***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: The efficacy of self-recording of blood pressure in the management of hypertension was assessed in a r and omized clinical trial involving 140 persons who had been receiving antihypertensive therapy for a year or more , but whose diastolic blood pressure had remained at 95 mm Hg or higher . To control for the increased attention implicit in self-recording , which might affect blood pressure , the patients were assigned at r and om to one of the four groups : self-recording and monthly home visits , self-recording only , monthly home visits only , and neither self-recording nor monthly home visits . This design also permitted assessment of the effect of home visits . During the 6-month experiment no significant differences were apparent between the groups in either compliance or diastolic blood pressure . However , both self-recording and monthly home visits produced a reduction in blood pressure among patients who admitted to difficulty remembering to take their pills ; a reduction was not seen among patients who said they had no such difficulty . This confirmed an earlier observation suggesting that this easily identified group of patients may be the most responsive to intervention programs OBJECTIVE : To compare adherence data from an electronic medication-event monitoring device ( MEMS , Aprex ) with pill counts in assisting pharmacists in making recommendations regarding diabetes therapy . DESIGN : Two-month , double-blind , r and omized , controlled trial . SETTING : Veterans Affairs Medical Center ambulatory care clinics . PATIENTS : Forty-seven patients with poor to fair metabolic control of diabetes mellitus were enrolled . Patients were excluded if they were receiving insulin , had a concurrent infection , required child-resistant caps or medication reminder devices , or could not return for follow-up visits . Twenty patients were r and omized to the MEMS and 27 to the control group ( pill counts ) . Fasting plasma glucose concentrations were measured monthly and glycohemoglobin concentrations were measured at baseline and 60 days . Thirty-two patients were evaluable : 15 using MEMS and 17 using pill counts . INTERVENTION : Investigators made pharmacologic or educational recommendations to the patient 's healthcare provider based on both laboratory data and MEMS readings in the treatment group or laboratory data and pill counts in the control group . MAIN OUTCOME MEASURE : Quantities and types of recommendations regarding diabetes therapy made by pharmacists using adherence data from the two methods were tabulated . RESULTS : In the MEMS group , 47 percent of the recommendations related to patient education compared with 12 percent in the control group ( p=0.028 ) . MEMS data would have changed four recommendations in the control group to involve patient education . CONCLUSIONS : MEMS data result ed in different numbers and types of recommendations than pill counts . Pharmacists then could make specific recommendations regarding patient education before resorting to pharmacologic manipulations OBJECTIVE To determine the effectiveness of structured adherence counseling by pharmacists on the eradication of Helicobacter pylori when using a st and ard drug treatment regimen . DESIGN R and omized controlled clinical trial . SETTING Nonprofit group- practice health maintenance organization ( HMO ) . PARTICIPANTS HMO primary care providers referred 1,393 adult dyspeptic patients for carbon 14 urea breath testing ( UBT ) . INTERVENTIONS Those whose tests were positive for H pylori ( 23.3 % ) were provided a st and ard antibiotic regimen and r and omly assigned to receive either usual-care counseling from a pharmacist or a longer adherence counseling session and a follow-up phone call from the pharmacist during drug treatment . All subjects were given the same 7-day course of omeprazole , bismuth subsalicylate , metronidazole , and tetracycline hydrochloride ( OBMT ) . Dyspepsia symptoms were recorded at baseline and following therapy . OUTCOMES The main outcome was eradication of H pylori as measured by UBT at 3-month follow-up . Secondary outcomes were patient satisfaction and dyspepsia symptoms at 3-month follow-up . RESULTS Of the 333 participants r and omly assigned to treatment , 90.7 % completed the 3-month follow-up UBT and question naires . Overall eradication rate with the OBMT regimen was 80.5 % with no significant difference in eradication rates between the 2 groups ( P=0.98 ) . Conclusions In this study , additional counseling by pharmacists did not affect self-reported adherence to the treatment regimen , eradication rates , or dyspepsia symptoms but did increase patient satisfaction Abstract An experimental study was carried out to test and analyze the effects of an educational program on a group of hypertensive patients , comparing those with known higher risks of stroke and heart attack , e.g. , secondary organ damage , with a group whose risks were relatively lower . Specific interventions have been shown to be differentially effective on specific patient behaviors ( e.g. , compliance with therapy )  and on blood pressure control for both higher- and lower-risk patients in most of the experimental groups . Such findings emphasize the importance of tailored educational approaches , not only for a hypertensive population , but , more importantly , for patients who are known to have more difficulty achieving their blood pressure control and who are at higher risk of morbidity and mortality , i.e. , patients who have secondary organ damage , have been previously hospitalized for hypertension , or are black males under 50 years of age BACKGROUND There is little information on the long-term effects and costs of a combination of Sertraline and interpersonal psychotherapy ( IPT ) for the treatment of dysthymia in primary care . METHODS In a single-blind , r and omized clinical trial , 707 adults ( 18 - 74 years of age inclusive ) with DSM-IV dysthymic disorder , with or without past and /or current major depression , as an acute or chronic episode , in a community-based primary care practice in Ontario , Canada , were r and omized to treatment with either  Sertraline alone ( 50 - 200 mg ) , or IPT alone ( 10 sessions ) , or Sertraline plus IPT combined . In the acute treatment phase ( first 6 months ) all groups received full active treatment . This was followed by an additional 18-month naturalistic follow-up phase . Subjects were assessed for effectiveness of treatment in reducing depressive symptoms using the Montgomery Asberg Depression Rating Scale ( MADRS ) at 6 months and twice again during the 18-month follow-up by blind independent observers . Treatment costs and subjects ' use of other health and social services were also investigated . RESULTS At 6 months , 586 subjects completed the MADRS question naire . There was a significant difference ( P=0.025 ) in mean MADRS scores : 14.3 ( Group I ) ; 14.9 ( Group II ) ; 16.8 ( Group III ) , using analysis of covariance . Response ( 40 % improvement ) rates were 60.2 % for Sertraline alone , 46.6 % for IPT alone , and 57.5 % for Sertraline augmented by IPT ( P=0.02 ) . At 2 years , 525 subjects were retained for follow-up . There was no statistically significant difference between Sertraline alone and Sertraline plus IPT in symptom reduction . However , both were more effective than IPT alone in reducing depressive symptoms ( P=0.03 ) . There was a statistically significant difference between groups in costs for use of health and social services . The IPT treatment groups had the lower costs for use of health and social services . CONCLUSIONS Sertraline or Sertraline plus IPT was more effective than IPT alone after 6 months . Over the long term ( 2 years ) , all three treatments provide reasonably effective treatment for reducing symptoms of dysthymia , but Sertraline or combining Sertraline with IPT is more effective than IPT alone . Of these two more effective treatments , subjects in the Sertraline plus IPT group had less health and social service costs by $ 480 per person over 2 years . These findings underscore the effects of combining pharmacotherapy and psychotherapy and the economic value of this more comprehensive treatment of dysthymia in primary care Background Gastrointestinal irritability can deter pregnant women from starting or continuing prenatal multivitamin supplementation . In a previous study , suboptimal tolerability was observed among pregnant women taking a large tablet ( 18 mm × 8 mm × 8 mm ) multivitamin with high elemental iron content ( 60 mg as ferrous fumarate ) . The objective of the present study was to compare rates of adherence and reported adverse events among pregnant women who were r and omized to commence supplementation with a small-tablet prenatal multivitamin , containing either low or high iron content . Methods Pregnant women who called the Motherisk Program ( Hospital for Sick Children , Toronto ) and had not started taking or had discontinued any multivitamin due to adverse events were included in this prospect i ve , r and omized , open-label , 2-arm study . Women were r and omized to take a small-size ( 16 mm × 9 mm × 4 mm ) , low elemental iron content ( 35 mg as ferrous fumarate ) multivitamin ( ' 35 mg ' group ) ; or a small-size ( 5 mm radius , 5 mm thickness ) , high elemental iron content ( 60 mg as ferrous sulphate ) multivitamin ( ' 60 mg ' group ) . Follow-up interviews documented pill intake and adverse events . Rates of adherence and adverse events were compared between groups using chi-squared tests and Kaplan-Meier survival curves . Results Of 167 r and omized women , 92 in the ' 35 mg ' group and 75 in the ' 60 mg ' group were included in the analysis . Despite ideal conditions and regular follow-ups , mean adherence based on pill intake recall , in both groups was approximately 50 % . No statistically significant difference was detected in proportions of women who actually started taking either multivitamin . Among those who started , no difference was detected in rates of adherence or reported adverse events . Conclusion The present results suggest that iron content is not a major determinant of adherence to prenatal multivitamins . Combined with our previous study , tablet size may be the more definitive factor affecting adherence Background : No r and omised studies have addressed whether self-management for asthma can be successfully delivered by community pharmacists . Most r and omised trials of asthma self-management have recruited participants from secondary care ; there is uncertainty regarding its effectiveness in primary care . A r and omised controlled study was undertaken to determine whether a community pharmacist could improve asthma control using self-management advice for individuals recruited during attendance at a community pharmacy . Methods : Twenty four adults attending a community pharmacy in Tower Hamlets , east London for routine asthma medication were r and omised into two groups : the intervention group received self-management advice from the pharmacist with weekly telephone follow up for 3 months and the control group received no input from the pharmacist . Participants self-completed the North of Engl and asthma symptom scale at baseline and 3 months later . Results : The groups were well matched at baseline for demographic characteristics and mean ( SD ) symptom scores ( 26.3 ( 4.8 ) and 27.8 ( 3.7 ) in the intervention and control groups , respectively ) . Symptom scores improved in the intervention group and marginally worsened in the control group to 20.3 ( 4.2 ) and 28.1 ( 3.5 ) , respectively ( p<0.001 ; difference adjusted for baseline scores = 7.0 ( 95 % CI 4.4 to 9.5 ) . Conclusions : A self-management programme delivered by a community pharmacist can improve asthma control in individuals recruited at a community pharmacy . Further studies should attempt to confirm these findings using larger sample s and a wider range of outcome measures The effect of pharmaceutical care on the prevention , detection , and resolution of medication-related problems in high-risk patients in a rural community was studied . Adult patients who received care at clinics in a medically underserved area of Alabama and who were identified as being at high risk of medication-related adverse events were r and omly assigned to a control group or an intervention group . The control group received st and ard medical care , and the intervention group received pharmaceutical care , including a medical record review , a medication history review , pharmacotherapeutic evaluation , and patient medication education and monitoring over a one-year period .  A total of 69 patients completed the study ( 33 in the intervention group and 36 in the control group ) . The percentage of patients responding to hypertension , diabetes , dyslipidemia , and anticoagulation therapy increased significantly in the intervention group and declined in the control group . Ratings for inappropriate prescribing improved in all 10 domains evaluated in the intervention group but worsened in 5 domains in the control group . There were no significant differences between the groups at 12 months in health-related quality of life or medication misadventures . Medication compliance scores improved in the intervention group but not in the control group . Medication knowledge increased in the intervention group and decreased in the control group . Pharmaceutical care in a rural , community-based setting appeared to reduce inappropriate prescribing , enhance disease management , and improve medication compliance and knowledge without adversely affecting health-related quality of life BACKGROUND Directly observed therapy ( DOT ) programs for HIV treatment have demonstrated feasibility , acceptability , and improved viral suppression , but few have been rigorously tested . We describe a r and omized controlled trial testing the efficacy of an antiretroviral DOT program in methadone maintenance clinics . Our objective was to determine if DOT is more efficacious than self-administered antiretroviral therapy for reducing HIV viral load , improving adherence , and reducing drug resistance among 
    Output:
    
Even the most effective interventions did not lead to large improvements in adherence or clinical outcomes .