***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 s Limited evidence is available regarding pharmacist managed anticoagulation clinic  in the Southeast Asian region where there is marked difference in terms of care model , genetic composition and patient demographics . Objectives This study aim ed at comparing the anticoagulation clinic managed by the pharmacist with physician advisory and the usual medical care provided in Kuala Lumpur Hospital ( KLH ) in terms of anticoagulation control and adverse outcomes . Setting A 2,302 bedded government tertiary referral hospital in Malaysia . Methods A 6-month retrospective cohort study of the effectiveness of two models of anticoagulation care , the pharmacist managed anticoagulation clinic which is known as warfarin medication therapy adherence clinic ( WMTAC ) and usual medical clinic ( UMC ) in KLH was conducted , where a r and om number generator was used to recruit patients . The UMC patients received st and ard medical care where they are managed by rotational medical officers in the physicians ’ clinic . As for the WMTAC with physician advisory , the pharmacist will counsel and review the patients internationalised normalization ratio at each clinic visit and also adjust the patients ’ warfarin dose accordingly . Patients are referred to physicians if immediate attention is required . Main outcome measure The main therapeutic outcome is time in therapeutic range ( TTR ) both actual and exp and ed TTR and thromboembolic and bleeding complications . Results Each of the WMTAC and usual medical care recruited 92 patients , which totals to 184 patients . The patient demographics in terms of age , race and indication of treatment were comparable . At the end of the 6 months follow-up , patients in the WMTAC group had significantly higher actual-TTR ( 65.1 vs. 48.3 % ; p < 0.05 ) compared to those in usual medical care group . Rates of admission were 6.5 versus 28.2 events per 100 person-years for the WMTAC and UMC groups , respectively . Though the bleeding incidences were not significantly different , it was reduced . Conclusions These findings will impact local warfarin patient management services and policies because there was no available evidence supporting the role of pharmacists in the management of warfarin patients prior to this study Background The beneficial outcomes of oral anticoagulation therapy are dependent upon achieving and maintaining an optimal INR therapeutic range . There is growing evidence that better outcomes are achieved when anticoagulation is managed by a pharmacist with expertise in anticoagulation management rather than usual care by family physicians . This study compared a pharmacist managed anticoagulation program ( PC ) to usual physician care ( UC ) in a family medicine clinic . Methods A retrospective cohort study was carried out in a family medicine clinic which included a clinical pharmacist . In 2006 , the pharmacist assumed anticoagulation management . For a 17-month period , the PC group ( n = 112 ) of patients on warfarin were compared to the UC patients ( n = 81 ) for a similar period prior to 2006 . The primary outcome was the percentage of time patients ' INR was in the therapeutic range ( TTR ) . Secondary outcomes were the percentage of time in therapeutic range within ± 0.3 units of the recommended range ( exp and ed TTR ) and percentage of time the INR was > 5.0 or < 1.5 . Results The baseline characteristics were similar between the groups . Fifty-five percent of the PC group was male with a mean age of 67 years ; 51 % of the UC group was male with a mean age of 71 years . The most common indications for warfarin in both groups were atrial fibrillation , mechanical heart valves and deep vein thrombosis . The TTR was 73 % for PC and 65 % for UC ( p < 0.0001 ) . The exp and ed TTR for PC was 91 % and 85 % for UC ( p < 0.0001 ) . The percentage of time INR values were < 1.5 was 0.7 % for PC patients and 1.9 % for UC patients ( p < 0.0001 ) , and > 5 were 0.3 % for PC patients and 0.1 % for UC ( p < 0.0001 ) . Conclusion The pharmacist-managed anticoagulation program within a family practice clinic compared to usual care by the physicians achieved significantly better INR control as measured by the percentage of time patients ' INR values were kept in both the therapeutic and exp and ed range . Based on the results of this study , a collaborative family practice clinic using pharmacists and physicians may be an effective model for anticoagulation management with these results verified in future prospect i ve r and omized studies BACKGROUND There is growing evidence that better outcomes are achieved when anticoagulation is managed by anticoagulation clinics rather than by family physicians . We carried out a r and omized controlled trial to evaluate these 2 models of anticoagulant care . METHODS We r and omly allocated patients who were expected to require warfarin sodium for 3 months either to anticoagulation clinics located in 3 Canadian tertiary hospitals or to their family physician practice s. We evaluated the quality of oral anticoagulant management by comparing the proportion of time that the international normalized ratio ( INR ) of patients receiving warfarin sodium  was within the target therapeutic range + /- 0.2 INR units ( exp and ed therapeutic range ) while they were managed in anticoagulation clinics as opposed to family physicians ' care over 3 months . We measured the rates of thromboembolic and major hemorrhagic events and patient satisfaction in the 2 groups . RESULTS Of the 221 patients enrolled , 112 were r and omly assigned to anticoagulation clinics and 109 to family physicians . The INR values of patients who were managed by anticoagulation clinics were within the exp and ed therapeutic range 82 % of the time versus 76 % of the time for those managed by family physicians ( p = 0.034 ) . High-risk INR values ( defined as being < 1.5 or > 5.0 ) were more commonly observed in patients managed by family physicians ( 40 % ) than in patients managed by anticoagulation clinics ( 30 % , p = 0.005 ) . More INR measurements were performed by family physicians than by anticoagulation clinics ( 13 v. 11 , p = 0.001 ) . Major bleeding events ( 2 [ 2 % ] v. 1 [ 1 % ] ) , thromboembolic events ( 1 [ 1 % ] v. 2 [ 2 % ] ) and deaths ( 5 [ 4 % ] v. 6 [ 6 % ] ) occurred at a similar frequency in the anticoagulation clinic and family physician groups respectively . Of the 170 ( 77 % ) patients who completed the patient satisfaction question naire , more were satisfied when their anticoagulant management was managed through anticoagulation clinics than by their family physicians ( p = 0.001 ) . INTERPRETATION Anticoagulation clinics provided better oral anticoagulant management than family physicians , but the differences were relatively modest AIM To compare the treatment outcomes of a clinical pharmacist-managed anticoagulation service with physician-managed service in Chinese patients . METHODS A prospect i ve , r and omized clinical trial was conducted at the anticoagulation clinic of a teaching hospital in Hong Kong . Patients aged > or = 18 years who would required warfarin therapy for at least 3 months were recruited . Patients were r and omized to the pharmacist-managed or physician-managed group .  Primary clinical outcome was assessed by the percentage of patient time spent within the target international normalized ratio ( INR ) range . The incidence of major thromboembolic events ( TEs ) and major bleeding was assessed as secondary clinical outcomes . The cost per patient per month ( cPPPM ) was calculated and patient satisfaction was assessed by patient satisfaction question naire (PSQ)-18 . RESULTS One hundred and forty-one patients were recruited at the anticoagulation clinic and 137 patients completed the study . Patients in the pharmacist-managed group ( n = 68 ) were in the target INR 64 % of patient time vs. 59 % in the physician-managed group ( n = 69 ) ( P < 0.001 ) . There was no significant difference in incidence of major TEs or bleeding . The cPPPM in the pharmacist-managed group ( 76 + /- 95 US dollar ) ( 43 + /- 53 British pound ) was lower than in the physician-managed group ( 98 + /- 158 US dollar ) ( 55 + /- 89 British pound ) ( P < 0.001 ) . The PSQ-18 score of the pharmacist-managed group ( 3.8 + /- 0.2 ) was higher than that of the physician-managed group ( 3.6 + /- 0.3 ) ( P < 0.001 ) . CONCLUSION The pharmacist-managed anticoagulation service was more effective and less costly than the physician-managed service in achieving target anticoagulation control for Chinese patients on warfarin therapy Hospitalized patients receiving anticoagulants such as warfarin  are at increased risk for adverse events because of difficulties maintaining a therapeutic international normalized ratio ( INR ) . We sought to determine whether a detailed warfarin dosing protocol administered by pharmacists with minimal physician oversight significantly reduced the proportion of hospitalized patients with a supratherapeutic INR . We conducted a prospect i ve , nonr and omized trial with patients on cardiology , internal medicine , and family medicine inpatient services who received at least 1 dose of warfarin while hospitalized . The baseline group included 293 patients , and the intervention group comprised 217 patients . Baseline characteristics were similar in each group , except that more patients received antibiotics in the intervention group . The defect rate ( INR > 5 after receiving warfarin ) in the baseline group was significantly higher than in the intervention group ( 7.85 vs. 1.85 % ) . Conversely , the percentage of patients with an INR less than 1.7 after 4 warfarin doses was lower in the intervention patients , indicating overall improvement in therapeutic levels . Dosing discussion s were required between the pharmacist and a physician for only 6 % of intervention patients . The protocol effectively reduced overanticoagulation without increasing under anticoagulation during hospitalization and reduced the need for close physician oversight OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity STUDY OBJECTIVE To evaluate the safety and economic impact of three models of anticoagulation management services : usual medical care , a nurse-managed service , and a pharmacist-managed service . DESIGN Retrospective medical record review . SETTING An eight-county health care system in central New York State . PATIENTS Nine hundred ninety-six patients ( age range 19 - 99 yrs ) who were receiving warfarin therapy for at least 6 months and who had three or more international normalized ratio ( INR ) values reported during the 1-year study period ; 489 patients ( 6243 INR values ) were in the pharmacist-managed group , 307 patients ( 3618 INR values ) were in the nurse-managed group , and 200 patients ( 3142 INR values ) were in the usual care group . MEASUREMENTS AND MAIN RESULTS All INR measurements were performed by the central laboratory or by on-site point-of-care testing . Data were queried from calendar year 2003 for the usual care and nurse-managed services and calendar year 2006 for the pharmacist-managed service .  Anticoagulation indication , INR goal , baseline characteristics , and rates and costs of hospitalization 
    Output:
    
The study supported PMWT regarding cost saving and patient satisfaction .
The results showed that the PMWT model is superior to UMC in managing warfarin therapy based on observational studies .
As well , it is comparable to UMC based on RCT studies