human
***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 establish whether an interactive booklet on  respiratory tract infections in children reduces reconsultation for the same illness episode , reduces antibiotic use , and affects future consulting intentions , while maintaining parental satisfaction with care . Design Pragmatic cluster r and omised controlled trial . Setting 61 general practice s in Wales and Engl and . Participants 558 children ( 6 months to 14 years ) presenting to primary care with an acute respiratory tract infection ( 7 days or less ) . Children with suspected pneumonia , asthma or a serious concomitant illness , or needing immediate hospital admission were excluded . Three withdrew and 27 were lost to follow-up , leaving 528 ( 94.6 % ) with main outcome data . Interventions Clinicians in the intervention group were trained in the use of an interactive booklet on respiratory tract infections and asked to use the booklet during consultations with recruited patients ( and provide it as a take home re source ) . Clinicians in the control group conducted their consultations as usual . Main outcome measures The proportion of children who attended a face-to-face consultation about the same illness during the two week follow-up period . Secondary outcomes included antibiotic prescribing , antibiotic consumption , future consulting intentions , and parental satisfaction , reassurance , and enablement . Results Reconsultation occurred in 12.9 % of children in the intervention group and 16.2 % in the control group ( absolute risk reduction 3.3 % , 95 % confidence interval −2.7 % to 9.3 % , P=0.29 ) . Using multilevel modelling ( at the practice and individual level ) to account for clustering , no significant difference in reconsulting was noted ( odds ratio 0.75 ; 0.41 to 1.38 ) . Antibiotics were prescribed at the index consultation to 19.5 % of children in the intervention group and 40.8 % of children in the control group ( absolute risk reduction 21.3 % , 95 % confidence interval 13.7 to 28.9 ) , P<0.001 ) . A significant difference was still present after adjusting for clustering ( odds ratio 0.29 ; 0.14 to 0.60 ) . There was also a significant difference in the proportion of parents who said they would consult in the future if their child developed a similar illness ( odds ratio 0.34 ; 0.20 to 0.57 ) . Satisfaction , reassurance , and parental enablement scores were not significantly different between the two groups . Conclusions Use of a booklet on respiratory tract infections in children within primary care consultations led to important reductions in antibiotic prescribing and reduced intention to consult without reducing satisfaction with care . Trial registration Current Controlled Trials IS RCT OBJECTIVE To test the hypothesis that educating parents about use of their primary care provider and providing information about common pediatric illnesses will reduce visits to the pediatric emergency department ( PED ) . DESIGN Prospect i ve , r and omized , controlled trial conducted from September 1 , 1993 , to October 31 , 1994 . SETTING Pediatric emergency department of an urban university hospital . PARTICIPANTS Parents of 130 patients seen in the PED for minor illness . INTERVENTIONS Subjects were r and omized to intervention or control groups . Parents in both groups were interviewed about their child 's health and use of health care services . The intervention group received education on pediatric health care issues ; the control group received usual PED discharge instructions . Use of the PED by all subjects was tracked for 6 months by telephone follow-up and medical record review . MAIN OUTCOME MEASURES Differences between the two groups in total number of return visits to the PED and return visits to the PED for minor illness . RESULTS Sixty-seven ( 97 % ) of the 69 patients in the intervention group and 56 ( 92 % ) of the 61 patients in the control group identified a primary care provider . At 6-month follow-up , 21 patients ( 30 % ) from the intervention group and 16 ( 26 % ) from the control group had returned to the PED ( P = .68 , chi 2 ) . Seventeen ( 81 % ) of intervention group returnees to the PED had minor illness , as did 11 ( 69 % ) of control group returnees . CONCLUSIONS A one-time educational intervention in the PED does not alter long-term emergency department utilization habits . More extensive education and greater availability of primary care providers may be needed to decrease use of the PED  for minor illness The aim of the study was to describe young families ' illness-behavior in connection with minor illness in children aged 0 - 8 years , and to assess the effect of delivered written health education . The effectiveness of written health education  in the management of minor illness was evaluated by a r and omized controlled trial . One hundred young families from one group practice were allocated at r and om to a study group and a control group . The study group received written health education . Health education result ed in more self-treatment and fewer contacts with the general practitioner ( GP ) , and the families indicated worry less often as the main reason for consulting the GP . The GPs ' assessment of the appropriateness of the families ' consultations showed no significant differences between the study and the control groups . It is recommended that GPs , in connection with prophylactic child examinations , h and over a patient education manual . This manual could form the basis for a dialogue between the GP and the parents when their child becomes ill Objective The aims of the study were to determine the following : 1 ) if a fever education program ( interactive or written ) reduces parent fever anxiety ; 2 ) if an interactive fever program was more effective as a teaching style than st and ard written material alone ; and 3 ) if a fever program increases parent fever home management and reduces return emergency department ( ED ) visits . Method A quasiexperimental , pretest and post-test pilot study examining parental fever anxiety was conducted at The Children ’s Hospital of Philadelphia . Eligible participants consisted of 87 parents and their children , aged 3 months to 5 years presenting with fever > 38.4 ° C , and without coexisting serious illness . Results Both the interactive fever education program and the st and ard written fever pamphlet were equally effective as teaching methods . Data revealed a 30 % reduction in fever anxiety rated as moderate-severe on arrival to none-low post-fever education , increased parent fever home management skills with correct use of thermometer and antipyretics , and reduced unnecessary return ED visits . Conclusion Parents in the acute and nonacute care setting may benefit from an interactive fever education program that includes the definition and benefit of fever , the correct use of a thermometer , fever home management skills , and appropriate fever telephone follow-up The Baby Check score card has been developed to help parents and health professionals grade the severity of acute illness in babies . This paper reports the results of two field trials in which mothers used Baby Check at home , 104 mothers scoring their babies daily for a week and 56 using it for six months . They all found Baby Check easy to use , between 68 % and 81 % found it useful , and 96 % would recommended it to others . Over 70 % of those using it daily used it very competently . Those using it infrequently did less well , suggesting that familiarity with the assessment is important . The scores obtained show that Baby Check 's use would not increase the number of mothers seeking medical advice . With introduction and practice most mothers should be able to use Baby Check effectively . It should help them assess their babies ' illnesses and make appropriate decisions about seeking medical advice IMPORTANCE Self-triage using web-based decision support could be a useful way to encourage appropriate care-seeking behavior and reduce health system surge in epidemics . However , the feasibility and safety of this strategy have not previously been evaluated . OBJECTIVE To assess the usability and safety of Strategy for Off-site Rapid Triage ( SORT ) for Kids , a web-based decision support tool design ed to translate clinical guidance developed by the Centers for Disease Control and Prevention to help parents and adult caregivers determine if a child with influenza-like illness requires immediate care in an emergency department ( ED ) . DESIGN Prospect i ve pilot validation study conducted between February 8 and April 30 , 2012 . Staff who abstract ed medical records and made follow-up calls were blinded to the SORT algorithm 's assessment of the child 's level of risk . SETTING Two pediatric emergency departments in the National Capital Region . PARTICIPANTS Convenience sample of 294 parents and adult caregivers who were at least 18 years of age ; able to read and speak English ; and the parent or legal guardian of a child 18 years or younger presenting to 1 of 2 EDs with signs and symptoms meeting Centers for Disease Control and Prevention criteria for influenza-like illness . INTERVENTION Completion of the SORT for Kids survey . MAIN OUTCOME MEASURES Caregiver ratings of the website 's usability and the sensitivity of the underlying algorithm for identifying children who required immediate ED management of influenza-like illness , defined as receipt of 1 or more of 5 essential clinical services . RESULTS Ninety percent of participants reported that the website was " very easy " to underst and and use . Ratings did not differ by respondent race , ethnicity , or educational attainment . Of the 15 patients whose initial ED visit met explicit criteria for clinical necessity , the Centers for Disease Control and Prevention algorithm classified 14 as high risk , result ing in an overall sensitivity of 93.3 % ( exact 95 % CI , 68.1%-99.8 % ) . Specificity of the algorithm was poor . CONCLUSIONS AND RELEVANCE This pilot study suggests that web-based decision support to help parents and adult caregivers self-triage children with influenza-like illness is feasible . However , prospect i ve refinement of the clinical algorithm is needed to improve its specificity without compromising patient safety Abstract Objective : To evaluate the effect of Baby Check , an illness scoring system for babies of 6 months or less , on parents ' use of health services for their baby . Design : R and omised controlled trial . Setting : 13 general practice s in Glasgow . Subjects : 997 newly delivered mothers , r and omised to receive either Baby Check and Play It Safe , an accident prevention leaflet ( n=497 ) , or Play It Safealone ( control group , n=500 ) . Main outcome measures : Data on consultations and referrals extracted from general practice notes after 6 months . Results : At the time of recruitment , maternal characteristics were similar for both groups ( mean maternal age 29 years ; deprivation categories 6 and 1 in both groups ; 424 ( 45 % ) mothers were primiparous ) . At 6 months , general practice notes were available for 467 ( 94 % ) of the Baby Check group and 468 ( 94 % ) of the control group . The number of general practitioner consultations did not differ between the groups : median number of consultations was 2 ( interquartile range 1 to 4 ) in the Baby Check group , and 2 ( 1 to 3 ) in the control group . Use of out of hours services did not differ significantly between the two groups ( 86 v 85 ; P=0.93 ) . Conclusion : Distributing Baby Check to an unselected group of mothers does not affect use of health services for infants up to 6 months of age To determine whether st and ardized instructions enhance communication of discharge information , we provided 197 parents of children in whom otitis media was diagnosed with one of three types of instruction at the time of discharge from a pediatric emergency department : ( 1 ) instruction by individual housestaff and medical students after consultation with an attending physician ( control group ) ; ( 2 ) st and ardized verbal instructions given by housestaff and students trained in their use ( verbal group ) ; or ( 3 ) the same instructions given to the verbal group , together with a type-written copy of the information to take home ( verbal + written group ) . Prior to leaving the emergency department and , again , by phone , 1 and 3 days later , parents were question ed concerning the prescribed medication 's name , dose , frequency , and duration of administration ( medication data ) , three signs of improvement , and eight signs indicating the need for medical advice ( worrisome signs ) . The mean percentage of correct responses per parent in each group was computed for each information category . Both at exit interview and at follow-up , parents receiving either form of st and ardized instructions showed significantly greater knowledge of information related to their child 's illness than did controls . Information regarding medication data was more likely to be communicated to parents in all groups than were signs of improvement or worrisome signs . The addition of written instructions to st and ardized verbal instructions did not improve parental recall of discharge information Objectives : This study aims to provide a better underst and ing of the motivations and actions of parents of children with non-urgent injury or illness who attend the emergency department at a tertiary paediatric hospital seeking care . Design : A prospect i ve question naire-based survey of 355 parents aim ed to ascertain information about parent care-giving and care-seeking behaviours prior to presentation at the emergency department with their child . Results : A total of 355 parents were surveyed , representing 8 % of the parents/carers presenting to the emergency department in a 3-month period for non-urgent ( Australasian Triage System 4 and 5 ) care of their child . The factors identified were : parents rated their child ’s condition as moderate to very serious ( 242 ( 68 % ) ) ; two-thirds of parents ( 234 ( 66 % ) ) had sought advice prior to attending the emergency department ; 54 % ( 77 ) of the 137 children who attended with an injury presented promptly to emergency ( ie , within 4 h of injury ) whereas of the 216 presenting with an illness , 41 % ( 88 ) presented within 2–7 days of the onset of the illness . Conclusions : This study displayed the accuracy of “ parental triage , ” that is , parents assess their child ’s 
    Output:
    
agent
***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 establish whether an interactive booklet on  respiratory tract infections in children reduces reconsultation for the same illness episode , reduces antibiotic use , and affects future consulting intentions , while maintaining parental satisfaction with care . Design Pragmatic cluster r and omised controlled trial . Setting 61 general practice s in Wales and Engl and . Participants 558 children ( 6 months to 14 years ) presenting to primary care with an acute respiratory tract infection ( 7 days or less ) . Children with suspected pneumonia , asthma or a serious concomitant illness , or needing immediate hospital admission were excluded . Three withdrew and 27 were lost to follow-up , leaving 528 ( 94.6 % ) with main outcome data . Interventions Clinicians in the intervention group were trained in the use of an interactive booklet on respiratory tract infections and asked to use the booklet during consultations with recruited patients ( and provide it as a take home re source ) . Clinicians in the control group conducted their consultations as usual . Main outcome measures The proportion of children who attended a face-to-face consultation about the same illness during the two week follow-up period . Secondary outcomes included antibiotic prescribing , antibiotic consumption , future consulting intentions , and parental satisfaction , reassurance , and enablement . Results Reconsultation occurred in 12.9 % of children in the intervention group and 16.2 % in the control group ( absolute risk reduction 3.3 % , 95 % confidence interval −2.7 % to 9.3 % , P=0.29 ) . Using multilevel modelling ( at the practice and individual level ) to account for clustering , no significant difference in reconsulting was noted ( odds ratio 0.75 ; 0.41 to 1.38 ) . Antibiotics were prescribed at the index consultation to 19.5 % of children in the intervention group and 40.8 % of children in the control group ( absolute risk reduction 21.3 % , 95 % confidence interval 13.7 to 28.9 ) , P<0.001 ) . A significant difference was still present after adjusting for clustering ( odds ratio 0.29 ; 0.14 to 0.60 ) . There was also a significant difference in the proportion of parents who said they would consult in the future if their child developed a similar illness ( odds ratio 0.34 ; 0.20 to 0.57 ) . Satisfaction , reassurance , and parental enablement scores were not significantly different between the two groups . Conclusions Use of a booklet on respiratory tract infections in children within primary care consultations led to important reductions in antibiotic prescribing and reduced intention to consult without reducing satisfaction with care . Trial registration Current Controlled Trials IS RCT OBJECTIVE To test the hypothesis that educating parents about use of their primary care provider and providing information about common pediatric illnesses will reduce visits to the pediatric emergency department ( PED ) . DESIGN Prospect i ve , r and omized , controlled trial conducted from September 1 , 1993 , to October 31 , 1994 . SETTING Pediatric emergency department of an urban university hospital . PARTICIPANTS Parents of 130 patients seen in the PED for minor illness . INTERVENTIONS Subjects were r and omized to intervention or control groups . Parents in both groups were interviewed about their child 's health and use of health care services . The intervention group received education on pediatric health care issues ; the control group received usual PED discharge instructions . Use of the PED by all subjects was tracked for 6 months by telephone follow-up and medical record review . MAIN OUTCOME MEASURES Differences between the two groups in total number of return visits to the PED and return visits to the PED for minor illness . RESULTS Sixty-seven ( 97 % ) of the 69 patients in the intervention group and 56 ( 92 % ) of the 61 patients in the control group identified a primary care provider . At 6-month follow-up , 21 patients ( 30 % ) from the intervention group and 16 ( 26 % ) from the control group had returned to the PED ( P = .68 , chi 2 ) . Seventeen ( 81 % ) of intervention group returnees to the PED had minor illness , as did 11 ( 69 % ) of control group returnees . CONCLUSIONS A one-time educational intervention in the PED does not alter long-term emergency department utilization habits . More extensive education and greater availability of primary care providers may be needed to decrease use of the PED  for minor illness The aim of the study was to describe young families ' illness-behavior in connection with minor illness in children aged 0 - 8 years , and to assess the effect of delivered written health education . The effectiveness of written health education  in the management of minor illness was evaluated by a r and omized controlled trial . One hundred young families from one group practice were allocated at r and om to a study group and a control group . The study group received written health education . Health education result ed in more self-treatment and fewer contacts with the general practitioner ( GP ) , and the families indicated worry less often as the main reason for consulting the GP . The GPs ' assessment of the appropriateness of the families ' consultations showed no significant differences between the study and the control groups . It is recommended that GPs , in connection with prophylactic child examinations , h and over a patient education manual . This manual could form the basis for a dialogue between the GP and the parents when their child becomes ill Objective The aims of the study were to determine the following : 1 ) if a fever education program ( interactive or written ) reduces parent fever anxiety ; 2 ) if an interactive fever program was more effective as a teaching style than st and ard written material alone ; and 3 ) if a fever program increases parent fever home management and reduces return emergency department ( ED ) visits . Method A quasiexperimental , pretest and post-test pilot study examining parental fever anxiety was conducted at The Children ’s Hospital of Philadelphia . Eligible participants consisted of 87 parents and their children , aged 3 months to 5 years presenting with fever > 38.4 ° C , and without coexisting serious illness . Results Both the interactive fever education program and the st and ard written fever pamphlet were equally effective as teaching methods . Data revealed a 30 % reduction in fever anxiety rated as moderate-severe on arrival to none-low post-fever education , increased parent fever home management skills with correct use of thermometer and antipyretics , and reduced unnecessary return ED visits . Conclusion Parents in the acute and nonacute care setting may benefit from an interactive fever education program that includes the definition and benefit of fever , the correct use of a thermometer , fever home management skills , and appropriate fever telephone follow-up The Baby Check score card has been developed to help parents and health professionals grade the severity of acute illness in babies . This paper reports the results of two field trials in which mothers used Baby Check at home , 104 mothers scoring their babies daily for a week and 56 using it for six months . They all found Baby Check easy to use , between 68 % and 81 % found it useful , and 96 % would recommended it to others . Over 70 % of those using it daily used it very competently . Those using it infrequently did less well , suggesting that familiarity with the assessment is important . The scores obtained show that Baby Check 's use would not increase the number of mothers seeking medical advice . With introduction and practice most mothers should be able to use Baby Check effectively . It should help them assess their babies ' illnesses and make appropriate decisions about seeking medical advice IMPORTANCE Self-triage using web-based decision support could be a useful way to encourage appropriate care-seeking behavior and reduce health system surge in epidemics . However , the feasibility and safety of this strategy have not previously been evaluated . OBJECTIVE To assess the usability and safety of Strategy for Off-site Rapid Triage ( SORT ) for Kids , a web-based decision support tool design ed to translate clinical guidance developed by the Centers for Disease Control and Prevention to help parents and adult caregivers determine if a child with influenza-like illness requires immediate care in an emergency department ( ED ) . DESIGN Prospect i ve pilot validation study conducted between February 8 and April 30 , 2012 . Staff who abstract ed medical records and made follow-up calls were blinded to the SORT algorithm 's assessment of the child 's level of risk . SETTING Two pediatric emergency departments in the National Capital Region . PARTICIPANTS Convenience sample of 294 parents and adult caregivers who were at least 18 years of age ; able to read and speak English ; and the parent or legal guardian of a child 18 years or younger presenting to 1 of 2 EDs with signs and symptoms meeting Centers for Disease Control and Prevention criteria for influenza-like illness . INTERVENTION Completion of the SORT for Kids survey . MAIN OUTCOME MEASURES Caregiver ratings of the website 's usability and the sensitivity of the underlying algorithm for identifying children who required immediate ED management of influenza-like illness , defined as receipt of 1 or more of 5 essential clinical services . RESULTS Ninety percent of participants reported that the website was " very easy " to underst and and use . Ratings did not differ by respondent race , ethnicity , or educational attainment . Of the 15 patients whose initial ED visit met explicit criteria for clinical necessity , the Centers for Disease Control and Prevention algorithm classified 14 as high risk , result ing in an overall sensitivity of 93.3 % ( exact 95 % CI , 68.1%-99.8 % ) . Specificity of the algorithm was poor . CONCLUSIONS AND RELEVANCE This pilot study suggests that web-based decision support to help parents and adult caregivers self-triage children with influenza-like illness is feasible . However , prospect i ve refinement of the clinical algorithm is needed to improve its specificity without compromising patient safety Abstract Objective : To evaluate the effect of Baby Check , an illness scoring system for babies of 6 months or less , on parents ' use of health services for their baby . Design : R and omised controlled trial . Setting : 13 general practice s in Glasgow . Subjects : 997 newly delivered mothers , r and omised to receive either Baby Check and Play It Safe , an accident prevention leaflet ( n=497 ) , or Play It Safealone ( control group , n=500 ) . Main outcome measures : Data on consultations and referrals extracted from general practice notes after 6 months . Results : At the time of recruitment , maternal characteristics were similar for both groups ( mean maternal age 29 years ; deprivation categories 6 and 1 in both groups ; 424 ( 45 % ) mothers were primiparous ) . At 6 months , general practice notes were available for 467 ( 94 % ) of the Baby Check group and 468 ( 94 % ) of the control group . The number of general practitioner consultations did not differ between the groups : median number of consultations was 2 ( interquartile range 1 to 4 ) in the Baby Check group , and 2 ( 1 to 3 ) in the control group . Use of out of hours services did not differ significantly between the two groups ( 86 v 85 ; P=0.93 ) . Conclusion : Distributing Baby Check to an unselected group of mothers does not affect use of health services for infants up to 6 months of age To determine whether st and ardized instructions enhance communication of discharge information , we provided 197 parents of children in whom otitis media was diagnosed with one of three types of instruction at the time of discharge from a pediatric emergency department : ( 1 ) instruction by individual housestaff and medical students after consultation with an attending physician ( control group ) ; ( 2 ) st and ardized verbal instructions given by housestaff and students trained in their use ( verbal group ) ; or ( 3 ) the same instructions given to the verbal group , together with a type-written copy of the information to take home ( verbal + written group ) . Prior to leaving the emergency department and , again , by phone , 1 and 3 days later , parents were question ed concerning the prescribed medication 's name , dose , frequency , and duration of administration ( medication data ) , three signs of improvement , and eight signs indicating the need for medical advice ( worrisome signs ) . The mean percentage of correct responses per parent in each group was computed for each information category . Both at exit interview and at follow-up , parents receiving either form of st and ardized instructions showed significantly greater knowledge of information related to their child 's illness than did controls . Information regarding medication data was more likely to be communicated to parents in all groups than were signs of improvement or worrisome signs . The addition of written instructions to st and ardized verbal instructions did not improve parental recall of discharge information Objectives : This study aims to provide a better underst and ing of the motivations and actions of parents of children with non-urgent injury or illness who attend the emergency department at a tertiary paediatric hospital seeking care . Design : A prospect i ve question naire-based survey of 355 parents aim ed to ascertain information about parent care-giving and care-seeking behaviours prior to presentation at the emergency department with their child . Results : A total of 355 parents were surveyed , representing 8 % of the parents/carers presenting to the emergency department in a 3-month period for non-urgent ( Australasian Triage System 4 and 5 ) care of their child . The factors identified were : parents rated their child ’s condition as moderate to very serious ( 242 ( 68 % ) ) ; two-thirds of parents ( 234 ( 66 % ) ) had sought advice prior to attending the emergency department ; 54 % ( 77 ) of the 137 children who attended with an injury presented promptly to emergency ( ie , within 4 h of injury ) whereas of the 216 presenting with an illness , 41 % ( 88 ) presented within 2–7 days of the onset of the illness . Conclusions : This study displayed the accuracy of “ parental triage , ” that is , parents assess their child ’s 
    Output:
    