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: PURPOSE Although vaccination of health care workers against influenza is widely recommended , vaccination uptake is low . Data on interventions to increase staff immunization in primary care are lacking . We examine the effect of a promotional and educational intervention program , not addressing vaccine availability , to raise the influenza vaccination rate among staff in primary care clinics . METHODS The study included all 344 staff members with direct patient contact ( physicians , nurses , pharmacists , and administrative and ancillary staff ) in 27 primary care community clinics in the Jerusalem area during the 2007–2008 influenza season . Thirteen clinics were r and omly selected for an intervention that consisted of a lecture session given by a family physician , e-mail-distributed literature and reminders , and a key figure from the local staff who personally approached each staff member .  RESULTS Influenza immunization rate was 52.8 % ( 86 of 163 ) in the intervention group compared with 26.5 % ( 48 of 181 ) in the control group ( P<.001 ) . When compared with the rate of immunization for the previous season , the absolute increase in immunization rate was 25.8 % in the intervention clinics and 6.6 % in the control clinics . Multivariate analysis showed a highly significant ( P<.001 ) independent association between intervention and immunization , with an odds ratio of 3.51 ( 95 % confidence interval , 2.03–6.09 ) . CONCLUSION We have developed an effective intervention program to increase previously low vaccination rates among primary health care workers . This simple intervention could be reproduced easily in other clinics and organizations with an expected substantial increase in influenza immunization rates OBJECTIVE To assess  influenza vaccination status and influenza vaccination practice s of family physicians in Quebec . DESIGN Mail survey of a r and om sample of 1000 family physicians . SETTING Family practice s in the province of Quebec . PARTICIPANTS Of 1000 Quebec family physicians sent question naires , 550 responded . After excluding physicians who worked only in institutions , had no patients older than 65 years , or did clinical work less than 20 % of the time , 379 respondents were eligible for the study . MAIN OUTCOME MEASURES Vaccination status of family physicians in 1996 and professional practice s based on six clinical and administrative activities pertaining to influenza vaccination . RESULTS Prevalence of vaccination was 35.5 % ( 95 % confidence interval 30.8 % to 40.4 % ) among responding physicians and was higher among those 60 years and older , those with a chronic condition , and those perceiving high peer pressure to get vaccinated . Most respondents frequently assessed the current influenza vaccination status of their patients , risk factors for influenza-related complications , and contraindications to the vaccine . They also frequently provided education about influenza and its vaccine  ,  recommended vaccination  , and  administered the vaccine .  Only a few reported assessing prior influenza vaccinations or recording vaccination status regularly . Finally , vaccinated physicians recommended the vaccine more frequently to their patients than unvaccinated physicians did . CONCLUSION Promotion programs focusing on peer influence could increase vaccination of family physicians . This could in turn improve vaccination coverage of elderly patients In a r and omized controlled trial , an intensive promotional campaign failed to increase the uptake of vaccination against influenza among health care workers . The uptake of vaccination was low 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 Influenza vaccination of health care workers ( HCW ) is widely recommended , but immunization rates are low . In order to assess performance among primary HCW and identify barriers , we conducted a survey among the staff of 27 primary care community clinics in Jerusalem . The low rate of vaccination ( 30.2 % ) was in contrast with the large proportion of HCW who considered it desirable to immunize primary health clinic staff ( 72.1 % ) . Physicians reported having been immunized significantly more ( p=0.008 ) than the rest of the staff . They also had better knowledge and more favorable attitude towards immunization . Also associated ( independently of profession ) with performance of immunization were age ( p<0.001 ) , knowledge ( that immunization can not cause influenza , p=0.051 ) , attitude ( the belief that it is desirable to immunize primary HCW , p<0.001 ) , previous years ' performance of immunization ( p<0.001 ) and a physician 's recommendation ( p=0.042 ) . A media scare which occurred during the vaccination period was reported to have influenced the decision not to get immunized of 34.1 % of HCW who had not been immunized . The study results raise hope of prospect i ve increase in vaccination through educational and technical interventions and by increasing physician involvement In previous years , the influenza vaccination rate among Dutch general practitioners ( GPs ) was low ( 36 % during the 2007/2008 season ) . Since 2008 , yearly influenza vaccination has been actively recommended for GPs in The Netherl and s. Moreover , in 2009 the Dutch government urged healthcare workers to receive additional vaccination against the p and emic influenza ( A/H1N1 ) . The effects of these recommendations are unknown . In February 2010 , a question naire was mailed to r and om sample s of GPs ( n=810 ) and GP-trainees ( n=300 ) .  Vaccination rates were determined and motives and barriers for vaccination were assessed . The response rates for GPs and GP-trainees were 83 % and 90 % , respectively . In total , 63 % of the GPs were vaccinated against seasonal influenza and 85 % against p and emic ( A/H1N1 ) influenza . For GP-trainees , these percentages were 47 % and 77 % , respectively . With regard to the medical staff working in the respondents ' practice s , 60 % received the seasonal and 76 % the p and emic ( A/H1N1 ) influenza vaccine . Reducing the risk of transmitting the virus to vulnerable patients and the individual 's personal protection were the most frequently reported motives for vaccination . Having no medical indication for influenza vaccination and the conviction of being protected against influenza because of frequent professional exposure to the virus were the most frequently mentioned reasons for not being vaccinated . In conclusion , the seasonal influenza vaccination rate among Dutch GPs has risen considerably since the previous survey and the vaccination rate against p and emic ( A/H1N1 ) influenza was very high . Moreover , Dutch GPs were convinced that influenza vaccination will reduce the risk of transmitting the virus to their patients This study sought : to describe  influenza vaccination coverages  among COPD patients treated in a primary -care setting ; and to analyse the factors linked to compliance with vaccination recommendations . This was a descriptive study in a primary -care ( PC ) setting . Each of the 2422 r and omly selected medical practitioners included in the study was required to recruit five COPD patients . Information was drawn from patients ' clinical histories and personal interviews . As the dependent variable , we took the answer ( yes or no ) to the question , " did you have an  influenza vaccination  in the most recent campaign ? " ; and as independent variables , we analysed socio-demographic data , health-status related variables , lifestyles and history of pneumococcal vaccination .  A total of 10,711 patients were enrolled 87.2 % reported having been vaccinated in the most recent campaign . In conclusion , Spanish COPD patients treated in a primary -care setting can be said to enjoy good vaccine coverages against the influenza virus . More frequent contact with the general practitioner and a history of pneumococcal vaccination increase the likelihood of being vaccinated considerably , and measures should be implemented with the aim of improving coverages among younger subjects and those who lead less healthy lifestyles 
    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: PURPOSE Although vaccination of health care workers against influenza is widely recommended , vaccination uptake is low . Data on interventions to increase staff immunization in primary care are lacking . We examine the effect of a promotional and educational intervention program , not addressing vaccine availability , to raise the influenza vaccination rate among staff in primary care clinics . METHODS The study included all 344 staff members with direct patient contact ( physicians , nurses , pharmacists , and administrative and ancillary staff ) in 27 primary care community clinics in the Jerusalem area during the 2007–2008 influenza season . Thirteen clinics were r and omly selected for an intervention that consisted of a lecture session given by a family physician , e-mail-distributed literature and reminders , and a key figure from the local staff who personally approached each staff member .  RESULTS Influenza immunization rate was 52.8 % ( 86 of 163 ) in the intervention group compared with 26.5 % ( 48 of 181 ) in the control group ( P<.001 ) . When compared with the rate of immunization for the previous season , the absolute increase in immunization rate was 25.8 % in the intervention clinics and 6.6 % in the control clinics . Multivariate analysis showed a highly significant ( P<.001 ) independent association between intervention and immunization , with an odds ratio of 3.51 ( 95 % confidence interval , 2.03–6.09 ) . CONCLUSION We have developed an effective intervention program to increase previously low vaccination rates among primary health care workers . This simple intervention could be reproduced easily in other clinics and organizations with an expected substantial increase in influenza immunization rates OBJECTIVE To assess  influenza vaccination status and influenza vaccination practice s of family physicians in Quebec . DESIGN Mail survey of a r and om sample of 1000 family physicians . SETTING Family practice s in the province of Quebec . PARTICIPANTS Of 1000 Quebec family physicians sent question naires , 550 responded . After excluding physicians who worked only in institutions , had no patients older than 65 years , or did clinical work less than 20 % of the time , 379 respondents were eligible for the study . MAIN OUTCOME MEASURES Vaccination status of family physicians in 1996 and professional practice s based on six clinical and administrative activities pertaining to influenza vaccination . RESULTS Prevalence of vaccination was 35.5 % ( 95 % confidence interval 30.8 % to 40.4 % ) among responding physicians and was higher among those 60 years and older , those with a chronic condition , and those perceiving high peer pressure to get vaccinated . Most respondents frequently assessed the current influenza vaccination status of their patients , risk factors for influenza-related complications , and contraindications to the vaccine . They also frequently provided education about influenza and its vaccine  ,  recommended vaccination  , and  administered the vaccine .  Only a few reported assessing prior influenza vaccinations or recording vaccination status regularly . Finally , vaccinated physicians recommended the vaccine more frequently to their patients than unvaccinated physicians did . CONCLUSION Promotion programs focusing on peer influence could increase vaccination of family physicians . This could in turn improve vaccination coverage of elderly patients In a r and omized controlled trial , an intensive promotional campaign failed to increase the uptake of vaccination against influenza among health care workers . The uptake of vaccination was low 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 Influenza vaccination of health care workers ( HCW ) is widely recommended , but immunization rates are low . In order to assess performance among primary HCW and identify barriers , we conducted a survey among the staff of 27 primary care community clinics in Jerusalem . The low rate of vaccination ( 30.2 % ) was in contrast with the large proportion of HCW who considered it desirable to immunize primary health clinic staff ( 72.1 % ) . Physicians reported having been immunized significantly more ( p=0.008 ) than the rest of the staff . They also had better knowledge and more favorable attitude towards immunization . Also associated ( independently of profession ) with performance of immunization were age ( p<0.001 ) , knowledge ( that immunization can not cause influenza , p=0.051 ) , attitude ( the belief that it is desirable to immunize primary HCW , p<0.001 ) , previous years ' performance of immunization ( p<0.001 ) and a physician 's recommendation ( p=0.042 ) . A media scare which occurred during the vaccination period was reported to have influenced the decision not to get immunized of 34.1 % of HCW who had not been immunized . The study results raise hope of prospect i ve increase in vaccination through educational and technical interventions and by increasing physician involvement In previous years , the influenza vaccination rate among Dutch general practitioners ( GPs ) was low ( 36 % during the 2007/2008 season ) . Since 2008 , yearly influenza vaccination has been actively recommended for GPs in The Netherl and s. Moreover , in 2009 the Dutch government urged healthcare workers to receive additional vaccination against the p and emic influenza ( A/H1N1 ) . The effects of these recommendations are unknown . In February 2010 , a question naire was mailed to r and om sample s of GPs ( n=810 ) and GP-trainees ( n=300 ) .  Vaccination rates were determined and motives and barriers for vaccination were assessed . The response rates for GPs and GP-trainees were 83 % and 90 % , respectively . In total , 63 % of the GPs were vaccinated against seasonal influenza and 85 % against p and emic ( A/H1N1 ) influenza . For GP-trainees , these percentages were 47 % and 77 % , respectively . With regard to the medical staff working in the respondents ' practice s , 60 % received the seasonal and 76 % the p and emic ( A/H1N1 ) influenza vaccine . Reducing the risk of transmitting the virus to vulnerable patients and the individual 's personal protection were the most frequently reported motives for vaccination . Having no medical indication for influenza vaccination and the conviction of being protected against influenza because of frequent professional exposure to the virus were the most frequently mentioned reasons for not being vaccinated . In conclusion , the seasonal influenza vaccination rate among Dutch GPs has risen considerably since the previous survey and the vaccination rate against p and emic ( A/H1N1 ) influenza was very high . Moreover , Dutch GPs were convinced that influenza vaccination will reduce the risk of transmitting the virus to their patients This study sought : to describe  influenza vaccination coverages  among COPD patients treated in a primary -care setting ; and to analyse the factors linked to compliance with vaccination recommendations . This was a descriptive study in a primary -care ( PC ) setting . Each of the 2422 r and omly selected medical practitioners included in the study was required to recruit five COPD patients . Information was drawn from patients ' clinical histories and personal interviews . As the dependent variable , we took the answer ( yes or no ) to the question , " did you have an  influenza vaccination  in the most recent campaign ? " ; and as independent variables , we analysed socio-demographic data , health-status related variables , lifestyles and history of pneumococcal vaccination .  A total of 10,711 patients were enrolled 87.2 % reported having been vaccinated in the most recent campaign . In conclusion , Spanish COPD patients treated in a primary -care setting can be said to enjoy good vaccine coverages against the influenza virus . More frequent contact with the general practitioner and a history of pneumococcal vaccination increase the likelihood of being vaccinated considerably , and measures should be implemented with the aim of improving coverages among younger subjects and those who lead less healthy lifestyles 
    Output:
    