistance . RESULTS : Both generalists and infectious diseases specialists were more likely to prefer newer , broader drugs for the treatment of CAP compared to older agents still recommended by national guidelines . Physicians rated the issue of contributing to antibiotic resistance lowest among 7 determinants of their choices . CONCLUSIONS : Despite national guidelines and increasing public awareness , the public health concern of contributing to the problem of antibiotic resistance does not exert a strong impact on physician prescribing decisions for CAP . Future efforts to optimize antibiotic prescribing decisions will need to consider options for increasing the impact of public health issues on the patient-oriented decisions of individual physicians BACKGROUND The patient package insert , an information leaflet included by law in the packaging of prescription drugs , contains information for the user on the specific medication . OBJECTIVES To explore how patient information leaflets influence  patient anxiety  and adherence . METHODS A prospect i ve cohort study was conducted in the practice s of 15 family physicians . All patients receiving a new prescription for antibiotics , analgesics or antihypertensives were included . Physicians completed a question naire containing demographic data , assessment of the patient 's anxiety , a prediction regarding adherence to the treatment , and response to the information leaflet . Patients were contacted by telephone for a follow-up structured interview . Patients ' reactions to the information leaflet , adherence to treatment , and use of other sources of information on medication were assessed . RESULTS The study group comprised 200 patients . The patient information leaflet was read by 103 of them ( 51.5 % ) . A higher educational level and a chronic medication were associated with reading the leaflet ( P= 0.02 and 0.01 respectively ) . In 36 ( 34.9 % ) , an increase in anxiety was reported after reading the leaflet . Among those who read the leaflet , 9.7 % had decreased adherence . Patients who stated that reading the leaflet caused anxiety were more likely to reduce their use of the medication--7/36 ( 19.5 % ) vs. 3/67 ( 4.5 % ) , P= 0.01 . CONCLUSIONS The proportion of patients reading the drug information leaflet is about 50 % , lower than that found in previous studies . Reading the leaflet did not greatly affect adherence but aroused anxiety and decreased adherence in some patients OBJECTIVE To describe how general practitioners use computers for clinical purpose s. DESIGN Mail survey of a cross-sectional national stratified r and om sample of 3000 GPs in primary care setting s between 10 October and 31 December 2005 . MAIN OUTCOME MEASURES Use of computers  , and use of computerised clinical functions such as prescribing , medication checking , generating health summaries , running recall systems , and writing progress notes . RESULTS Of 1186 GPs responding ( 39.5 % response rate ) , 90 % used a clinical software package . GPs used clinical packages for prescribing ( 98 % ) , checking for drug-drug interactions ( 88 % ) , recording a reason for prescribing ( 65 % ) , to order laboratory tests ( 85 % ) , run recall systems ( 78 % ) , and record progress notes ( 64 % ) . Less frequently used functions included generating lists of patients needing vaccines ( 43 % ) and taking the same medication ( 39 % ) . Less than 20 % of GPs who used a clinical package accessed computerised information during the consultation . CONCLUSIONS Australian general practice has achieved near-universal clinical computerisation . Electronic prescribing alone has probably improved efficiency and quality of care , and reduced medication errors . Increasing the use of other functions , such as accessing online decision support and maintaining registries of patients , is likely to lead to further health gains , especially in managing chronic conditions BACKGROUND Physicians are often called on to manage children with acute respiratory tract infections with cough when the clinical presentation may not allow a different 
    Output:
    
Doctors ' socio-demographic and personal factors did not appear to exert much influence .
Complacency ( fulfilling what professionals perceived as being patients ' /parents ' expectations ) and , to a lesser extent , fear ( fear of possible complications in the patient ) were the attitudes associated with misprescription of antibiotics .
Before design ing interventions aim ed at improving the prescription and use of antibiotics , studies are needed to identify precisely which factors influence prescribing