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: BACKGROUND We compared the efficacy of a computer-generated prompt sheet placed on the front of patients ' charts with a patient-carried prompt card to remind physicians to perform selected health maintenance items . METHODS A r and omized prospect i ve single-blind study was performed in private practice offices in rural eastern North Carolina , with 28 family practitioners and nine general internists participating . Twenty-two physicians were r and omized to the computer prompt group and 22 to the card prompt group .  Four physicians in the computer group did not complete the study because of computer software problems , and three physicians did not complete the study because their limited staff was unable to enter patient data into the computer . Before the intervention , 20 patient charts ( 10 males and 10 females ) from each physician were audited for the performance of influenza vaccinations , stool for occult blood , pap smears , breast examinations performed by the physicians , and mammograms . One year after the intervention was instituted , chart audits for the above five items were done again on 20 different patient charts for each physician . RESULTS There was a 7 % increase in the performance of influenza vaccinations  in the card group ( 17 % vs 24 % ) compared with a 6 % increase in the computer group ( 20 % vs 26 % ) . There was a 5 % decrease in the performance of stool for occult blood in the card group ( 28 % vs 23 % ) compared with a 1 % increase in the computer group ( 30 % vs 31 % ) . There was an 11 % decrease in the performance of pap smears in the card group ( 26 % vs 15 % ) compared with a 3 % increase in the computer group ( 23 % vs 26 % ) . There was a 2 % decrease in the performance of breast examinations by the physician in the card group ( 35 % vs 33 % ) compared with a 3 % increase in the computer group ( 30 % vs 33 % ) . Finally , there was a 3 % increase in the performance of mammograms in the card group ( 22 % vs 25 % ) compared with an 11 % increase in the computer group ( 15 % vs 26 % ) . CONCLUSIONS Our data show a greater increase in performance of health maintenance items in the computer-prompted group . The performance of stool for occult blood , pap smears , breast examinations performed by the physician , and mammograms were increased more in the computer-prompted group than in the card group . However , there was not a statistically significant difference after intervention for any of the audited health maintenance items for either the computer group or the card group . Overall , health maintenance measures were performed in only a minority of appropriate patients CONTEXT Immunization rates in the inner city remain lower than in the general US population , but efforts to raise immunization levels in inner-city areas have been largely untested . OBJECTIVE To assess the effectiveness of case management in raising immunization levels among infants of inner-city , African American families . DESIGN R and omized controlled trial with follow-up through 1 year of life . SETTING Low-income areas of inner-city Los Angeles , Calif. PATIENTS A representative sample of 419 African American infants and their families . INTERVENTIONS In-depth assessment by case managers before infants were 6 weeks of age , with home visits 2 weeks prior to when immunizations were scheduled and additional follow-up visits as needed . MAIN OUTCOME MEASURES Percentage of children with up-to- date immunizations at age 1 year , characteristics associated with improved immunization rates , and cost-effectiveness of case management intervention .  RESULTS A total of 365 newborns were followed up to age 1 year . Overall , the immunization completion for the case management group was 13.2 percentage points higher than the control group ( 63.8 % vs 50.6 % ; P=.01 ) . In a logistic model , the case management effect was limited to the 25 % of the sample who reported 3 or fewer well-child visits ( odds ratio , 3.43 ; 95 % confidence interval , 1.26 - 9.35 ) ; for them , immunization levels increased by 28 percentage points . Although for the case management group intervention was not cost-effective ( $ 12022 per additional child immunized ) , it was better ( $ 4546 ) for the 25 % of the sample identified retrospectively to have inadequate utilization of preventive health visits . CONCLUSIONS A case management intervention in the first year of life was effective but not cost-effective at raising immunization levels in inner-city , African American infants . The intervention was demonstrated to be particularly effective for sub population s that do not access well-child care ; however , currently there are no means to identify these groups prospect ively . For case management to be a useful tool to raise immunizations levels among high-risk population s , better methods of tracking and targeting , such as immunization registries , need to be developed PURPOSE To assess whether we could export a successful multifaceted influenza vaccination program from an academic medical center to a community setting . DESIGN Pre/post study using concurrent control groups . SETTING Clinics in a staff model Health Maintenance Organization ( HMO ) . One urban and one suburban clinic were chosen as intervention clinics , while two similar clinics were selected as control clinics . PATIENTS All patients aged 65 and over enrolled in the four clinics . INTERVENTIONS An informational mailing to patients , a st and ing-order policy allowing nurses to administer vaccine , a vaccination reminder on daily appointment lists , and availability of walk-in visits for vaccination .  Patients in the control clinics received usual care . MEASUREMENTS Vaccination rates were determined using a vali date d postcard survey of 150 r and omly selected patients at each clinic both at baseline ( 1988 - 89 ) and after the intervention ( 1989 - 90 ) . RESULTS The baseline vaccination rates ranged from 51.4 % to 74.6 % , with nearly all vaccinations taking place at the HMO . In one intervention clinic , the vaccination rate improved from 56.4 % to 72.3 % , P = 0.01 . In the other , the baseline rate was 74.6 % and did not change significantly after the intervention . There was no change in the vaccination rate in the control clinics after the intervention period . CONCLUSIONS An influenza vaccination program that combines several organizational interventions may be successfully exported from an academic to a community setting and may serve as a useful model for others We conducted a r and omized , controlled trial to determine the effectiveness of an immunization tracking system design ed to increase the number of infants of lower socioeconomic status who receive their primary series of vaccinations at age-appropriate times . By 7 months of age , 91 % ( 274/301 ) of the infants in the intervention group were up-to- date on their primary series of vaccinations versus 72 % ( 214/296 ) of the infants in the control group ( p < 0.0001 ) . The estimated cost of follow-up for each infant in the intervention group was $ 18.05 . ( J PEDIATR 1995 ; 126:583 - 6 To improve the  pneumococcal vaccination status of an elderly patients group , those older than 64 years of age were identified from a computer file of all continuing care patients in a general internal medicine clinic . In a r and omly chosen study group ( N = 163 ) , 91 elderly patients ( 56 per cent ) had received the pneumococcal vaccine .  Factors associated with a higher rate of pneumococcal vaccination  included receiving the previous year 's influenza vaccine , a medical problem list attached to the patient 's chart , active clinic status ( i.e. , seen in the year before the study began ) , and more than two problems listed in the computer record . Letters encouraging pneumococcal vaccination were then sent to patients who had not been vaccinated . Twenty of 72 patients ( 28 per cent ) who received the letter were vaccinated during the next year ; 8 per cent of control patients ( three of 39 ) who did not receive the letter were vaccinated . The 95 per cent confidence limit for the relative difference between the study and control group is 6 to 53 per cent . The relative difference was also significant for influenza vaccination  between the intervention group and the portion of the control group that had not been vaccinated at the first chart review . Factors associated with pneumococcal vaccination rate following the mailing of the reminder letter were active clinic status and being up to date for either influenza or tetanus vaccination . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE To determine the measles vaccination rate in adolescents that could be achieved with a mailed notification of the recommendation , and to determine if the response rate differed if the mailing was addressed to the parents or to the adolescents . DESIGN R and omized trial . SETTING A family medicine residency training clinic serving a low-socioeconomic population . PATIENTS OR OTHER PARTICIPANTS Four hundred forty-nine adolescents aged 12 through 18 years who were seen in the clinic within the previous 21 months without receiving a documented second dose of measles vaccine were r and omized into two groups . INTERVENTION A letter recommending measles revaccination was sent to the parents in one group ( parent group ) and to the adolescents themselves in the second group ( adolescent group ) . The content of both letters was basically the same , but they differed in style and reading level . MAIN OUTCOME MEASURE Measles vaccinations administered to adolescents during the 2-month period following mailing of the letters . RESULTS Twenty-eight patients were excluded after r and omization . Fifty-six letters were undeliverable after two mailing attempts . Eleven ( 6.3 % ) of 176 adolescents in the parent group and five ( 2.6 % ) of 189 adolescents in the adolescent group received the measles vaccination ( P > .05 ) . CONCLUSIONS Although the adolescents whose parents received the letter were twice as likely to be vaccinated , the response rate was poor in both groups . The letter campaign was not an effective method to reach adolescents for measles revaccination OBJECTIVE To evaluate the effectiveness of computer-generated telephone reminder calls in increasing kept appointment rates in a public health setting . DESIGN R and omized controlled trial . SETTING Public health clinic , Georgia . PATIENTS Five hundred seventeen clients with scheduled appointments during a 4-week period at immunization , women , infant , and children ; well-child ; or family-planning programs . INTERVENTION A single computer-generated telephone reminder 1 day before each client 's scheduled appointment . MAIN OUTCOME MEASURE Rates of kept appointments . RESULTS Of the 277 clients assigned to receive the intervention , 144 ( 52 % ) kept their appointments , compared with only 78 ( 32.5 % ) of 240 who were not assigned to receive a message ( P < .05 ) . Improvement in kept appointment rates associated with receiving the message was highest for the immunization-program ( 183 % increase , P < .05 ) , with increases of 64 % , 53 % , and 44 % for the well-child ; women , infant , and children ; and family-planning programs , respectively . CONCLUSIONS These results suggest a simple and effective method to increase kept appointment rates in a variety of public health programs Background . Immunization rates have improved in the United States , but are still far from the national 90 % goal for the year 2000 . There is scant evidence about the effectiveness and costs of automated telephone messages to improve immunization rates among privately insured children . Objective . To evaluate the effectiveness and cost-effectiveness of sending letters , automated telephone messages , or both to families of underimmunized 20-month-olds in a health maintenance organization ( HMO ) . Methods . In this r and omized trial , underimmunized 20-month-olds identified by the HMO 's computerized immunization tracking system were assigned to one of four interventions : 1 ) an automated telephone message alone ; 2 ) a letter alone ; 3 ) an automated telephone message followed by a letter 1 week later ; and 4 ) a letter followed by an automated telephone message 1 week later . The primary outcome was receipt of any needed immunization by 24 months of age . Decision analysis was used to evaluate the projected cost-effectiveness of the alternative strategies . Results . A total of 648 children were r and omized . A letter followed by a telephone message ( 58 % immunized ) was significantly better than either a letter alone ( 44 % immunized ) or a telephone message alone ( 44 % immunized ) . A telephone message followed by a letter ( 53 % immunized ) also was more effective than either alone , although the differences were not statistically significant . Among a similar comparison group that received no systematic intervention , 36 % were immunized . The estimated cost per child immunized was $ 7.00 using letters followed by automated telephone messages , $ 9.80 using automated telephone messages alone , and $ 10.50 using letters alone . Under alternative cost assumptions for automated telephone messages and mailed messages , the cost per child immunized ranged from $ 2.20 to $ 6.50 . Conclusions . For underimmunized 20-month-olds in this HMO setting , letters followed by automated telephone messages were more effective and cost-effective than either message alone . The cost-effectiveness of automated telephone messages and letters may vary widely depending on the setting , and choices among strategies should be tailored to the population s being served OBJECTIVE To assess current practice s and attitudes among pediatricians and family physicians across the United States regarding immunizations . DESIGN Survey of a r and om sample of pediatricians and family physicians . SUB 
    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: BACKGROUND We compared the efficacy of a computer-generated prompt sheet placed on the front of patients ' charts with a patient-carried prompt card to remind physicians to perform selected health maintenance items . METHODS A r and omized prospect i ve single-blind study was performed in private practice offices in rural eastern North Carolina , with 28 family practitioners and nine general internists participating . Twenty-two physicians were r and omized to the computer prompt group and 22 to the card prompt group .  Four physicians in the computer group did not complete the study because of computer software problems , and three physicians did not complete the study because their limited staff was unable to enter patient data into the computer . Before the intervention , 20 patient charts ( 10 males and 10 females ) from each physician were audited for the performance of influenza vaccinations , stool for occult blood , pap smears , breast examinations performed by the physicians , and mammograms . One year after the intervention was instituted , chart audits for the above five items were done again on 20 different patient charts for each physician . RESULTS There was a 7 % increase in the performance of influenza vaccinations  in the card group ( 17 % vs 24 % ) compared with a 6 % increase in the computer group ( 20 % vs 26 % ) . There was a 5 % decrease in the performance of stool for occult blood in the card group ( 28 % vs 23 % ) compared with a 1 % increase in the computer group ( 30 % vs 31 % ) . There was an 11 % decrease in the performance of pap smears in the card group ( 26 % vs 15 % ) compared with a 3 % increase in the computer group ( 23 % vs 26 % ) . There was a 2 % decrease in the performance of breast examinations by the physician in the card group ( 35 % vs 33 % ) compared with a 3 % increase in the computer group ( 30 % vs 33 % ) . Finally , there was a 3 % increase in the performance of mammograms in the card group ( 22 % vs 25 % ) compared with an 11 % increase in the computer group ( 15 % vs 26 % ) . CONCLUSIONS Our data show a greater increase in performance of health maintenance items in the computer-prompted group . The performance of stool for occult blood , pap smears , breast examinations performed by the physician , and mammograms were increased more in the computer-prompted group than in the card group . However , there was not a statistically significant difference after intervention for any of the audited health maintenance items for either the computer group or the card group . Overall , health maintenance measures were performed in only a minority of appropriate patients CONTEXT Immunization rates in the inner city remain lower than in the general US population , but efforts to raise immunization levels in inner-city areas have been largely untested . OBJECTIVE To assess the effectiveness of case management in raising immunization levels among infants of inner-city , African American families . DESIGN R and omized controlled trial with follow-up through 1 year of life . SETTING Low-income areas of inner-city Los Angeles , Calif. PATIENTS A representative sample of 419 African American infants and their families . INTERVENTIONS In-depth assessment by case managers before infants were 6 weeks of age , with home visits 2 weeks prior to when immunizations were scheduled and additional follow-up visits as needed . MAIN OUTCOME MEASURES Percentage of children with up-to- date immunizations at age 1 year , characteristics associated with improved immunization rates , and cost-effectiveness of case management intervention .  RESULTS A total of 365 newborns were followed up to age 1 year . Overall , the immunization completion for the case management group was 13.2 percentage points higher than the control group ( 63.8 % vs 50.6 % ; P=.01 ) . In a logistic model , the case management effect was limited to the 25 % of the sample who reported 3 or fewer well-child visits ( odds ratio , 3.43 ; 95 % confidence interval , 1.26 - 9.35 ) ; for them , immunization levels increased by 28 percentage points . Although for the case management group intervention was not cost-effective ( $ 12022 per additional child immunized ) , it was better ( $ 4546 ) for the 25 % of the sample identified retrospectively to have inadequate utilization of preventive health visits . CONCLUSIONS A case management intervention in the first year of life was effective but not cost-effective at raising immunization levels in inner-city , African American infants . The intervention was demonstrated to be particularly effective for sub population s that do not access well-child care ; however , currently there are no means to identify these groups prospect ively . For case management to be a useful tool to raise immunizations levels among high-risk population s , better methods of tracking and targeting , such as immunization registries , need to be developed PURPOSE To assess whether we could export a successful multifaceted influenza vaccination program from an academic medical center to a community setting . DESIGN Pre/post study using concurrent control groups . SETTING Clinics in a staff model Health Maintenance Organization ( HMO ) . One urban and one suburban clinic were chosen as intervention clinics , while two similar clinics were selected as control clinics . PATIENTS All patients aged 65 and over enrolled in the four clinics . INTERVENTIONS An informational mailing to patients , a st and ing-order policy allowing nurses to administer vaccine , a vaccination reminder on daily appointment lists , and availability of walk-in visits for vaccination .  Patients in the control clinics received usual care . MEASUREMENTS Vaccination rates were determined using a vali date d postcard survey of 150 r and omly selected patients at each clinic both at baseline ( 1988 - 89 ) and after the intervention ( 1989 - 90 ) . RESULTS The baseline vaccination rates ranged from 51.4 % to 74.6 % , with nearly all vaccinations taking place at the HMO . In one intervention clinic , the vaccination rate improved from 56.4 % to 72.3 % , P = 0.01 . In the other , the baseline rate was 74.6 % and did not change significantly after the intervention . There was no change in the vaccination rate in the control clinics after the intervention period . CONCLUSIONS An influenza vaccination program that combines several organizational interventions may be successfully exported from an academic to a community setting and may serve as a useful model for others We conducted a r and omized , controlled trial to determine the effectiveness of an immunization tracking system design ed to increase the number of infants of lower socioeconomic status who receive their primary series of vaccinations at age-appropriate times . By 7 months of age , 91 % ( 274/301 ) of the infants in the intervention group were up-to- date on their primary series of vaccinations versus 72 % ( 214/296 ) of the infants in the control group ( p < 0.0001 ) . The estimated cost of follow-up for each infant in the intervention group was $ 18.05 . ( J PEDIATR 1995 ; 126:583 - 6 To improve the  pneumococcal vaccination status of an elderly patients group , those older than 64 years of age were identified from a computer file of all continuing care patients in a general internal medicine clinic . In a r and omly chosen study group ( N = 163 ) , 91 elderly patients ( 56 per cent ) had received the pneumococcal vaccine .  Factors associated with a higher rate of pneumococcal vaccination  included receiving the previous year 's influenza vaccine , a medical problem list attached to the patient 's chart , active clinic status ( i.e. , seen in the year before the study began ) , and more than two problems listed in the computer record . Letters encouraging pneumococcal vaccination were then sent to patients who had not been vaccinated . Twenty of 72 patients ( 28 per cent ) who received the letter were vaccinated during the next year ; 8 per cent of control patients ( three of 39 ) who did not receive the letter were vaccinated . The 95 per cent confidence limit for the relative difference between the study and control group is 6 to 53 per cent . The relative difference was also significant for influenza vaccination  between the intervention group and the portion of the control group that had not been vaccinated at the first chart review . Factors associated with pneumococcal vaccination rate following the mailing of the reminder letter were active clinic status and being up to date for either influenza or tetanus vaccination . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE To determine the measles vaccination rate in adolescents that could be achieved with a mailed notification of the recommendation , and to determine if the response rate differed if the mailing was addressed to the parents or to the adolescents . DESIGN R and omized trial . SETTING A family medicine residency training clinic serving a low-socioeconomic population . PATIENTS OR OTHER PARTICIPANTS Four hundred forty-nine adolescents aged 12 through 18 years who were seen in the clinic within the previous 21 months without receiving a documented second dose of measles vaccine were r and omized into two groups . INTERVENTION A letter recommending measles revaccination was sent to the parents in one group ( parent group ) and to the adolescents themselves in the second group ( adolescent group ) . The content of both letters was basically the same , but they differed in style and reading level . MAIN OUTCOME MEASURE Measles vaccinations administered to adolescents during the 2-month period following mailing of the letters . RESULTS Twenty-eight patients were excluded after r and omization . Fifty-six letters were undeliverable after two mailing attempts . Eleven ( 6.3 % ) of 176 adolescents in the parent group and five ( 2.6 % ) of 189 adolescents in the adolescent group received the measles vaccination ( P > .05 ) . CONCLUSIONS Although the adolescents whose parents received the letter were twice as likely to be vaccinated , the response rate was poor in both groups . The letter campaign was not an effective method to reach adolescents for measles revaccination OBJECTIVE To evaluate the effectiveness of computer-generated telephone reminder calls in increasing kept appointment rates in a public health setting . DESIGN R and omized controlled trial . SETTING Public health clinic , Georgia . PATIENTS Five hundred seventeen clients with scheduled appointments during a 4-week period at immunization , women , infant , and children ; well-child ; or family-planning programs . INTERVENTION A single computer-generated telephone reminder 1 day before each client 's scheduled appointment . MAIN OUTCOME MEASURE Rates of kept appointments . RESULTS Of the 277 clients assigned to receive the intervention , 144 ( 52 % ) kept their appointments , compared with only 78 ( 32.5 % ) of 240 who were not assigned to receive a message ( P < .05 ) . Improvement in kept appointment rates associated with receiving the message was highest for the immunization-program ( 183 % increase , P < .05 ) , with increases of 64 % , 53 % , and 44 % for the well-child ; women , infant , and children ; and family-planning programs , respectively . CONCLUSIONS These results suggest a simple and effective method to increase kept appointment rates in a variety of public health programs Background . Immunization rates have improved in the United States , but are still far from the national 90 % goal for the year 2000 . There is scant evidence about the effectiveness and costs of automated telephone messages to improve immunization rates among privately insured children . Objective . To evaluate the effectiveness and cost-effectiveness of sending letters , automated telephone messages , or both to families of underimmunized 20-month-olds in a health maintenance organization ( HMO ) . Methods . In this r and omized trial , underimmunized 20-month-olds identified by the HMO 's computerized immunization tracking system were assigned to one of four interventions : 1 ) an automated telephone message alone ; 2 ) a letter alone ; 3 ) an automated telephone message followed by a letter 1 week later ; and 4 ) a letter followed by an automated telephone message 1 week later . The primary outcome was receipt of any needed immunization by 24 months of age . Decision analysis was used to evaluate the projected cost-effectiveness of the alternative strategies . Results . A total of 648 children were r and omized . A letter followed by a telephone message ( 58 % immunized ) was significantly better than either a letter alone ( 44 % immunized ) or a telephone message alone ( 44 % immunized ) . A telephone message followed by a letter ( 53 % immunized ) also was more effective than either alone , although the differences were not statistically significant . Among a similar comparison group that received no systematic intervention , 36 % were immunized . The estimated cost per child immunized was $ 7.00 using letters followed by automated telephone messages , $ 9.80 using automated telephone messages alone , and $ 10.50 using letters alone . Under alternative cost assumptions for automated telephone messages and mailed messages , the cost per child immunized ranged from $ 2.20 to $ 6.50 . Conclusions . For underimmunized 20-month-olds in this HMO setting , letters followed by automated telephone messages were more effective and cost-effective than either message alone . The cost-effectiveness of automated telephone messages and letters may vary widely depending on the setting , and choices among strategies should be tailored to the population s being served OBJECTIVE To assess current practice s and attitudes among pediatricians and family physicians across the United States regarding immunizations . DESIGN Survey of a r and om sample of pediatricians and family physicians . SUB 
    Output:
    