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 Influenza and pneumococcal vaccines are underused . Systems approaches that incorporate administrative and organizational strategies are more successful than education of providers for improving vaccination rates . Little has been published on the long-term success and durability of such efforts . METHODS We performed a 10-year time-series study to examine the durability and success of an ongoing , multifaceted , institution-wide influenza and pneumococcal vaccination program . The program was first implemented at the Minneapolis Department of Veterans Affairs ( VA ) Medical Center in 1987 - 88 following the demonstration that a clinic-based st and ing order policy was much more successful than provider education for improving vaccine delivery . The program ensures that vaccine is offered to all high-risk patients followed up at the medical center , promotes convenient access for patients , and facilitates efficient administration of vaccine . Specific elements include an annual mailing to patients , st and ing orders for nurses , walk-in clinics , and the use of st and ardized , preprinted documentation forms . Initially the program targeted high-risk out patients for influenza vaccination .  It was extended to include in patients in 1989 - 90 .  Pneumococcal vaccinations were added to the program in 1994 - 95 . Vaccination rates are estimated each year from surveys mailed to r and omly selected patients , and vaccine utilization is monitored through pharmacy logs . RESULTS The survey response rates have exceeded 75 % each year .  Influenza vaccination rates for all high-risk patients followed up at the medical center have increased from 58 % following the 1987 - 88 vaccination season to 84 % in 1996 - 97 ( P < 0.001 ) . Pneumococcal vaccination rates have also increased from 34 % in 1994 - 95 to 63 % in 1996 - 97 ( P < 0.001 ) . Vaccination rates are similar for in patients and out patients , but rates for high-risk patients < 65 years of age remain lower than for the elderly : 69 % versus 89 % for influenza , 1996 - 97 ( P < 0.001 ) ; 52 % versus 66 % for pneumococcal , 1996 - 97 ( P = 0.05 ) . For elderly patients followed up at the medical center , influenza ( 89 % versus 67 % , P < 0.0001 ) and pneumococcal ( 66 % versus 43 % , P < 0.0001 ) vaccination rates significantly exceeded those for the state of Minnesota in 1996 - 97 . The annual number of influenza vaccine doses dispensed has increased from 10,000 in 1987 - 88 to more than 22,000 in 1996 - 97 ; and more than 13,000 doses of pneumococcal vaccine have been administered from 1994 - 95 through 1996 - 97 . CONCLUSION This simple , multifaceted program that incorporates administrative and organizational strategies to enhance influenza and pneumococcal vaccination rates has been highly durable and successful over a 10-year peroid . Similar strategies if implemented in other setting s may enhance vaccination rates for the millions of high-risk patients who have yet to be immunized 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 In a study comparing the side effects of two  influenza vaccines  in a health centre vaccination programme involving patients in ; at risk ' groups , no significant difference was found between the vaccines used or the method of administration . The majority of side effects were minor , but as many as 35 per cent of the study group reported some systemic upset after vaccination . A follow-up study a year later showed that the incidence of side effects did not appear to influence the uptake of revaccination OBJECTIVES To evaluate the use of influenza and pneumococcal vaccines  in long term care facilities . DESIGN Cross-sectional survey in a r and om sample of 30 facilities in two regions of Quebec . Information was collected from the general manager or the chief of nursing , all consultant physicians and a r and om sample of 20 residents in each facility . RESULTS Twenty-nine centres agreed to participate . The mean influenza vaccination rate was 70 % , and was not influenced by differences in the types of facilities or the organization of the programs for immunization . The main obstacle to influenza vaccination reported by physicians was nonacceptance by a significant proportion of residents . Of the residents who did not initially request influenza vaccine , only 64 % accepted  vaccination  when it was offered . The vast majority of residents were satisfied with the information they had received and the respect shown for their freedom of choice . Forty per cent of residents were unfit to provide a valid consent and the vaccination rate was 76 % in this group . Only one-third of the physicians regularly obtained authorization from a relative or the legal guardian before prescribing vaccination for incompetent residents . None of the facilities studied had an effective program for pneumococcal vaccination , only 43 % of the physicians reported any use of pneumococcal vaccine  and 98 % of residents had never heard of the vaccine . CONCLUSIONS The national objective of 95 % coverage with influenza vaccine  will be difficult to achieve in long term care facilities , mainly because a minority of residents are not likely to be convinced of the benefit of immunization . Much remains to be done to promote and administer pneumococcal vaccine in this setting BACKGROUND Although they are effective in outpatient setting s , computerized reminders have not been proved to increase preventive care in inpatient setting s. METHODS We conducted a r and omized , controlled trial to determine the effects of computerized reminders on the rates at which four preventive therapies were ordered for in patients . During an 18-month study period , a computerized system processed on-line information for all 6371 patients admitted to a general-medicine service ( for a total of 10,065 hospitalizations ) , generating preventive care reminders as appropriate . Physicians who were in the intervention group viewed these reminders when they were using a computerized order-entry system for in patients . RESULTS The reminder system identified 3416 patients ( 53.6 percent ) as eligible for preventive measures that had not been ordered by the admitting physician . For patients with at least one indication , computerized reminders result ed in higher adjusted ordering rates for pneumococcal vaccination ( 35.8 percent of the patients in the intervention group vs. 0.8 percent of those in the control group , P<0.001 ) ,  influenza vaccination ( 51.4 percent vs. 1.0 percent , P < 0.001 ) , prophylactic heparin ( 32.2 percent vs. 18.9 percent , P<0.001 ) , and prophylactic aspirin at discharge ( 36.4 percent vs. 27.6 percent , P<0.001 ) . CONCLUSIONS A majority of hospitalized patients in this study were eligible for preventive measures , and computerized reminders significantly increased the rate of delivery of such therapies OBJECTIVE To demonstrate the feasibility of systematic influenza and pneumococcal vaccination in a busy Emergency Department ( ED ) . SETTING A public , inner-city hospital with an annual adult ED census of 120,000 . 93 % of patients are people of color . 78 % deny having either government or private insurance . Only 28 % of patients report having a primary care provider . Only 15 % present with complaints requiring immediate evaluation by a physician . METHODS Two uncontrolled demonstration projects were conducted during two periods , from 10/21/96 through 12/2/96 , ( during the influenza immunization season ) and from 5/27/97 to 7/26/97 . During project one , nurses were given st and ing orders that all non-urgent patients meeting CDC recommended criteria were to be offered immunization against influenza and /or pneumococcus at triage . The date of immunization was entered into unused fields in the computerized patient registration system , making it available system-wide , to all providers having access to billing system terminals . From 11/4 through 11/18 , an extra ' immunization nurse ' was assigned to test for improvement in immunization figures . A time/motion study of the time required for each immunization was conducted using a convenience sample of eight nurses over all three shifts . During project two , responsibility for carrying out st and ing orders for immunization was transferred to the patient 's nurses in the treatment area , and all high-risk patients were made eligible for immunization . An immunization card was issued to the patient at the time of each immunization . A monetary incentive to nurses was used to encourage completion of tracking forms . Computer record-keeping was continued . RESULTS Both projects required intense supervision to ensure performance . Despite initial resistance , and extreme variation in individual performance , many nurses and physicians became supportive of ED immunization during the two projects . During project one , 2631 patients were screened , and 789 high-risk patients were identified . 1238 patients were immunized against influenza and 374 against pneumococcus . Immunizations per shift per nurse varied from 0 to 24 . Median time for immunization was 4 min ( range 2 - 10 ) . The addition of an extra nurse at triage did not improve performance . During period two , 1907 patients were screened , 1532 high-risk patients were identified , and 1179 patients were immunized against pneumococcus . CONCLUSION Systematic ED immunization of high-risk adults is feasible even in a busy public ED setting In this paper we describe a successful multi-level participatory intervention grounded in principles of individual and group empowerment , and guided by social construction theory . The intervention addressed known and persistent inequities in influenza vaccination among African American and Latino older adults , and associated infections , hospitalizations and mortality . It was design ed to increase resident ability to make informed decisions about vaccination , and to build internal and external infrastructure to support sustainability over time . The intervention brought a group of social scientists , vaccine research ers , geriatricians , public health nurses , elder services providers and advocates together with senior housing management and activist African American and Latino residents living in public senior housing in a small east coast city . Two buildings of equal size and similar ethnic composition were r and omized as intervention and control buildings . Pre and post intervention surveys were conducted in both buildings , measuring knowledge , attitudes and peer norms . Processes and outcomes were documented at four levels : Influenza Strategic Alliance ( macro and exo levels ) , building management ( meso level ) , building resident committee ( meso level ) and individual residents . The Influenza Strategic Alliance ( I.S.A. ) provided ongoing re sources , information and vaccine ; the building management provided economic and other in-kind re sources and supported residents to continue flu clinics in the building . The V.I.P. Resident Committee conducted flu campaigns with flu clinics in English and Spanish . The vaccination rate in the intervention building at post test exceeded the study goal of 70 % and showed a significant improvement over the control building . The intervention achieved desired outcomes at all four levels and result ed in a significant increase in influenza vaccination , and improvements in pro-vaccination knowledge , beliefs , and underst and ing of health consequences 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 ] 1.4 
    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 Influenza and pneumococcal vaccines are underused . Systems approaches that incorporate administrative and organizational strategies are more successful than education of providers for improving vaccination rates . Little has been published on the long-term success and durability of such efforts . METHODS We performed a 10-year time-series study to examine the durability and success of an ongoing , multifaceted , institution-wide influenza and pneumococcal vaccination program . The program was first implemented at the Minneapolis Department of Veterans Affairs ( VA ) Medical Center in 1987 - 88 following the demonstration that a clinic-based st and ing order policy was much more successful than provider education for improving vaccine delivery . The program ensures that vaccine is offered to all high-risk patients followed up at the medical center , promotes convenient access for patients , and facilitates efficient administration of vaccine . Specific elements include an annual mailing to patients , st and ing orders for nurses , walk-in clinics , and the use of st and ardized , preprinted documentation forms . Initially the program targeted high-risk out patients for influenza vaccination .  It was extended to include in patients in 1989 - 90 .  Pneumococcal vaccinations were added to the program in 1994 - 95 . Vaccination rates are estimated each year from surveys mailed to r and omly selected patients , and vaccine utilization is monitored through pharmacy logs . RESULTS The survey response rates have exceeded 75 % each year .  Influenza vaccination rates for all high-risk patients followed up at the medical center have increased from 58 % following the 1987 - 88 vaccination season to 84 % in 1996 - 97 ( P < 0.001 ) . Pneumococcal vaccination rates have also increased from 34 % in 1994 - 95 to 63 % in 1996 - 97 ( P < 0.001 ) . Vaccination rates are similar for in patients and out patients , but rates for high-risk patients < 65 years of age remain lower than for the elderly : 69 % versus 89 % for influenza , 1996 - 97 ( P < 0.001 ) ; 52 % versus 66 % for pneumococcal , 1996 - 97 ( P = 0.05 ) . For elderly patients followed up at the medical center , influenza ( 89 % versus 67 % , P < 0.0001 ) and pneumococcal ( 66 % versus 43 % , P < 0.0001 ) vaccination rates significantly exceeded those for the state of Minnesota in 1996 - 97 . The annual number of influenza vaccine doses dispensed has increased from 10,000 in 1987 - 88 to more than 22,000 in 1996 - 97 ; and more than 13,000 doses of pneumococcal vaccine have been administered from 1994 - 95 through 1996 - 97 . CONCLUSION This simple , multifaceted program that incorporates administrative and organizational strategies to enhance influenza and pneumococcal vaccination rates has been highly durable and successful over a 10-year peroid . Similar strategies if implemented in other setting s may enhance vaccination rates for the millions of high-risk patients who have yet to be immunized 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 In a study comparing the side effects of two  influenza vaccines  in a health centre vaccination programme involving patients in ; at risk ' groups , no significant difference was found between the vaccines used or the method of administration . The majority of side effects were minor , but as many as 35 per cent of the study group reported some systemic upset after vaccination . A follow-up study a year later showed that the incidence of side effects did not appear to influence the uptake of revaccination OBJECTIVES To evaluate the use of influenza and pneumococcal vaccines  in long term care facilities . DESIGN Cross-sectional survey in a r and om sample of 30 facilities in two regions of Quebec . Information was collected from the general manager or the chief of nursing , all consultant physicians and a r and om sample of 20 residents in each facility . RESULTS Twenty-nine centres agreed to participate . The mean influenza vaccination rate was 70 % , and was not influenced by differences in the types of facilities or the organization of the programs for immunization . The main obstacle to influenza vaccination reported by physicians was nonacceptance by a significant proportion of residents . Of the residents who did not initially request influenza vaccine , only 64 % accepted  vaccination  when it was offered . The vast majority of residents were satisfied with the information they had received and the respect shown for their freedom of choice . Forty per cent of residents were unfit to provide a valid consent and the vaccination rate was 76 % in this group . Only one-third of the physicians regularly obtained authorization from a relative or the legal guardian before prescribing vaccination for incompetent residents . None of the facilities studied had an effective program for pneumococcal vaccination , only 43 % of the physicians reported any use of pneumococcal vaccine  and 98 % of residents had never heard of the vaccine . CONCLUSIONS The national objective of 95 % coverage with influenza vaccine  will be difficult to achieve in long term care facilities , mainly because a minority of residents are not likely to be convinced of the benefit of immunization . Much remains to be done to promote and administer pneumococcal vaccine in this setting BACKGROUND Although they are effective in outpatient setting s , computerized reminders have not been proved to increase preventive care in inpatient setting s. METHODS We conducted a r and omized , controlled trial to determine the effects of computerized reminders on the rates at which four preventive therapies were ordered for in patients . During an 18-month study period , a computerized system processed on-line information for all 6371 patients admitted to a general-medicine service ( for a total of 10,065 hospitalizations ) , generating preventive care reminders as appropriate . Physicians who were in the intervention group viewed these reminders when they were using a computerized order-entry system for in patients . RESULTS The reminder system identified 3416 patients ( 53.6 percent ) as eligible for preventive measures that had not been ordered by the admitting physician . For patients with at least one indication , computerized reminders result ed in higher adjusted ordering rates for pneumococcal vaccination ( 35.8 percent of the patients in the intervention group vs. 0.8 percent of those in the control group , P<0.001 ) ,  influenza vaccination ( 51.4 percent vs. 1.0 percent , P < 0.001 ) , prophylactic heparin ( 32.2 percent vs. 18.9 percent , P<0.001 ) , and prophylactic aspirin at discharge ( 36.4 percent vs. 27.6 percent , P<0.001 ) . CONCLUSIONS A majority of hospitalized patients in this study were eligible for preventive measures , and computerized reminders significantly increased the rate of delivery of such therapies OBJECTIVE To demonstrate the feasibility of systematic influenza and pneumococcal vaccination in a busy Emergency Department ( ED ) . SETTING A public , inner-city hospital with an annual adult ED census of 120,000 . 93 % of patients are people of color . 78 % deny having either government or private insurance . Only 28 % of patients report having a primary care provider . Only 15 % present with complaints requiring immediate evaluation by a physician . METHODS Two uncontrolled demonstration projects were conducted during two periods , from 10/21/96 through 12/2/96 , ( during the influenza immunization season ) and from 5/27/97 to 7/26/97 . During project one , nurses were given st and ing orders that all non-urgent patients meeting CDC recommended criteria were to be offered immunization against influenza and /or pneumococcus at triage . The date of immunization was entered into unused fields in the computerized patient registration system , making it available system-wide , to all providers having access to billing system terminals . From 11/4 through 11/18 , an extra ' immunization nurse ' was assigned to test for improvement in immunization figures . A time/motion study of the time required for each immunization was conducted using a convenience sample of eight nurses over all three shifts . During project two , responsibility for carrying out st and ing orders for immunization was transferred to the patient 's nurses in the treatment area , and all high-risk patients were made eligible for immunization . An immunization card was issued to the patient at the time of each immunization . A monetary incentive to nurses was used to encourage completion of tracking forms . Computer record-keeping was continued . RESULTS Both projects required intense supervision to ensure performance . Despite initial resistance , and extreme variation in individual performance , many nurses and physicians became supportive of ED immunization during the two projects . During project one , 2631 patients were screened , and 789 high-risk patients were identified . 1238 patients were immunized against influenza and 374 against pneumococcus . Immunizations per shift per nurse varied from 0 to 24 . Median time for immunization was 4 min ( range 2 - 10 ) . The addition of an extra nurse at triage did not improve performance . During period two , 1907 patients were screened , 1532 high-risk patients were identified , and 1179 patients were immunized against pneumococcus . CONCLUSION Systematic ED immunization of high-risk adults is feasible even in a busy public ED setting In this paper we describe a successful multi-level participatory intervention grounded in principles of individual and group empowerment , and guided by social construction theory . The intervention addressed known and persistent inequities in influenza vaccination among African American and Latino older adults , and associated infections , hospitalizations and mortality . It was design ed to increase resident ability to make informed decisions about vaccination , and to build internal and external infrastructure to support sustainability over time . The intervention brought a group of social scientists , vaccine research ers , geriatricians , public health nurses , elder services providers and advocates together with senior housing management and activist African American and Latino residents living in public senior housing in a small east coast city . Two buildings of equal size and similar ethnic composition were r and omized as intervention and control buildings . Pre and post intervention surveys were conducted in both buildings , measuring knowledge , attitudes and peer norms . Processes and outcomes were documented at four levels : Influenza Strategic Alliance ( macro and exo levels ) , building management ( meso level ) , building resident committee ( meso level ) and individual residents . The Influenza Strategic Alliance ( I.S.A. ) provided ongoing re sources , information and vaccine ; the building management provided economic and other in-kind re sources and supported residents to continue flu clinics in the building . The V.I.P. Resident Committee conducted flu campaigns with flu clinics in English and Spanish . The vaccination rate in the intervention building at post test exceeded the study goal of 70 % and showed a significant improvement over the control building . The intervention achieved desired outcomes at all four levels and result ed in a significant increase in influenza vaccination , and improvements in pro-vaccination knowledge , beliefs , and underst and ing of health consequences 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 ] 1.4 
    Output:
    