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: We evaluate the results of a field experiment design ed to measure the effect of prompts to form implementation intentions on realized behavioral outcomes . The outcome of interest is influenza vaccination receipt at free on-site clinics offered by a large firm to its employees . All employees eligible for study participation received reminder mailings that listed the times and locations of the relevant vaccination clinics . Mailings to employees r and omly assigned to the treatment conditions additionally included a prompt to write down either ( 1 ) the date the employee planned to be vaccinated or ( 2 ) the date and time the employee planned to be vaccinated .  Vaccination rates increased when these implementation intentions prompts were included in the mailing . The vaccination rate among control condition employees was 33.1 % . Employees who received the prompt to write down just a date had a vaccination rate 1.5 percentage points higher than the control group , a difference that is not statistically significant . Employees who received the more specific prompt to write down both a date and a time had a 4.2 percentage point higher vaccination rate , a difference that is both statistically significant and of meaningful magnitude Uptake of the measles , mumps , and rubella vaccine in the United Kingdom has declined to levels that will allow outbreaks of these preventable diseases to occur . A leaflet sent with a personalized reminder did not increase vaccine uptake in children who had not been immunised at 21 months of age OBJECTIVE : To assess the effectiveness of reminder/recall ( R/R ) for immunizing adolescents in private pediatric practice s and to describe the associated costs and revenues . METHODS : We conducted a r and omized controlled trial in 4 private pediatric practice s in metropolitan Denver . In each practice , 400 adolescents aged 11 to 18 years who had not received 1 or more targeted vaccinations ( tetanus-diphtheria-acellular pertussis , meningococcal conjugate , or first dose of human papillomavirus vaccine for female patients ) were r and omly selected and r and omized to intervention ( 2 letters and 2 telephone calls ) or  control  ( usual care ) groups . Primary outcomes were receipt of > 1 targeted vaccines and receipt of all targeted vaccines 6 months postintervention . We calculated net additional revenue for each additional adolescent who received at least 1 targeted vaccine and for those who received all targeted vaccines . RESULTS : Eight hundred adolescents were r and omized to the intervention and 800 to the control group . Baseline rates of having already received tetanus-diphtheria-acellular pertussis , meningococcal conjugate , and first dose of human papillomavirus vaccine before R/R ranged from 33 % to 54 % . Postintervention , the intervention group had significantly higher proportions of receipt of at least 1 targeted vaccine ( 47.1 % vs 34.6 % , P < .0001 ) and receipt of all targeted vaccines ( 36.2 % vs 25.2 % , P < .0001 ) compared with the control group . Three practice s had positive net revenues from R/R ; 1 showed net losses . CONCLUSIONS : R/R was successful at increasing immunization rates in adolescents and effect sizes were comparable to those in younger children . Practice s conducting R/R may benefit financially if they can generate additional well-child care visits and keep supply costs low 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 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 OBJECTIVE To determine whether reminder notices would improve the timeliness of toddler-age vaccinations . DESIGN Prospect i ve , r and omized , controlled trial . POPULATION STUDIED Two convenience cohorts of 320 children due to receive either measles-mumps-rubella ( MMR ) vaccine ( at 12 months of age ) or diphtheria-pertussis-tetanus (DPT)-inactivated polio (IPV)- Haemophilus influenzae type b ( Hib ) booster vaccine ( at 18 months of age ) . SETTING Suburban community . INTERVENTIONS Parents of the identified children were r and omly assigned either to a group to receive a reminder notice of pending vaccinations or a control group that did not receive a notice at a ratio of 1:1 . Immunization uptake was assessed eights weeks after the initial due date for vaccination . RESULTS Information was obtained for 224 children in the MMR group and 227 children in the DPT-IPV-Hib  booster group . MMR uptake within eight weeks of the due date was about 90 % in both the test and control groups , probably because of publicity surrounding a local college-based measles outbreak . In the DPT-IPV-Hib group , reminder notices had no effect ; the uptake rates within eight weeks of the due date were 73.7 % to 75.2 % . Delays in immunization result ed mostly from parents ' scheduling problems and provider-recommended delays . More than half of the parents whose child had delayed immunization did not recall receiving the reminder notice . CONCLUSIONS Mailed reminders did not increase on-time immunization rates in the second year of a child 's life . A telephone call or a more memorable reminder notice may be better suited to catch the attention of parents Background . An Advisory Committee on Immunization Practice s policy of encouraging influenza vaccination for healthy 6- to 23-month-old children was in effect during the 2003–2004 influenza season , which was unusually severe in Colorado . We collaborated with 5 pediatric practice s to attempt universal influenza immunization in this age group . Objectives . The objectives were ( 1 ) to assess the maximal influenza immunization rates that could be achieved for healthy young children in private practice setting s , ( 2 ) to evaluate the efficacy of registry-based reminder/recall for influenza vaccination , and ( 3 ) to describe methods used by private practice s to implement the recommendations . Methods . The study was conducted in 5 private pediatric practice s in Denver , Colorado , with a common billing system and immunization registry . Although recommendations by the Advisory Committee on Immunization Practice s included children who were 6 to 23 months of age at any point during the influenza season , our practice s chose not to recall children 22 to 23 months of age , because they would have become > 24 months of age during the study period . Therefore , our study population consisted of all healthy children 6 to 21 months of age from the 5 practice s ( N = 5193 ) , who were r and omized to intervention groups ( n = 2595 ) that received up to 3 reminder/recall letters or to control groups ( n = 2598 ) that received usual care . The primary outcome was receipt of ≥1 influenza immunization , as noted either in the immunization registry or in billing data . Results . Immunization rates for ≥1 dose of influenza vaccine for the intervention groups in the 5 practice s were 75.9 % , 75.4 % , 68.1 % , 55.6 % , and 44.3 % at the end of the season . Overall , 62.4 % of children in the intervention groups and 58.0 % of children in the control groups were immunized ( 4.4 % absolute difference ) , with absolute differences , compared with control values , ranging from 1.0 % to 9.1 % according to practice . However , before intensive media coverage of the influenza outbreak began ( November 15 , 2003 ) , absolute differences , compared with control values , ranged from 5.1 % to 15.3 % and were 9.6 % overall . Before November 15 , significant effects of recall were seen for children in the intervention groups , in both the 12- to 21-month age category ( 10.4 % increase over control ) and the 6- to 11-month category ( 8.1 % increase over control ) ; at the end of the season , however , significant effects of recall were seen only for the older age group ( 6.2 % increase over control ) . The rates of receipt of 2 vaccine doses ≥1 month apart for eligible children ranged from 21 % to 48 % among the practice s. Four of the 5 practice s held influenza immunization clinics during office hours , evenings , or weekends , and these clinics achieved higher coverage rates . Conclusions . These results demonstrated that , in an epidemic influenza year , private practice s were able to immunize the majority of 6- to 21-month-old children in a timely manner . Although media coverage regarding the epidemic blunted the effect of registry-based recall , recall was effective in increasing rates early in the epidemic , especially for children between 1 and 2 years of age . The practice s that achieved the highest immunization rates were proactive in planning influenza 
    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: We evaluate the results of a field experiment design ed to measure the effect of prompts to form implementation intentions on realized behavioral outcomes . The outcome of interest is influenza vaccination receipt at free on-site clinics offered by a large firm to its employees . All employees eligible for study participation received reminder mailings that listed the times and locations of the relevant vaccination clinics . Mailings to employees r and omly assigned to the treatment conditions additionally included a prompt to write down either ( 1 ) the date the employee planned to be vaccinated or ( 2 ) the date and time the employee planned to be vaccinated .  Vaccination rates increased when these implementation intentions prompts were included in the mailing . The vaccination rate among control condition employees was 33.1 % . Employees who received the prompt to write down just a date had a vaccination rate 1.5 percentage points higher than the control group , a difference that is not statistically significant . Employees who received the more specific prompt to write down both a date and a time had a 4.2 percentage point higher vaccination rate , a difference that is both statistically significant and of meaningful magnitude Uptake of the measles , mumps , and rubella vaccine in the United Kingdom has declined to levels that will allow outbreaks of these preventable diseases to occur . A leaflet sent with a personalized reminder did not increase vaccine uptake in children who had not been immunised at 21 months of age OBJECTIVE : To assess the effectiveness of reminder/recall ( R/R ) for immunizing adolescents in private pediatric practice s and to describe the associated costs and revenues . METHODS : We conducted a r and omized controlled trial in 4 private pediatric practice s in metropolitan Denver . In each practice , 400 adolescents aged 11 to 18 years who had not received 1 or more targeted vaccinations ( tetanus-diphtheria-acellular pertussis , meningococcal conjugate , or first dose of human papillomavirus vaccine for female patients ) were r and omly selected and r and omized to intervention ( 2 letters and 2 telephone calls ) or  control  ( usual care ) groups . Primary outcomes were receipt of > 1 targeted vaccines and receipt of all targeted vaccines 6 months postintervention . We calculated net additional revenue for each additional adolescent who received at least 1 targeted vaccine and for those who received all targeted vaccines . RESULTS : Eight hundred adolescents were r and omized to the intervention and 800 to the control group . Baseline rates of having already received tetanus-diphtheria-acellular pertussis , meningococcal conjugate , and first dose of human papillomavirus vaccine before R/R ranged from 33 % to 54 % . Postintervention , the intervention group had significantly higher proportions of receipt of at least 1 targeted vaccine ( 47.1 % vs 34.6 % , P < .0001 ) and receipt of all targeted vaccines ( 36.2 % vs 25.2 % , P < .0001 ) compared with the control group . Three practice s had positive net revenues from R/R ; 1 showed net losses . CONCLUSIONS : R/R was successful at increasing immunization rates in adolescents and effect sizes were comparable to those in younger children . Practice s conducting R/R may benefit financially if they can generate additional well-child care visits and keep supply costs low 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 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 OBJECTIVE To determine whether reminder notices would improve the timeliness of toddler-age vaccinations . DESIGN Prospect i ve , r and omized , controlled trial . POPULATION STUDIED Two convenience cohorts of 320 children due to receive either measles-mumps-rubella ( MMR ) vaccine ( at 12 months of age ) or diphtheria-pertussis-tetanus (DPT)-inactivated polio (IPV)- Haemophilus influenzae type b ( Hib ) booster vaccine ( at 18 months of age ) . SETTING Suburban community . INTERVENTIONS Parents of the identified children were r and omly assigned either to a group to receive a reminder notice of pending vaccinations or a control group that did not receive a notice at a ratio of 1:1 . Immunization uptake was assessed eights weeks after the initial due date for vaccination . RESULTS Information was obtained for 224 children in the MMR group and 227 children in the DPT-IPV-Hib  booster group . MMR uptake within eight weeks of the due date was about 90 % in both the test and control groups , probably because of publicity surrounding a local college-based measles outbreak . In the DPT-IPV-Hib group , reminder notices had no effect ; the uptake rates within eight weeks of the due date were 73.7 % to 75.2 % . Delays in immunization result ed mostly from parents ' scheduling problems and provider-recommended delays . More than half of the parents whose child had delayed immunization did not recall receiving the reminder notice . CONCLUSIONS Mailed reminders did not increase on-time immunization rates in the second year of a child 's life . A telephone call or a more memorable reminder notice may be better suited to catch the attention of parents Background . An Advisory Committee on Immunization Practice s policy of encouraging influenza vaccination for healthy 6- to 23-month-old children was in effect during the 2003–2004 influenza season , which was unusually severe in Colorado . We collaborated with 5 pediatric practice s to attempt universal influenza immunization in this age group . Objectives . The objectives were ( 1 ) to assess the maximal influenza immunization rates that could be achieved for healthy young children in private practice setting s , ( 2 ) to evaluate the efficacy of registry-based reminder/recall for influenza vaccination , and ( 3 ) to describe methods used by private practice s to implement the recommendations . Methods . The study was conducted in 5 private pediatric practice s in Denver , Colorado , with a common billing system and immunization registry . Although recommendations by the Advisory Committee on Immunization Practice s included children who were 6 to 23 months of age at any point during the influenza season , our practice s chose not to recall children 22 to 23 months of age , because they would have become > 24 months of age during the study period . Therefore , our study population consisted of all healthy children 6 to 21 months of age from the 5 practice s ( N = 5193 ) , who were r and omized to intervention groups ( n = 2595 ) that received up to 3 reminder/recall letters or to control groups ( n = 2598 ) that received usual care . The primary outcome was receipt of ≥1 influenza immunization , as noted either in the immunization registry or in billing data . Results . Immunization rates for ≥1 dose of influenza vaccine for the intervention groups in the 5 practice s were 75.9 % , 75.4 % , 68.1 % , 55.6 % , and 44.3 % at the end of the season . Overall , 62.4 % of children in the intervention groups and 58.0 % of children in the control groups were immunized ( 4.4 % absolute difference ) , with absolute differences , compared with control values , ranging from 1.0 % to 9.1 % according to practice . However , before intensive media coverage of the influenza outbreak began ( November 15 , 2003 ) , absolute differences , compared with control values , ranged from 5.1 % to 15.3 % and were 9.6 % overall . Before November 15 , significant effects of recall were seen for children in the intervention groups , in both the 12- to 21-month age category ( 10.4 % increase over control ) and the 6- to 11-month category ( 8.1 % increase over control ) ; at the end of the season , however , significant effects of recall were seen only for the older age group ( 6.2 % increase over control ) . The rates of receipt of 2 vaccine doses ≥1 month apart for eligible children ranged from 21 % to 48 % among the practice s. Four of the 5 practice s held influenza immunization clinics during office hours , evenings , or weekends , and these clinics achieved higher coverage rates . Conclusions . These results demonstrated that , in an epidemic influenza year , private practice s were able to immunize the majority of 6- to 21-month-old children in a timely manner . Although media coverage regarding the epidemic blunted the effect of registry-based recall , recall was effective in increasing rates early in the epidemic , especially for children between 1 and 2 years of age . The practice s that achieved the highest immunization rates were proactive in planning influenza 
    Output:
    