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: OBJECTIVES To evaluate the effect of staff influenza vaccination on all-cause mortality in nursing home residents . DESIGN Pair-matched cluster-r and omized trial . SETTING Forty nursing homes matched for size , staff vaccination coverage during the previous season , and resident disability index . PARTICIPANTS All persons aged 60 and older residing in the nursing homes . INTERVENTION Influenza vaccine was administered to volunteer staff after a face-to-face interview . No intervention took place in control nursing homes . MEASUREMENTS The primary endpoint was total mortality rate in residents from 2 weeks before to 2 weeks after the influenza epidemic in the community . Secondary endpoints were rates of hospitalization and influenza-like illness ( ILI ) in residents and sick leave from work in staff . RESULTS Staff influenza vaccination rates were 69.9 % in the vaccination arm versus 31.8 % in the control arm . Primary unadjusted analysis did not show significantly lower mortality in residents in the vaccination arm ( odds ratio=0.86 , P=.08 ) , although multivariate-adjusted analysis showed 20 % lower mortality ( P=.02 ) , and a strong correlation was observed between staff vaccination coverage and all-cause mortality in residents ( correlation coefficient=-0.42 , P=.007 ) . In the vaccination arm , significantly lower resident hospitalization rates were not observed , but ILI in residents was 31 % lower ( P=.007 ) , and sick leave from work in staff was 42 % lower ( P=.03 ) . CONCLUSION These results support influenza vaccination of staff caring for institutionalized elderly people 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 Objective To determine whether vaccination of care home staff  against influenza indirectly protects residents . Design Pair matched cluster r and omised controlled trial . Setting Large private chain of UK care homes during the winters of 2003 - 4 and 2004 - 5 . Participants Nursing home staff ( n=1703 ) and residents ( n=2604 ) in 44 care homes ( 22 intervention homes and 22 matched control homes ) . Interventions Vaccination offered to staff in intervention homes but not in control homes . Main outcome measures The primary outcome was all cause mortality of residents . Secondary outcomes were influenza-like illness and health service use in residents . Results In 2003 - 4 vaccine coverage in full time staff was 48.2 % ( 407/884 ) in intervention homes and 5.9 % ( 51/859 ) in control homes . In 2004 - 5 uptake rates were 43.2 % ( 365/844 ) and 3.5 % ( 28/800 ) . National influenza rates were substantially below average in 2004 - 5 . In the 2003 - 4 period of influenza activity significant decreases were found in mortality of residents in intervention homes compared with control homes ( rate difference −5.0 per 100 residents , 95 % confidence interval −7.0 to −2.0 ) and in influenza-like illness ( P=0.004 ) , consultations with general practitioners for influenza-like illness ( P=0.008 ) , and admissions to hospital with influenza-like illness ( P=0.009 ) . No significant differences were found in 2004 - 5 or during periods of no influenza activity in 2003 - 4 . Conclusions Vaccinating care home staff against influenza can prevent deaths , health service use , and influenza-like illness in residents during periods of moderate influenza activity . Trial registration National Research Register N0530147256 Background Healthcare personnel influenza immunization rates  remain sub-optimal . Following multiple studies and expert consultations , the “ Successful Influenza Immunization Programs for Healthcare Personnel : A Guide for Program Planners ” was produced . This trial assessed the impact of the Guide with facilitation in improving healthcare personnel influenza immunization rates in Canadian healthcare organizations . Methods A sample of 26 healthcare organizations across six Canadian provinces ( ON , MB , NS , BC , SK , NL ) was r and omized to Intervention ( n=13 ) or Control groups ( n=13 ) . Baseline influenza immunization rates were obtained for 2008–2009 ; the study groups were followed over two subsequent influenza seasons . The Intervention group received the Guide , facilitation support through workshops for managers and ongoing support . The Control groups conducted programs as usual . The Groups were compared using their reported influenza healthcare personnel influenza immunization rates and scores from a program assessment question naire . Findings Twenty-six organizations agreed to participate . 35 % ( 9/26 ) of sites were acute care hospitals , 19 % ( 5/26 ) continuing care , long-term care organizations or nursing homes , and 46 % ( 12/26 ) were mixed acute care hospitals and long-term care or regional health authorities . The median rate of influenza immunization among healthcare personnel for the Intervention group was 43 % , 44 % , and 51 % at three points in time respectively , and in the Control group : 62 % , 57 % , and 55 % respectively . No significant differences were observed between the groups at the three points in time . However , there was a 7 % increase in the median rates between the Baseline Year and Year Two in the Intervention group , and a 6 % decrease in the Control group over the same time period , which was statistically significant ( 0.071 versus -0.058 , p < 0.001 ) . Interpretation This pragmatic r and omized trial of the Guide with facilitation of its implementation improved  healthcare personnel immunization rates , but these rates continued to be sub-optimal and below rates achievable in programs requiring personnel to be immunized . Trial Registration Clinical Trials.gov OBJECTIVE To determine trends , patient characteristics , and outcome of patients with healthcare-associated influenza in Canadian hospitals . DESIGN Prospect i ve surveillance of laboratory-confirmed influenza among hospitalized adults was conducted from 2006 to 2012 . Adults with positive test results at or after admission to the hospital were assessed . Influenza was considered to be healthcare associated if symptom onset was equal to or more than 96 hours after admission to a facility or if a patient was readmitted less than 96 hours after discharge or admitted less than 96 hours after transfer from another facility . Baseline characteristics of influenza patients were collected . Patients were reassessed at 30 days to determine the outcome . SETTING Acute care hospitals participating in the Canadian Nosocomial Infection Surveillance Program . RESULTS A total of 570 ( 17.3 % ) of 3,299 influenza cases were healthcare associated ; 345 ( 60.5 % ) were acquired in a long-term care facility ( LTCF ) , and 225 ( 39.5 % ) were acquired in an acute care facility ( ACF ) . There was year-to-year variability in the rate and proportion of cases that were healthcare associated and variability in the proportion that were acquired in a LTCF versus an ACF . Patients with LTCF-associated cases were older , had a higher proportion of chronic heart disease , and were less likely to be immunocompromised compared with patients with ACF-associated cases ; there was no significant difference in 30-day all-cause and influenza-specific mortality . CONCLUSIONS Healthcare-associated influenza is a major component of the burden of disease from influenza in hospitals , but the proportion of cases that are healthcare associated varies markedly from year to year , as does the proportion of healthcare-associated infections that are acquired in an ACF versus an LTCF OBJECTIVES To establish uptake of influenza vaccine amongst care home clinical staff in Greater Nottingham , and to investigate what could be done to improve vaccine uptake in this group . STUDY DESIGN Postal question naire surveys were used . In the first instance , a total sample survey was used . In the second instance , a sample of care home staff was surveyed , r and omized at the care home level . METHODS A postal question naire completed by care home matrons was used to obtain a preliminary estimate of staff vaccine uptake . Individual staff question naires were then used to vali date this finding , and measure attitudes , beliefs and behaviours associated with vaccination . RESULTS Vaccine uptake among those working in care homes with nursing was found to be low . Vaccine uptake was higher in homes with a policy recommending vaccination of staff . Most respondents who had received vaccination reported that they had done so because of an existing medical condition , rather than because of being a healthcare worker . A statistically significant relationship ( P=0.02 ) was found between individuals ' reported beliefs on how well they could resist influenza and their vaccination status . CONCLUSIONS All care homes for the elderly should have a vaccination policy which recommends staff vaccination . Educational campaigns , vaccination in the workplace and free provision of the influenza vaccine may help to improve vaccine uptake in this group Background Influenza-associated deaths is an important risk for the elderly in nursing homes ( NHs ) worldwide . Vaccination coverage among residents is high but poorly effective due to immunosenescence . Hence , vaccination of personnel is an efficient way to protect residents . Our objective was to quantify the seasonal  influenza vaccination ( IV ) coverage among NH for elderly workers and identify its determinants in France . Methods We conducted a cross-sectional study in March 2016 in a r and omized sample of NHs of the Ille-et-Vilaine department of Brittany , in western France . A st and ardized question naire was administered to a r and omized sample of NH workers for face-to-face interviews . General data about the establishment was also collected . Results Among the 33 NHs surveyed , IV coverage for the 2015–2016 season among permanent workers was estimated at 20 % ( 95 % Confidence Interval ( CI ) 15.3%–26.4 % ) ranging from 0 % to 69 % depending on the establishments surveyed . Moreover , IV was associated with having previously experienced a “ severe ” influenza episode in the past ( Prevalence Ratio 1.48 , 95 % CI 1.01–2.17 ) , and varied by professional categories ( p < 0.004 ) with better coverage among administrative staff . Better knowledge about influenza prevention tools was also correlated ( p < 0.001 ) with a higher IV coverage . Individual perceptions of vaccination benefits had a significant influence on the IV coverage ( p < 0.001 ) . Although IV coverage did not reach a high rate , our study showed that personnel considered themselves sufficiently informed about IV . Conclusions IV coverage remains low in the NH worker population in Ille-et-Vilaine and also possibly in France . Strong variations of  IV coverage among NHs suggest that management and working environment play an important role . To overcome vaccine “ hesitancy ” , specific communication tools may be required to be adapted to the various NH professionals to improve influenza prevention OBJECTIVES Little is known about the relationship between how medical care is organized and delivered in nursing homes . Taking a lead from the acute care arena , we hypothesize that nursing home medical staff organization ( NHMSO ) is an important predictor of clinical outcomes in the nursing home . METHODS A total of 202 usable surveys from a 2-wave survey process using the Dillman Method were returned from medical directors who were r and omly selected from the AMDA membership and were asked to fill out a survey on the structure of medical organization in their primary nursing home practice . Quality measures that are likely to be affected by physician practice patterns were culled from NH Compare and OSCAR data sets and matched to the physician surveys , ie , long stay residents ' prevalence of pain , restraint use , catheter use , pressure ulcers , pneumococcal vaccination , influenza vaccination , presence of advanced directives , prescription of antibiotics , and prevalence of depression . RESULTS Using a series of hierarchical multiple regressions , significant R(2 ) changes were found when the medical staff organization dimensions were added in the regressions after controlling for nursing home structural characteristics for the following outcomes : pneumococcal vaccination and restraint use . Near significant findings were noted for pain prevalence among long-stay residents , catheter use , and prevalence of pressure ulcers . CONCLUSIONS This study is the first to demonstrate a relationship between medical staff organizational dimensions and clinical outcomes in the nursing home setting and as such represents an initial " proof of concept . " NHMSO should be considered as a potentially important mediating or moderating variable in the quality of care equation for nursing homes OBJECTIVES We examined barriers to influenza vaccination among long-term care facility ( LTCF ) health care workers in Southern California and developed simple , effective interventions to improve influenza vaccine coverage of these workers . METHODS In 2002 , health care workers at LTCFs were surveyed regarding their knowledge and attitudes about influenza and the influenza vaccine . Results were used to develop 2 interventions , an educational campaign and Vaccine Day ( a well-publicized day for free influenza vaccination of all employees at the worksite ) . Seventy facilities were recruited to participate in an intervention trial and r and omly assigned to 4 study groups . RESULTS The combination of Vaccine Day and an educational campaign was most effective in increasing vaccine coverage ( 53 % coverage ; prevalence ratio [PR]=1.45 ; 95 % confidence interval [CI]=1.24 , 1.71 , compared with 27 % coverage in the control group ) . Vaccine Day alone was also effective ( 46 % coverage ; PR= 1.41 ; 9 
    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: OBJECTIVES To evaluate the effect of staff influenza vaccination on all-cause mortality in nursing home residents . DESIGN Pair-matched cluster-r and omized trial . SETTING Forty nursing homes matched for size , staff vaccination coverage during the previous season , and resident disability index . PARTICIPANTS All persons aged 60 and older residing in the nursing homes . INTERVENTION Influenza vaccine was administered to volunteer staff after a face-to-face interview . No intervention took place in control nursing homes . MEASUREMENTS The primary endpoint was total mortality rate in residents from 2 weeks before to 2 weeks after the influenza epidemic in the community . Secondary endpoints were rates of hospitalization and influenza-like illness ( ILI ) in residents and sick leave from work in staff . RESULTS Staff influenza vaccination rates were 69.9 % in the vaccination arm versus 31.8 % in the control arm . Primary unadjusted analysis did not show significantly lower mortality in residents in the vaccination arm ( odds ratio=0.86 , P=.08 ) , although multivariate-adjusted analysis showed 20 % lower mortality ( P=.02 ) , and a strong correlation was observed between staff vaccination coverage and all-cause mortality in residents ( correlation coefficient=-0.42 , P=.007 ) . In the vaccination arm , significantly lower resident hospitalization rates were not observed , but ILI in residents was 31 % lower ( P=.007 ) , and sick leave from work in staff was 42 % lower ( P=.03 ) . CONCLUSION These results support influenza vaccination of staff caring for institutionalized elderly people 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 Objective To determine whether vaccination of care home staff  against influenza indirectly protects residents . Design Pair matched cluster r and omised controlled trial . Setting Large private chain of UK care homes during the winters of 2003 - 4 and 2004 - 5 . Participants Nursing home staff ( n=1703 ) and residents ( n=2604 ) in 44 care homes ( 22 intervention homes and 22 matched control homes ) . Interventions Vaccination offered to staff in intervention homes but not in control homes . Main outcome measures The primary outcome was all cause mortality of residents . Secondary outcomes were influenza-like illness and health service use in residents . Results In 2003 - 4 vaccine coverage in full time staff was 48.2 % ( 407/884 ) in intervention homes and 5.9 % ( 51/859 ) in control homes . In 2004 - 5 uptake rates were 43.2 % ( 365/844 ) and 3.5 % ( 28/800 ) . National influenza rates were substantially below average in 2004 - 5 . In the 2003 - 4 period of influenza activity significant decreases were found in mortality of residents in intervention homes compared with control homes ( rate difference −5.0 per 100 residents , 95 % confidence interval −7.0 to −2.0 ) and in influenza-like illness ( P=0.004 ) , consultations with general practitioners for influenza-like illness ( P=0.008 ) , and admissions to hospital with influenza-like illness ( P=0.009 ) . No significant differences were found in 2004 - 5 or during periods of no influenza activity in 2003 - 4 . Conclusions Vaccinating care home staff against influenza can prevent deaths , health service use , and influenza-like illness in residents during periods of moderate influenza activity . Trial registration National Research Register N0530147256 Background Healthcare personnel influenza immunization rates  remain sub-optimal . Following multiple studies and expert consultations , the “ Successful Influenza Immunization Programs for Healthcare Personnel : A Guide for Program Planners ” was produced . This trial assessed the impact of the Guide with facilitation in improving healthcare personnel influenza immunization rates in Canadian healthcare organizations . Methods A sample of 26 healthcare organizations across six Canadian provinces ( ON , MB , NS , BC , SK , NL ) was r and omized to Intervention ( n=13 ) or Control groups ( n=13 ) . Baseline influenza immunization rates were obtained for 2008–2009 ; the study groups were followed over two subsequent influenza seasons . The Intervention group received the Guide , facilitation support through workshops for managers and ongoing support . The Control groups conducted programs as usual . The Groups were compared using their reported influenza healthcare personnel influenza immunization rates and scores from a program assessment question naire . Findings Twenty-six organizations agreed to participate . 35 % ( 9/26 ) of sites were acute care hospitals , 19 % ( 5/26 ) continuing care , long-term care organizations or nursing homes , and 46 % ( 12/26 ) were mixed acute care hospitals and long-term care or regional health authorities . The median rate of influenza immunization among healthcare personnel for the Intervention group was 43 % , 44 % , and 51 % at three points in time respectively , and in the Control group : 62 % , 57 % , and 55 % respectively . No significant differences were observed between the groups at the three points in time . However , there was a 7 % increase in the median rates between the Baseline Year and Year Two in the Intervention group , and a 6 % decrease in the Control group over the same time period , which was statistically significant ( 0.071 versus -0.058 , p < 0.001 ) . Interpretation This pragmatic r and omized trial of the Guide with facilitation of its implementation improved  healthcare personnel immunization rates , but these rates continued to be sub-optimal and below rates achievable in programs requiring personnel to be immunized . Trial Registration Clinical Trials.gov OBJECTIVE To determine trends , patient characteristics , and outcome of patients with healthcare-associated influenza in Canadian hospitals . DESIGN Prospect i ve surveillance of laboratory-confirmed influenza among hospitalized adults was conducted from 2006 to 2012 . Adults with positive test results at or after admission to the hospital were assessed . Influenza was considered to be healthcare associated if symptom onset was equal to or more than 96 hours after admission to a facility or if a patient was readmitted less than 96 hours after discharge or admitted less than 96 hours after transfer from another facility . Baseline characteristics of influenza patients were collected . Patients were reassessed at 30 days to determine the outcome . SETTING Acute care hospitals participating in the Canadian Nosocomial Infection Surveillance Program . RESULTS A total of 570 ( 17.3 % ) of 3,299 influenza cases were healthcare associated ; 345 ( 60.5 % ) were acquired in a long-term care facility ( LTCF ) , and 225 ( 39.5 % ) were acquired in an acute care facility ( ACF ) . There was year-to-year variability in the rate and proportion of cases that were healthcare associated and variability in the proportion that were acquired in a LTCF versus an ACF . Patients with LTCF-associated cases were older , had a higher proportion of chronic heart disease , and were less likely to be immunocompromised compared with patients with ACF-associated cases ; there was no significant difference in 30-day all-cause and influenza-specific mortality . CONCLUSIONS Healthcare-associated influenza is a major component of the burden of disease from influenza in hospitals , but the proportion of cases that are healthcare associated varies markedly from year to year , as does the proportion of healthcare-associated infections that are acquired in an ACF versus an LTCF OBJECTIVES To establish uptake of influenza vaccine amongst care home clinical staff in Greater Nottingham , and to investigate what could be done to improve vaccine uptake in this group . STUDY DESIGN Postal question naire surveys were used . In the first instance , a total sample survey was used . In the second instance , a sample of care home staff was surveyed , r and omized at the care home level . METHODS A postal question naire completed by care home matrons was used to obtain a preliminary estimate of staff vaccine uptake . Individual staff question naires were then used to vali date this finding , and measure attitudes , beliefs and behaviours associated with vaccination . RESULTS Vaccine uptake among those working in care homes with nursing was found to be low . Vaccine uptake was higher in homes with a policy recommending vaccination of staff . Most respondents who had received vaccination reported that they had done so because of an existing medical condition , rather than because of being a healthcare worker . A statistically significant relationship ( P=0.02 ) was found between individuals ' reported beliefs on how well they could resist influenza and their vaccination status . CONCLUSIONS All care homes for the elderly should have a vaccination policy which recommends staff vaccination . Educational campaigns , vaccination in the workplace and free provision of the influenza vaccine may help to improve vaccine uptake in this group Background Influenza-associated deaths is an important risk for the elderly in nursing homes ( NHs ) worldwide . Vaccination coverage among residents is high but poorly effective due to immunosenescence . Hence , vaccination of personnel is an efficient way to protect residents . Our objective was to quantify the seasonal  influenza vaccination ( IV ) coverage among NH for elderly workers and identify its determinants in France . Methods We conducted a cross-sectional study in March 2016 in a r and omized sample of NHs of the Ille-et-Vilaine department of Brittany , in western France . A st and ardized question naire was administered to a r and omized sample of NH workers for face-to-face interviews . General data about the establishment was also collected . Results Among the 33 NHs surveyed , IV coverage for the 2015–2016 season among permanent workers was estimated at 20 % ( 95 % Confidence Interval ( CI ) 15.3%–26.4 % ) ranging from 0 % to 69 % depending on the establishments surveyed . Moreover , IV was associated with having previously experienced a “ severe ” influenza episode in the past ( Prevalence Ratio 1.48 , 95 % CI 1.01–2.17 ) , and varied by professional categories ( p < 0.004 ) with better coverage among administrative staff . Better knowledge about influenza prevention tools was also correlated ( p < 0.001 ) with a higher IV coverage . Individual perceptions of vaccination benefits had a significant influence on the IV coverage ( p < 0.001 ) . Although IV coverage did not reach a high rate , our study showed that personnel considered themselves sufficiently informed about IV . Conclusions IV coverage remains low in the NH worker population in Ille-et-Vilaine and also possibly in France . Strong variations of  IV coverage among NHs suggest that management and working environment play an important role . To overcome vaccine “ hesitancy ” , specific communication tools may be required to be adapted to the various NH professionals to improve influenza prevention OBJECTIVES Little is known about the relationship between how medical care is organized and delivered in nursing homes . Taking a lead from the acute care arena , we hypothesize that nursing home medical staff organization ( NHMSO ) is an important predictor of clinical outcomes in the nursing home . METHODS A total of 202 usable surveys from a 2-wave survey process using the Dillman Method were returned from medical directors who were r and omly selected from the AMDA membership and were asked to fill out a survey on the structure of medical organization in their primary nursing home practice . Quality measures that are likely to be affected by physician practice patterns were culled from NH Compare and OSCAR data sets and matched to the physician surveys , ie , long stay residents ' prevalence of pain , restraint use , catheter use , pressure ulcers , pneumococcal vaccination , influenza vaccination , presence of advanced directives , prescription of antibiotics , and prevalence of depression . RESULTS Using a series of hierarchical multiple regressions , significant R(2 ) changes were found when the medical staff organization dimensions were added in the regressions after controlling for nursing home structural characteristics for the following outcomes : pneumococcal vaccination and restraint use . Near significant findings were noted for pain prevalence among long-stay residents , catheter use , and prevalence of pressure ulcers . CONCLUSIONS This study is the first to demonstrate a relationship between medical staff organizational dimensions and clinical outcomes in the nursing home setting and as such represents an initial " proof of concept . " NHMSO should be considered as a potentially important mediating or moderating variable in the quality of care equation for nursing homes OBJECTIVES We examined barriers to influenza vaccination among long-term care facility ( LTCF ) health care workers in Southern California and developed simple , effective interventions to improve influenza vaccine coverage of these workers . METHODS In 2002 , health care workers at LTCFs were surveyed regarding their knowledge and attitudes about influenza and the influenza vaccine . Results were used to develop 2 interventions , an educational campaign and Vaccine Day ( a well-publicized day for free influenza vaccination of all employees at the worksite ) . Seventy facilities were recruited to participate in an intervention trial and r and omly assigned to 4 study groups . RESULTS The combination of Vaccine Day and an educational campaign was most effective in increasing vaccine coverage ( 53 % coverage ; prevalence ratio [PR]=1.45 ; 95 % confidence interval [CI]=1.24 , 1.71 , compared with 27 % coverage in the control group ) . Vaccine Day alone was also effective ( 46 % coverage ; PR= 1.41 ; 9 
    Output:
    