BackgroundImmunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events.Methodology/Principal FindingsElectronic databases and grey literature were searched and records were screened against eligibility criteria. Data extraction and risk of bias assessments were performed in duplicate. Results were synthesised narratively and meta-analyses were conducted where feasible. Heterogeneity was assessed using I2 and publication bias was assessed using Begg's funnel plot and Egger's regression test. Many of the 209 eligible studies included an unclear or high risk of bias. Meta-analyses showed a significant effect of preventing influenza-like illness (odds ratio [OR] = 0.23; 95% confidence interval [CI] = 0.16–0.34; p<0.001) and laboratory confirmed influenza infection (OR = 0.15; 95% CI = 0.03–0.63; p = 0.01) through vaccinating immunocompromised patie nts compared to placebo or unvaccinated controls. We found no difference in the odds of influenza-like illness compared to vaccinated immunocompetent controls. The pooled odds of seroconversion were lower in vaccinated patients compared to immunocompetent controls for seasonal influenza A(H1N1), A(H3N2) and B. A similar trend was identified for seroprotection. Meta-analyses of seroconversion showed higher odds in vaccinated patients compared to placebo or unvaccinated controls, although this reached significance for influenza B only. Publication bias was not detected and narrative synthesis supported our findings. No consistent evidence of safety concerns was identified.Conclusions/SignificanceInfection prevention and control strategies should recommend vaccinating immunocompromised patients. Potential for bias and confounding and the presence of heterogeneity mean the evidence reviewed is generally weak, although the directions of effects are consistent. Areas for further research are identified.

Implementation and monitoring of MedMAP were feasible in these community mental health settings. Additional implementation projects are crucial for advancing evidence-based practice in clinical settings.

Vaccination of immunocompromised patients is recommended in many national guidelines to protect against severe or complicated influenza infection. However, due to uncertainties over the evidence base, implementation is frequently patchy and dependent on individual clinical discretion. We conducted a systematic review and meta‐analysis to assess the evidence for influenza vaccination in this patient group. Healthcare databases and grey literature were searched and screened for eligibility. Data extraction and assessments of risk of bias were undertaken in duplicate, and results were synthesised narratively and using meta‐analysis where possible. Our data show that whilst the serological response following vaccination of immunocompromised patients is less vigorous than in healthy controls, clinical protection is still meaningful, with only mild variation in adverse events between aetiological groups. Although we encountered significant clinical and statistical heterogeneity in many of our meta‐analyses, we advocate that immunocompromised patients should be targeted for influenza vaccination.

Need assessment is an important component in planning, prioritizing and evaluating care provision. Old age psychiatry is an expanding community-based speciality. It is important for community mental health services to be need-led (McCrone and Strathdee, 1994), since this ensures better targeting of the limited resources. The available needs assessment instruments are either those problem-oriented methods that have limited applicability in health service planning or methods that are too complicated and cumbersome to be used in the community. Some of these instruments have been standardized on adult general psychiatry patients and might not be appropriate for old age psychiatry services. There is thus an opportunity for the development of a needs assessment method that is standardized on old age psychiatry patients and measures need for the range of interventions offered by old age psychiatry services.KEY woms-health care needs; social disablement; needs for psychiatric services; needs of the elderly; old age psychiatry services Assessment of individual needs is an important component of proposed community care plans (Department of Health, 1991). The multidisciplinary nature and community-based emphasis of old age psychiatry services would make a need assessment procedure a very useful tool for targeting and evaluating services. The assessment of need is an essential prerequisite to setting up health care programmes (Abramson, 1984) and an important part of the evaluation of health services and establishing priorities for services (Donabedian, 1974). Cassel (1994), in a recent editorial, has emphasized the particular importance of assessing health care needs in the elderly with the current climate of health care rationing. Furthermore, a recent study has shown that a needs-led health care provision for the elderly can reduce the cost and the length of stay in hospital (McLean et al., 1994). NEEDS FOR HEALTH CARENeed for health care is defined as the requirement for preventative, curative and rehabilitative care

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