***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 
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    ***EXAMPLES*** 
    Input: To assess the value of improved monitoring of medication‐taking behavior in a drug trial , we employed a modified pill vial with microcircuitry to record the precise times when the vials were opened . After a 3‐week placebo washout period , 21 ambulatory subjects with mild hypertension ( mean age , 57 years ; 67 % men ; 76 % white ) r and omly received isradipine or enalapril twice daily in a double‐blind titration during 10 weeks . Both drugs achieved a 13 % reduction in sitting diastolic blood pressure ( p < 0.01 ) with minimal symptomatic or laboratory toxicity . Although pill counts indicated near‐perfect compliance ( 92 % to 99 % for both groups ) , the electronic monitor showed that fewer than half of all openings occurred at the prescribed interval of 12 ± 2 hours . Modest overdispensing was documented in the 3 days before scheduled visits . The monitor confirmed that pill count misclassified compliance sufficiency in 22 % of visits and permitted more discrete attribution for drug‐associated adverse reactions and secondary resistance to treatment . We conclude that the electronic monitor reduces ambiguity about medication compliance and helps interpret both the biology and pharmacology of the trial Background The objective of this study was to develop and psychometrically evaluate a general measure of patients ' satisfaction with medication , the Treatment Satisfaction Question naire for Medication ( TSQM ) . Methods The content and format of 55 initial questions were based on a formal conceptual framework , an extensive literature review , and the input from three patient focus groups . Patient interviews were used to select the most relevant questions for further evaluation ( n = 31 ) . The psychometric performance of items and result ing TSQM scales were examined using eight diverse patient groups ( arthritis , asthma , major depression , type I diabetes , high cholesterol , hypertension , migraine , and psoriasis ) recruited from a national longitudinal panel study of chronic illness ( n = 567 ) . Participants were then r and omized to complete the test items using one of two alternate scaling methods ( Visual Analogue vs. Likert-type ) . Results A factor analysis ( principal component extraction with varimax rotation ) of specific items revealed three factors ( Eigenvalues > 1.7 ) explaining 75.6 % of the total variance ; namely Side effects ( 4 items , 28.4 % , Cronbach 's Alpha = .87 ) , Effectiveness ( 3 items , 24.1 % , Cronbach 's Alpha = .85 ) , and Convenience ( 3 items , 23.1 % , Cronbach 's Alpha = .87 ) . A second factor analysis of more generally worded items yielded a Global Satisfaction scale ( 3 items , Eigenvalue = 2.3 , 79.1 % , Cronbach 's Alpha = .85 ) . The final four scales possessed good psychometric properties , with the Likert-type scaling method performing better than the VAS approach . Significant differences were found on the TSQM by the route of medication administration ( oral , injectable , topical , inhalable ) , level of illness severity , and length of time on medication . Regression analyses using the TSQM scales accounted for 40–60 % of variation in patients ' ratings of their likelihood to persist with their current medication . Conclusion The TSQM is a psychometrically sound and valid measure of the major dimensions of patients ' satisfaction with medication . Preliminary evidence suggests that the TSQM may also be a good predictor of patients ' medication adherence across different types of medication and patient population BACKGROUND Adherence is essential to a positive treatment outcome . Whether adequate doses of topically applied drugs are used among patients with dermatologic conditions has not been investigated adequately . OBJECTIVES The objective of this prospect i ve study was to determine to what extent first-time out patients with dermatologic conditions apply the appropriate dosage of initial treatment with topically administered medication . METHODS Consultations with first-time patients in the dermatologic outpatient clinic were observed . Patients receiving a prescription for a previously untried topically administered drug were eligible . The expected quantity of topical treatment  to be used by each patient was calculated from the affected skin area to be treated . The affected area was estimated in numbers of palms of the h and , and an amount of 0.25 g of ointment or cream was chosen as sufficient treatment to cover the area of one palm . Two weeks after the consultation , a question naire with items regarding the size of the affected area , intentions to follow the treatment , and the applied dose the previous day was mailed to each patient . The question naires were personally collected from the patients ' homes and at the same visit the patients ' topical drug containers were weighed on a balance . Both patients and staff were blinded to the particular study purpose concerning adherence and dosing . RESULTS In all , 17 patients were eligible . The majority received a prescription for  topical corticosteroids  , and the median area to be treated was 3 palms of the h and ( interquartile range : 1.5 - 8 ) . Two patients did not redeem their prescriptions . Only one patient used the expected dosage ; in general median 35 % ( interquartile range : 22%-50 % ) of the expected individual dosages were used . LIMITATIONS Only first-time patients who received a new and previously untried topical treatment were included , result ing in a small study size . CONCLUSIONS Most first-time patients with dermatologic conditions underdose new topical treatments . Consequently , clinicians should always consider nonadherence when topical therapies fail The objective of this study was to develop a prospect ively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies . A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients . The 1-yr mortality rates for the different scores were : " 0 " , 12 % ( 181 ) ; " 1 - 2 " , 26 % ( 225 ) ; " 3 - 4 " , 52 % ( 71 ) ; and " greater than or equal to 5 " , 85 % ( 82 ) . The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up . The percent of patients who died of comorbid disease for the different scores were : " 0 " , 8 % ( 588 ) ; " 1 " , 25 % ( 54 ) ; " 2 " , 48 % ( 25 ) ; " greater than or equal to 3 " , 59 % ( 18 ) . With each increased level of the comorbidity index , there were stepwise increases in the cumulative mortality attributable to comorbid disease ( log rank chi 2 = 165 ; p less than 0.0001 ) . In this longer follow-up , age was also a predictor of mortality ( p less than 0.001 ) . The new index performed similarly to a previous system devised by Kaplan and Feinstein . The method of classifying comorbidity provides a simple , readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies . Further work in larger population s is still required to refine the approach because the number of patients with any given condition in this study was relatively small OBJECTIVE To assess patient  compliance with psoriasis treatment . DESIGN Open prospect i ve study . Patients with psoriasis were examined and completed a brief medical and social history , a compliance assessment sheet , and the Dermatology Life Quality Index ( DLQI ) . Patients were reexamined at 3 months , and their actual treatment use was assessed and compared with the expected use . Medication adherence was assessed by direct question ing . SETTING Dermatology outpatient clinic . PATIENTS Two hundred ninety-four patients fulfilled the inclusion criteria , and 201 completed the study . MAIN OUTCOME MEASURE Adherence with  topical and oral therapies  , using objective and self-reporting methods and description of factors affecting compliance . RESULTS The overall mean + /- SD medication adherence was 60.6 % + /- 33.0 % ( range , 0%-169 % ) . The mean + /- SD DLQI in the study was 17.4 + /- 8.9 ( range , 0 - 30 ) . There was a highly significant negative correlation ( r = -0.92 ) between these variables . Being female , married , employed , and not paying for prescriptions were characteristics associated with increased medication adherence and a lower DLQI . Medication adherence was greater for topical or combined therapy , for once-daily treatment , and for first-time use of treatment . Adverse effects reduced compliance . The major reasons for missing treatment were drinking alcohol , being fed up , forgetfulness , and being too busy .  Patients with facial disease and with more extensive disease had lower medication adherence . CONCLUSIONS A range of disease-related and social factors may affect compliance with psoriasis treatment . The inversely proportional relationship between DLQI and medication adherence reflects the interaction of physical and psychological factors , as well as perceived treatment failure BACKGROUND In the treatment of psoriasis , patient adherence to oral medications is poor and even worse for topical therapy . However , few data exist about adherence rates to home phototherapy , adding to concerns about the appropriateness of home phototherapy as a psoriasis treatment option . OBJECTIVE We sought to assess adherence to both oral acitretin and home ultraviolet B phototherapy for the treatment of psoriasis . METHODS In all , 27 patients with moderate to severe psoriasis were treated with 10 to 25 mg of acitretin daily , combined with narrowb and ultraviolet B , 3 times weekly at home , for 12 weeks . Adherence to acitretin was monitored by an electronic monitoring medication bottle cap , and to phototherapy by a light-sensing data logger . RESULTS Adherence data were collected on 22 patients for acitretin and 16 patients for adherence to ultraviolet B.  Mean adherence to acitretin  decreased steadily during the 12-week trial ( slope -0.24 ) , whereas mean adherence to home phototherapy remained steady at 2 to 3 d/wk . Adherence was similar between patients who reported side effects and those who did not . LIMITATIONS Small sample size and lack of follow-up on some patients were limitations of this study . CONCLUSIONS Adherence rates to home phototherapy were very good and higher than adherence rates for the oral medication . Side effects of treatment were well tolerated in this small group and did not affect use of the treatment . Home phototherapy with acitretin may be an appropriate option for some patients with extensive psoriasis INTRODUCTION Medication nonadherence is common throughout medicine , and research into this area is increasing ; however , knowledge about topical medication adherence is limited . METHODS A total of 30 patients were enrolled in a clinical trial for psoriasis and followed up for 8 weeks using 3 methods of adherence monitoring : electronic monitoring caps ; medication logs ; and medication usage by weight . RESULTS Adherence rates calculated from the medication logs and medication weights were consistently higher than those of the electronic monitors ( P < .05 ) . Electronically measured adherence rates declined from 84.6 % to 51 % during the 8-week study ( P < .0001 ) . Female sex and increasing age by 1 year predicted improved adherence of 5 % and 0.8 % , respectively ( P < .0001 ) . The number of treatment gaps increased from the first half to the last half of the study , and weekend days were overrepresented in treatment gaps . CONCLUSION Medication logs and weights do not ensure medication adherence to topical therapy . Electronic monitoring allows a more precise method of adherence measurement BACKGROUND A group of vitamin D derivatives has revealed to be an efficient treatment for psoriasis . Different types of studies have been design ed to confirm the efficacy of its use without relevant side-effects . OBJECTIVE Evaluation of tolerability and efficacy of tacalcitol ointment in moderate psoriasis . DESIGN A 2-month multicentre prospect i ve open-label observational study in patients with psoriasis treated with tacalcitol ointment .  METHODS A cohort of patients with psoriasis vulgaris seeking medical advice and being treated with tacalcitol based on the decision of their dermatologists was selected . A 2-month follow-up was performed to assess efficacy and tolerability of tacalcitol in an ointment formulation ( 4 microg/g ) once daily . A psoriatic lesion was selected in each patient in order to assess clinical symptoms ( erythema , desquamation and thickness ) by means of five-point scale : 0 ( none ) to 4 ( maximal severity ) . Percentages of involved skin , adverse effects , physicians ' global assessment s of efficacy and tolerability , and patients ' global satisfaction scores were also evaluated after 15 - 30 days ( first visit ) and 2 months ( second visit ) of treatment . RESULTS A total of 556 patients were included . Mean psoriasis duration was 10.1 years ( range , 0 - 61 years ) . Follow-up data were available for 493 patients in first follow-up visit and 449 in second ( final ) visit . Adverse events were uncommon ( 1.0 % and 0.6 % of patients in first and second follow-up visits , respectively ) . At first follow-up visit , mean decrease in selected lesions surface area ( from a baseline value of 185.8 cm(2 ) per lesion ) was 11.1 cm(2 ) ( 95 % CI , 1.6 - 20.6 ; P = 0.0213 ) . After 2 months of treatment , mean scores for erythema , desquamation and thickness changed from 2 
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No consistent pattern of results emerged for sociodemographical , disease and lifestyle factors as determinants of adherence .
However , some treatment factors were associated with adherence .
While mixed findings were reported for quality of life as a determinant of adherence , psychological factors ( psychological distress and patient satisfaction with care and therapy ) were associated with adherence .