***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: OBJECTIVE To assess the quality of antibiotic prescribing by Victorian general practitioners , and the effectiveness of educational intervention techniques in improving prescribing . DESIGN A r and omised , controlled , parallel group trial . SETTING AND PARTICIPANTS In rural and metropolitan Victoria , 182 general practitioners ( 78 control , 104 intervention ) began and 103 ( 41 control , 62 intervention ) completed the study . INTERVENTION Participants recorded their  antibiotic prescribing for tonsillitis .  The intervention group received an educational mailing campaign . A project pharmacist visited each doctor to discuss campaign messages . MAIN OUTCOME MEASURE The percentages of prescriptions of antibiotics for tonsillitis complying with those recommended in Antibiotic guidelines . RESULTS In the intervention group , prescriptions consistent with recommendations in the guidelines increased from 60.5 % before the campaign to 87.7 % afterwards . Improvement also occurred in the control group , from 52.9 % to 71.7 % of prescriptions . The improvement within the intervention group was significantly greater than that within the control group . CONCLUSIONS The educational campaign significantly improved the prescribing of appropriate antibiotics for tonsillitis by general practitioners BACKGROUND Antibiotics are a front-line weapon against many infectious diseases . However , antibiotic overuse is the key driver of drug resistance . Previously published studies have suggested benefits of using peer-to-peer education , working with group leaders to build trust and maintain confidentiality within a quality initiative . We hypothesized that working with physicians as a peer group might be beneficial in influencing antibiotic prescribing patterns . OBJECTIVE To describe and evaluate a peer group model for an intervention to reduce the volume of antibiotic prescriptions among physicians with above average prescribing rates serving an Arab community in northern Israel . METHODS Primary care physicians in a defined geographic area who served Arab communities and had high antibiotic prescribing rates -- defined as above average number of antibiotic prescriptions per office visit compared with regional and organizational averages -- were recruited for the intervention . All other physicians from the same region served as a comparison group . The intervention was administered during 2007 and was completed in early 2008 . Four structured meetings scheduled 2 months apart , in which the group explored the issues related to antibiotic overuse , included the following topics : adherence to clinical guidelines ; the special position physicians serving Arab communities hold and the influence it has on their practice s ; pressure due to consumer dem and s ; and suggestions for possible strategies to face ethnic sensitivity , mainly because of the special ties the physicians have with their communities . T-tests for independent sample s were used to perform between-group comparisons for each quarter and year of observation from 2006 through 2010 , and t-tests for paired sample s were used to compare pre-intervention with post-intervention antibiotic prescribing rates . RESULTS In the 2006 pre-intervention period , the antibiotic prescribing rates were 0.17 for the peer group ( n = 11 physicians ) and 0.15 for the comparison group ( n = 72 physicians , P = 0.279 ) . In 2008 following the intervention , rates were 0.12 and 0.14 , respectively ( P = 0.396 ) . In the paired t-test analysis , rates declined significantly from 2006 to 2008 in the intervention group ( P < 0.001 ) but not in the comparison group ( P = 0.138 ) . Antibiotic prescribing rates remained similar in 2009 and 2010 . CONCLUSION In the context of a community with special ethnic and cultural characteristics , an intervention relying on peer group techniques was associated with a modest reduction in the volume of antibiotic prescriptions Our aim was to evaluate effects on prescribing for urinary tract infection ( UTI ) and asthma , of an education with messages based on national guidelines , aim ed at improving prescribing in primary care in Sweden . The study is part of the European Drug Education Project . A r and omized controlled trial , with groups of general practitioners ( GPs ) allocated to education on UTI ( 18 groups , 104 GPs ) or asthma ( 18 groups , 100 GPs ) , the two parallel intervention arms being controls for each other . Feedback was provided on the GP 's judgments of simulated cases and prescribing . Prescribing indicators were developed and measured before and after the intervention . Analysis was performed by multi-level technique . Prescribing of first choice UTI drugs increased in the intervention arm from 52 % to 70 % and remained constant in the control arm ( P < 0.001 ) . The proportion of patients receiving an inhaled corticosteroid increased insignificantly in both study arms . The educational model can be used to improve prescribing . Further studies are needed to define when the model is effective Irrational antibiotic use for respiratory tract infections ( RTI ) is a major driver of bacterial resistance . The aim of this study was to evaluate the effect of a multifaceted peer-group based intervention aim ing to reduce RTI-related antibiotic prescriptions in family practice . This was a cluster r and omized controlled trial with pre- and follow-up measurement . The intervention was implemented through PharmacoTherapy Audit Meetings ( PTAM ) in which family physicians ( FPs ) and pharmacists collaborate . Four PTAM groups received the intervention consisting of : ( 1 ) FP communication skills training , including communication about delayed prescribing ; ( 2 ) implementation of antibiotic prescribing agreements in FPs ’ Electronic Prescribing Systems ; ( 3 ) quarterly feedback figures for FPs .  Four other PTAM groups were matched controls . Primary outcome measure was the number of RTI-related antibiotic prescriptions after the intervention , assessed with multilevel linear regression analyses . Total number and number of prescriptions stratified by age ( under/over 12 years ) were analysed . At baseline , the average total number of RTI-related antibiotic prescriptions per 1,000 patients was 207.9 and 176.7 in the intervention and control PTAM groups , respectively . At follow-up , FPs in both the intervention and control groups prescribed significantly less antibiotics . For  adolescents and adults  , the drop in number of antibiotic prescription was significantly larger in the intervention groups ( −27.8 per 1,000 patients ) than the control groups ( −7.2 per 1,000 patients ; P<0.05 ) . This multifaceted peer-group-based intervention was effective in reducing the number of RTI-related antibiotic prescriptions for adolescents and adults . To affect antibiotic prescribing in children other methods are needed Abstract Objectives To assess the effectiveness of a multiple intervention aim ed at reducing antibiotic prescription rates for symptoms of the respiratory tract in primary care . Design R and omised controlled trial . Subjects Twelve peer review groups including 100 general practitioners with their collaborating pharmacists in the region of Utrecht , Netherl and s. Intervention The intervention consisted of group education meetings , with a consensus procedure on indication for and type of antibiotics and with training in communication skills ; monitoring and feedback on prescribing behaviour ; group education for assistants of general practitioners and pharmacists ; and educational material for patients . The control group did not receive any of these elements . Main outcome measures Antibiotic prescription rates for acute symptoms of the respiratory tract and patients ' satisfaction . Results 89 general practitioners completed the study ( 89 % ) . At baseline , prescription rates for antibiotics for respiratory tract symptoms did not differ between intervention and control group ( 27 % v 29 % , respectively ) . After nine months , the prescription rates in the intervention group fell to 23 % , whereas the control group 's rose to 37 % ( mean difference in change −12 % , 95 % confidence interval −18.9 % to −4.0 % ) . Multilevel analysis confirmed the results of the unadjusted analysis ( intervention effect −10.7 % , −20.3 % to −1.0 % ) . Patients ' satisfaction was high and did not differ in the two groups at baseline or after the intervention . Conclusions A multiple intervention reduced prescribing rates of antibiotics for respiratory tract symptoms while maintaining a high degree of satisfaction among patients . Further research should focus on the sustainability and cost effectiveness of this intervention Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies Background It is difficult to keep control over prescribing behaviour in general practice s. The purpose of this study was to assess the effects of a dissemination strategy of multidisciplinary guidelines on the volume of drug prescribing . Methods The study included two design s , a quasi-experimental pre/post study with concurrent control group and a r and om sample of GPs within the intervention group . The intervention area with 53 GPs was compared with a control group of 54 r and omly selected GPs in the south and centre of the Netherl and s. Additionally , a r and omisation was executed in the intervention group to create two arms with 27 GPs who were more intensively involved in the development of the guideline and 26 GPs in the control group .  A multidisciplinary committee developed prescription guidelines . Subsequently these guidelines were disseminated to all GPs in the intervention region . Additional effects were studied in the subgroup trial in which GPs were invited to be more intensively involved in the guideline development procedure . The guidelines contained 14 recommendations on antibiotics , asthma/ COPD drugs and cholesterol drugsThe main outcome measures were prescription data of a three-year period ( one year before and 2 years after guideline dissemination ) and proportion of change according to recommendations . Results Significant short-term improvements were seen for one recommendation : mupirocin . Long-term changes were found for cholesterol drug prescriptions . No additional changes were seen for the r and omised controlled study in the subgroup . GPs did not take up the invitation for involvement . Conclusion Disseminating multidisciplinary guidelines that were developed within a region , has no clear effect on prescribing behaviour even though GPs and specialists were involved more intensively in their development . Apparently , more effort is needed to bring about change Background The grading of recommendation , assessment , development and evaluation ( GRADE ) approach is widely implemented in health technology assessment and guideline development organisations throughout the world . GRADE provides a transparent approach to reaching judgements about the quality of evidence on the effects of a health care intervention , but is complex and therefore challenging to apply in a consistent manner . Methods We developed a checklist to guide the research er to extract the data required to make a GRADE assessment . We applied the checklist to 29 meta-analyses of r and omised controlled trials on the effectiveness of health care interventions . Two review ers used the checklist for each paper and used these data to rate the quality of evidence for a particular outcome . Results For most ( 70 % ) checklist items , there was good agreement between review ers . The main problems were for items relating to indirectness where considerable judgement is required . Conclusions There was consistent agreement between review ers on most items in the checklist . The use of this checklist may be an aid to improving the consistency and reproducibility of GRADE assessment s , particularly for inexperienced users or in rapid review s without the re sources to conduct assessment s by two research ers independently PURPOSE Acute uncomplicated urinary tract infection is a common and costly disorder in women . To reduce potentially unnecessary expense and inconvenience , a large staff-model health maintenance organization instituted a telephone-based clinical practice guideline for managing presumed cystitis in which women 18 to 55 years of age who met specific criteria were managed without a clinic visit or laboratory testing . We sought to evaluate the effects of the guideline . SUBJECTS AND METHODS We performed a population -based , before- and -after study with concurrent control groups at 24 primary care clinics to assess the effect of guideline implementation on re source utilization and on the occurrence of potential adverse outcomes . We measured the proportion of patients with presumed uncomplicated cystitis who had a return office visit for cystitis or sexually transmitted disease or who developed pyelonephritis within 60 days of the initial diagnosis .  Relative risks ( RR ) and 95 % confidence intervals ( CI ) were estimated , adjusting for the effects of clustering within clinics . RESULTS A total of 3,889 eligible patients with presumed acute uncomplicated cystitis were evaluated . As compared with baseline , guideline implementation significantly decreased the proportion of patients with presumed cystitis who received urinalysis ( RR = 0.75 ; CI , 0.70 to 0.80 ) , urine culture ( RR = 0.73 ; CI , 0.68 to 0.79 ) , and an initial office visit ( RR = 0.67 ; CI , 0.62 to 0.73 ) , while increasing the proportion who received a guideline -recommended antibiotic 2.9-fold ( CI , 2.4 to 3.7-fold ) . In the prospect i ve comparison of the 22 intervention and two control clinics , the guideline decreased the proportion of patients who had urinalyses performed ( RR = 0.80 ; CI , 0.65 to 0.98 ) and increased the proportion of patients who were prescribed a 
    Output:
    
Conclusions ASPs involving pharmacists are effective in decreasing antibiotic prescribing and increasing guideline -adherent antibiotic prescribing by GPs