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: Improved pneumococcal vaccine ( PPV ) immunization for seniors is a national goal of the Medicare program . This study examined whether adding a simple telephone follow-up to an existing mailed physician performance feedback under the Medicare program would increase the impact on billed pneumococcal immunizations . Medicare fee-for-service cl aims data were used to select New York primary care physicians with high volume ( n = 732 ) or African-American serving ( n = 329 ) practice s. All practice s received mailed feedback on their 1999 Medicare practice specific PPV coverage rates , along with educational material s and offers of assistance . Practice s were also r and omized to receive telephone calls directing attention to the mailing and further promoting improvements in PPV coverage or no active follow-up . Physicians r and omized to telephone follow-up showed significantly higher rates of practice specific PPV coverage in 2000 than those receiving the routine mailing only , and 27 % vs. 17 % ( p = 0.01 ) of high volume physicians and 34 % vs. 22 % ( p = .052 ) of African American serving physicians achieved at least a 5 % increase in their cumulative PPV cl aims coverage . This study concludes that telephone follow-up is an effective and straightforward method to enhance the impact of practice specific feedback to promote improvements in Medicare PPV immunization . However , improved methods may be needed to induce a large percentage of physicians to change BACKGROUND Immunisation against influenza is an effective intervention that reduces serologically confirmed cases by between 60 % and 70 % . Almost all influenza immunisation in the UK is done within general practice . Current evidence on the effectiveness of patient reminders for all types of immunisation programmes is largely based on North American studies . AIM To determine whether telephone appointments offered bygeneral practice receptionists increase the uptake of irfluenza immunisation among the registered population aged over 65 years in east London practice s. DESIGN OF STUDY R and omised controlled trial . SETTING Three research general practice s within the East London and Essex network of research ers ( ELENoR ) . METHOD Participants were 1,820 low-risk patients aged 65 to 74 years who had not previously been in a recall system for influenza immunisation at their general practice . The intervention , during October 2000 , was a telephone call from the practice receptionist to intervention group households , offering an appointment for influenza immunisation at a nurse-run . clinic Main outcome measures were the numbers of individuals in each group receiving immunisation , and practice costs of a telephone-appointing programme . RESULTS intention to treat analysis showed an immunisation rate in the control group of 44 % , compared with 50 % in the intervention group ( odds ratio = 1.29 , 95 % confidence interval = 1.03 to 1.63 ) . Of the patients making a telephone appointment  , 88 % recieved immunisation , while 22 % of those not wanting an appointment went on to be immunised . In the controlgroup , income generated was 11.35 pounds per immunisation , for each additional immunisation in the intervention group the income was 5.20 pounds . The ' number needed to telephone ' was 17 . CONCLUSION Uptake of influenza immunisation among the low-risk older population in inner-city areas can be boosted by around 6 % using a simple intervention by receptionists . Immunisation rates in this low-risk group fell well short of the 60 % government target . Improving immunisation rates will require a sustained public health campaign . Retaining the item-of-service payments to practice s should support costs of practice -based interventions OBJECTIVES To determine national adult  immunization rates  for influenza and pneumonia and assess the effect of various predisposing factors on immunization status for both diseases . DESIGN Retrospective , cross-sectional , r and om national sample data from the Centers for Disease Control and Prevention 's 1999 Behavioral Risk Factor Surveillance System survey . Data extraction and analysis were conducted using SPSS and STATA , with adjustments made for weighted data . PARTICIPANTS Individuals aged 65 years and older and individuals aged 50 to 64 years ( for influenza only ) . RESULTS Immunization rates in the 65 and older age group were 66.7 % for influenza and 53.8 % for pneumonia ; immunization rate for influenza in the 50 to 64 age group was 35.6 % . Predisposing factors such as race ( white ) and education ( high school and above ) positively influenced immunization status . Enabling factors such as income , health insurance , and physician visits and need-related factors such as health status and comorbidities exhibited a strong relationship with influenza and pneumonia vaccination status in both study population s. Health care coverage ( odds ratio [ OR ] = 1.76 for influenza and OR = 1.66 for pneumonia in the 65 years and older group ; OR = 1.80 for influenza in the 50 to 64 years age group ) and physician visit in the last year ( OR = 2.00 for influenza and OR = 1.87 for pneumonia for 65 years and older group ; OR = 1.86 for influenza in the 50 to 64 years age group ) were strong positive predictors of vaccination status . Individuals with comorbidities and those who perceived their health as being poor had high vaccination rates . CONCLUSION Underst and ing the positive and negative influences on adult immunization status will allow pharmacists to better identify and target prospect i ve recipients of immunization services PURPOSE To determine whether an educational brochure or a lottery-type incentive increases influenza immunization rates . PATIENTS AND METHODS In a prospect i ve , single-blind factorial design r and omized trial at an urban community health center , all high-risk patients ( n = 797 ) seen in the preceding 18 months were r and omly assigned to one of four groups : a control group ; a group mailed a large print , illustrated educational brochure emphasizing factors important to patients in making a decision about influenza immunization ; a group mailed a lottery-type incentive announcing that all patients receiving influenza immunization  would be eligible for grocery gift certificates ; and a group mailed both educational brochure and incentive . Immunization was free , available without an appointment , and recorded by a computerized tracking system . RESULTS The group mailed the brochure was more likely to be immunized than control ( odds ratio [ OR ] = 2.29 , 95 % confidence interval [ CI ] 1.45 to 3.61 ) , as was the group mailed the incentive ( OR = 1.68 , 95 % CI 1.05 to 2.68 ) , but there was no difference between the group mailed both interventions and the control group . The effectiveness of the brochure was more striking for individuals who had not accepted immunization in the prior year ( OR = 4.21 , 95 % CI 2.48 to 7.14 ) , suggesting a true educational effect rather than simply a reminder . CONCLUSION In this community health center setting , an illustrated educational brochure increased influenza immunization among high-risk patients , a lottery-type incentive was much less effective , and both together was not effective BACKGROUND Influenza is responsible for significant morbidity , mortality , and medical costs , but immunization rates in the elderly remain low . METHODS As part of a demonstration project in rural Pennsylvania , 1,989 community-dwelling Medicare beneficiaries , 65 - 79 years old , completed a health risk appraisal including questions about flu shots . Participants were r and omized to two experimental ( hospital or physician ) or control groups . Experimental groups were offered free flu shots for the 1990 - 91 flu season . Follow-up interviews to determine vaccination rates were completed about 1 year later . RESULTS Baseline immunization rates were almost identical for the hospital-based ( 41.2 % ) , physician-based ( 41.3 % ) , and control group not offered free immunizations ( 40.6 % ) . Follow-up rates for the groups offered immunizations rose significantly to 63.6 and 69.1 % for hospital and physician groups , respectively , while the control group also increased significantly to 54.1 % . Individuals who were more educated , were older , and had greater chronic diseases history ( myocardial infa rct ion , hypertension , and pulmonary disease ) were more likely to be immunized . Male and married elderly were more likely to be immunized as a result of the demonstration . CONCLUSIONS Increasing community education and providing immunizations free through Medicare will increase immunization rates among elderly . The elderly are more likely to receive flu shots provided through physicians ' offices than through hospital-based clinics OBJECTIVES To determine the proportion of patients vaccinated with pneumococcal ( PVAX ) and influenza ( IVAX ) vaccines under an emergency department ( ED ) vaccination program , that would not otherwise have been vaccinated by other primary care re sources . METHODS This prospect i ve cohort study was performed in a tertiary care academic centre . A question naire was administered to all consenting ED patients who met screening eligibility criteria to receive either IVAX or PVAX . Eligible unvaccinated patients who did not plan on receiving vaccination elsewhere were offered one or both of the vaccines and , if agreeable , were immunized in the ED . RESULTS During the 4-week study period , 754 patients ( 36 % of all presenting ED patients ) were eligible for vaccination with one or both vaccines . Of these 525 ( 70 % ) consented to participate in the study and completed a question naire . Of the 525 participants , 289 ( 55 % of IVAX eligible patients ; 95 % confidence interval [ CI ] , 51%-59 % ) were unvaccinated against influenza that year and did not plan on being vaccinated elsewhere and 277 ( 60 % of PVAX eligible patients ; 95 % CI , 56%-64 % ) were unvaccinated against pneumococcus and did not plan on being vaccinated elsewhere . IVAX was administered to 187 patients ( 65 % penetration ; 95 % CI , 59%-70 % ) , and PVAX was administered to 165 patients ( 60 % penetration ; 95 % CI , 54%-65 % ) . Overall vaccine penetration was 46 % ( 95 % CI , 42%-50 % ) in the study participants and 32 % ( 95 % CI , 29%-35 % ) for the entire ED screened and eligible group . Reasons for vaccination refusal included concerns about benefit , side effects , and the desire to discuss vaccination with their primary care physician . CONCLUSIONS An ED-based program can result in the vaccination of a significant proportion of patients eligible for IVAX and /or PVAX who would otherwise likely go unprotected BACKGROUND Immunizations decrease morbidity from influenza and pneumococcal infections . Immunization levels remain below desired levels despite clinic-based and public education efforts . This paper describes a r and omized , controlled trial of a senior center-based program , which used peer-to-peer outreach to increase pneumococcal and influenza immunization rates among an urban senior population . METHODS Seniors were r and omized to intervention or control groups . The intervention group received educational brochures mailed with reply cards to report immunization status , telephone calls from senior volunteers to unimmunized participants , and computerized immunization tracking .  Immunization rates were obtained before and after the intervention by self-report . RESULTS Among participants without prior pneumococcal immunization , the pneumococcal immunization rate among the intervention group ( 52.0 % ; 95 % CI = 46.6%-57.4 % ) was significantly higher than that of the control group ( 30.9 % ; 95 % CI = 26.6%-35.2 % ) ( rate ratio = 1.68 ; 95 % CI = 1.40 - 2.03 ) . Among those without influenza immunization in the prior year , significantly more ( 50.0 % ; 95 % CI = 40.0%-60.0 % ) were immunized against influenza in the intervention group than in the control group ( 23.0 % ; 95 % CI = 15.2%-33.3 % ) ( rate ratio = 2.17 ; 95 % CI = 1.42 - 3.31 ) . Among those with influenza immunization in the prior year , the rate ratio was 1.04 ( 95 % CI = 1.01 - 1.07 ) . CONCLUSIONS The intervention increased both influenza and pneumococcal immunization rates to high levels , suggesting that further progress in increasing adult immunization coverage is possible OBJECTIVE To compare three approaches for improving compliance with influenza and pneumococcal vaccination of elderly patients . DESIGN R and omized controlled trial using three parallel group practice s at a public urban teaching hospital . SETTING Public teaching hospital . SUBJECTS All patients 65 years of age and older ( n = 1202 ) seen by resident physicians ( n = 66 ) attending three ambulatory medical practice s from October 1 , 1989 to March 31 , 1990 . INTERVENTIONS All three provider groups received intensive education in immunization st and ards . The control group received no further intervention . Staff in the second group offered education to patients at their visits . In the third group , the prevention team , a flowsheet was used , patient education offered , and staff had their tasks redefined to facilitate compliance ; for vaccinations , eg , 
    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: Improved pneumococcal vaccine ( PPV ) immunization for seniors is a national goal of the Medicare program . This study examined whether adding a simple telephone follow-up to an existing mailed physician performance feedback under the Medicare program would increase the impact on billed pneumococcal immunizations . Medicare fee-for-service cl aims data were used to select New York primary care physicians with high volume ( n = 732 ) or African-American serving ( n = 329 ) practice s. All practice s received mailed feedback on their 1999 Medicare practice specific PPV coverage rates , along with educational material s and offers of assistance . Practice s were also r and omized to receive telephone calls directing attention to the mailing and further promoting improvements in PPV coverage or no active follow-up . Physicians r and omized to telephone follow-up showed significantly higher rates of practice specific PPV coverage in 2000 than those receiving the routine mailing only , and 27 % vs. 17 % ( p = 0.01 ) of high volume physicians and 34 % vs. 22 % ( p = .052 ) of African American serving physicians achieved at least a 5 % increase in their cumulative PPV cl aims coverage . This study concludes that telephone follow-up is an effective and straightforward method to enhance the impact of practice specific feedback to promote improvements in Medicare PPV immunization . However , improved methods may be needed to induce a large percentage of physicians to change BACKGROUND Immunisation against influenza is an effective intervention that reduces serologically confirmed cases by between 60 % and 70 % . Almost all influenza immunisation in the UK is done within general practice . Current evidence on the effectiveness of patient reminders for all types of immunisation programmes is largely based on North American studies . AIM To determine whether telephone appointments offered bygeneral practice receptionists increase the uptake of irfluenza immunisation among the registered population aged over 65 years in east London practice s. DESIGN OF STUDY R and omised controlled trial . SETTING Three research general practice s within the East London and Essex network of research ers ( ELENoR ) . METHOD Participants were 1,820 low-risk patients aged 65 to 74 years who had not previously been in a recall system for influenza immunisation at their general practice . The intervention , during October 2000 , was a telephone call from the practice receptionist to intervention group households , offering an appointment for influenza immunisation at a nurse-run . clinic Main outcome measures were the numbers of individuals in each group receiving immunisation , and practice costs of a telephone-appointing programme . RESULTS intention to treat analysis showed an immunisation rate in the control group of 44 % , compared with 50 % in the intervention group ( odds ratio = 1.29 , 95 % confidence interval = 1.03 to 1.63 ) . Of the patients making a telephone appointment  , 88 % recieved immunisation , while 22 % of those not wanting an appointment went on to be immunised . In the controlgroup , income generated was 11.35 pounds per immunisation , for each additional immunisation in the intervention group the income was 5.20 pounds . The ' number needed to telephone ' was 17 . CONCLUSION Uptake of influenza immunisation among the low-risk older population in inner-city areas can be boosted by around 6 % using a simple intervention by receptionists . Immunisation rates in this low-risk group fell well short of the 60 % government target . Improving immunisation rates will require a sustained public health campaign . Retaining the item-of-service payments to practice s should support costs of practice -based interventions OBJECTIVES To determine national adult  immunization rates  for influenza and pneumonia and assess the effect of various predisposing factors on immunization status for both diseases . DESIGN Retrospective , cross-sectional , r and om national sample data from the Centers for Disease Control and Prevention 's 1999 Behavioral Risk Factor Surveillance System survey . Data extraction and analysis were conducted using SPSS and STATA , with adjustments made for weighted data . PARTICIPANTS Individuals aged 65 years and older and individuals aged 50 to 64 years ( for influenza only ) . RESULTS Immunization rates in the 65 and older age group were 66.7 % for influenza and 53.8 % for pneumonia ; immunization rate for influenza in the 50 to 64 age group was 35.6 % . Predisposing factors such as race ( white ) and education ( high school and above ) positively influenced immunization status . Enabling factors such as income , health insurance , and physician visits and need-related factors such as health status and comorbidities exhibited a strong relationship with influenza and pneumonia vaccination status in both study population s. Health care coverage ( odds ratio [ OR ] = 1.76 for influenza and OR = 1.66 for pneumonia in the 65 years and older group ; OR = 1.80 for influenza in the 50 to 64 years age group ) and physician visit in the last year ( OR = 2.00 for influenza and OR = 1.87 for pneumonia for 65 years and older group ; OR = 1.86 for influenza in the 50 to 64 years age group ) were strong positive predictors of vaccination status . Individuals with comorbidities and those who perceived their health as being poor had high vaccination rates . CONCLUSION Underst and ing the positive and negative influences on adult immunization status will allow pharmacists to better identify and target prospect i ve recipients of immunization services PURPOSE To determine whether an educational brochure or a lottery-type incentive increases influenza immunization rates . PATIENTS AND METHODS In a prospect i ve , single-blind factorial design r and omized trial at an urban community health center , all high-risk patients ( n = 797 ) seen in the preceding 18 months were r and omly assigned to one of four groups : a control group ; a group mailed a large print , illustrated educational brochure emphasizing factors important to patients in making a decision about influenza immunization ; a group mailed a lottery-type incentive announcing that all patients receiving influenza immunization  would be eligible for grocery gift certificates ; and a group mailed both educational brochure and incentive . Immunization was free , available without an appointment , and recorded by a computerized tracking system . RESULTS The group mailed the brochure was more likely to be immunized than control ( odds ratio [ OR ] = 2.29 , 95 % confidence interval [ CI ] 1.45 to 3.61 ) , as was the group mailed the incentive ( OR = 1.68 , 95 % CI 1.05 to 2.68 ) , but there was no difference between the group mailed both interventions and the control group . The effectiveness of the brochure was more striking for individuals who had not accepted immunization in the prior year ( OR = 4.21 , 95 % CI 2.48 to 7.14 ) , suggesting a true educational effect rather than simply a reminder . CONCLUSION In this community health center setting , an illustrated educational brochure increased influenza immunization among high-risk patients , a lottery-type incentive was much less effective , and both together was not effective BACKGROUND Influenza is responsible for significant morbidity , mortality , and medical costs , but immunization rates in the elderly remain low . METHODS As part of a demonstration project in rural Pennsylvania , 1,989 community-dwelling Medicare beneficiaries , 65 - 79 years old , completed a health risk appraisal including questions about flu shots . Participants were r and omized to two experimental ( hospital or physician ) or control groups . Experimental groups were offered free flu shots for the 1990 - 91 flu season . Follow-up interviews to determine vaccination rates were completed about 1 year later . RESULTS Baseline immunization rates were almost identical for the hospital-based ( 41.2 % ) , physician-based ( 41.3 % ) , and control group not offered free immunizations ( 40.6 % ) . Follow-up rates for the groups offered immunizations rose significantly to 63.6 and 69.1 % for hospital and physician groups , respectively , while the control group also increased significantly to 54.1 % . Individuals who were more educated , were older , and had greater chronic diseases history ( myocardial infa rct ion , hypertension , and pulmonary disease ) were more likely to be immunized . Male and married elderly were more likely to be immunized as a result of the demonstration . CONCLUSIONS Increasing community education and providing immunizations free through Medicare will increase immunization rates among elderly . The elderly are more likely to receive flu shots provided through physicians ' offices than through hospital-based clinics OBJECTIVES To determine the proportion of patients vaccinated with pneumococcal ( PVAX ) and influenza ( IVAX ) vaccines under an emergency department ( ED ) vaccination program , that would not otherwise have been vaccinated by other primary care re sources . METHODS This prospect i ve cohort study was performed in a tertiary care academic centre . A question naire was administered to all consenting ED patients who met screening eligibility criteria to receive either IVAX or PVAX . Eligible unvaccinated patients who did not plan on receiving vaccination elsewhere were offered one or both of the vaccines and , if agreeable , were immunized in the ED . RESULTS During the 4-week study period , 754 patients ( 36 % of all presenting ED patients ) were eligible for vaccination with one or both vaccines . Of these 525 ( 70 % ) consented to participate in the study and completed a question naire . Of the 525 participants , 289 ( 55 % of IVAX eligible patients ; 95 % confidence interval [ CI ] , 51%-59 % ) were unvaccinated against influenza that year and did not plan on being vaccinated elsewhere and 277 ( 60 % of PVAX eligible patients ; 95 % CI , 56%-64 % ) were unvaccinated against pneumococcus and did not plan on being vaccinated elsewhere . IVAX was administered to 187 patients ( 65 % penetration ; 95 % CI , 59%-70 % ) , and PVAX was administered to 165 patients ( 60 % penetration ; 95 % CI , 54%-65 % ) . Overall vaccine penetration was 46 % ( 95 % CI , 42%-50 % ) in the study participants and 32 % ( 95 % CI , 29%-35 % ) for the entire ED screened and eligible group . Reasons for vaccination refusal included concerns about benefit , side effects , and the desire to discuss vaccination with their primary care physician . CONCLUSIONS An ED-based program can result in the vaccination of a significant proportion of patients eligible for IVAX and /or PVAX who would otherwise likely go unprotected BACKGROUND Immunizations decrease morbidity from influenza and pneumococcal infections . Immunization levels remain below desired levels despite clinic-based and public education efforts . This paper describes a r and omized , controlled trial of a senior center-based program , which used peer-to-peer outreach to increase pneumococcal and influenza immunization rates among an urban senior population . METHODS Seniors were r and omized to intervention or control groups . The intervention group received educational brochures mailed with reply cards to report immunization status , telephone calls from senior volunteers to unimmunized participants , and computerized immunization tracking .  Immunization rates were obtained before and after the intervention by self-report . RESULTS Among participants without prior pneumococcal immunization , the pneumococcal immunization rate among the intervention group ( 52.0 % ; 95 % CI = 46.6%-57.4 % ) was significantly higher than that of the control group ( 30.9 % ; 95 % CI = 26.6%-35.2 % ) ( rate ratio = 1.68 ; 95 % CI = 1.40 - 2.03 ) . Among those without influenza immunization in the prior year , significantly more ( 50.0 % ; 95 % CI = 40.0%-60.0 % ) were immunized against influenza in the intervention group than in the control group ( 23.0 % ; 95 % CI = 15.2%-33.3 % ) ( rate ratio = 2.17 ; 95 % CI = 1.42 - 3.31 ) . Among those with influenza immunization in the prior year , the rate ratio was 1.04 ( 95 % CI = 1.01 - 1.07 ) . CONCLUSIONS The intervention increased both influenza and pneumococcal immunization rates to high levels , suggesting that further progress in increasing adult immunization coverage is possible OBJECTIVE To compare three approaches for improving compliance with influenza and pneumococcal vaccination of elderly patients . DESIGN R and omized controlled trial using three parallel group practice s at a public urban teaching hospital . SETTING Public teaching hospital . SUBJECTS All patients 65 years of age and older ( n = 1202 ) seen by resident physicians ( n = 66 ) attending three ambulatory medical practice s from October 1 , 1989 to March 31 , 1990 . INTERVENTIONS All three provider groups received intensive education in immunization st and ards . The control group received no further intervention . Staff in the second group offered education to patients at their visits . In the third group , the prevention team , a flowsheet was used , patient education offered , and staff had their tasks redefined to facilitate compliance ; for vaccinations , eg , 
    Output:
    