***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: Although r and omised trials are important for evidence -based medicine , little is known about their overall characteristics . We assessed the epidemiology and reporting of method ological details for all 519 PubMed -indexed r and omised trials published in December , 2000 ( 383 [ 74 % ] parallel-group , 116 [ 22 % ] crossover ) . 482 ( 93 % ) were published in specialty journals . A median of 80 participants ( 10th-90th percentile 25 - 369 ) were recruited for parallel-group trials . 309 ( 60 % ) were blinded . Power calculation , primary outcomes , r and om sequence generation , allocation concealment , and h and ling of attrition were each adequately described in less than half of publications . The small sample sizes are worrying , and poor reporting of method ological characteristics will prevent reliable quality assessment of many published trials Outpatient medication adherence is a major problem , especially for patients repeatedly hospitalized for psychiatric disorders . This study included 39 such patients who were receiving case management services from a community mental health center . Patients were matched and r and omly assigned to receive in a single session either ( 1 ) information regarding medication and its benefits , ( 2 ) guidelines for assuring adherence which encompassed all phases related to pill-taking including filling prescriptions , use of a pill container , transportation , self-reminders , doctor 's appointments and so forth , or ( 3 ) the same guidelines as ( 2 ) above but given in the presence of a family member who was enlisted in support . The results showed that adherence increased to about 94 % after the guidelines were given for both the individual and family guideline procedure , whereas adherence remained unchanged at 73 % after the medication information procedure . These results suggest a practical means for assuring a high level of medication adherence for patients with psychiatric disorders CONTEXT Poor medication adherence diminishes the health benefits of pharmacotherapies . Elderly patients with coronary risk factors frequently require treatment with multiple medications , placing them at increased risk for nonadherence . OBJECTIVE To test the efficacy of a comprehensive pharmacy care program to improve medication adherence and its associated effects on blood pressure ( BP ) and low-density lipoprotein cholesterol ( LDL-C ) . DESIGN , SETTING , AND PATIENTS A multiphase , prospect i ve study with an observational phase and a r and omized controlled trial conducted at the Walter Reed Army Medical Center of 200 community-based patients aged 65 years or older taking at least 4 chronic medications . The study was conducted from June 2004 to August 2006 . INTERVENTION After a 2-month run-in phase ( measurement of baseline adherence , BP , and LDL-C ) , patients entered a 6-month intervention phase ( st and ardized medication education , regular follow-up by pharmacists , and medications dispensed in time-specific packs ) . Following the intervention phase , patients were r and omized to continued pharmacy care vs usual care for an additional 6 months . MAIN OUTCOME MEASURES Primary end point of the observation phase was change in the proportion of pills taken vs baseline ; secondary end points were the associated changes in BP and LDL-C. Primary end point of the r and omization phase was the between-group comparison of medication persistence . RESULTS A total of 200 elderly patients ( 77.1 % men ; mean [ SD ] age , 78 [ 8.3 ] years ) , taking a mean ( SD ) of 9 ( 3 ) chronic medications were enrolled . Coronary risk factors included drug-treated hypertension in 184 patients ( 91.5 % ) and drug-treated hyperlipidemia in 162 ( 80.6 % ) . Mean ( SD ) baseline medication adherence was 61.2 % ( 13.5 % ) . After 6 months of intervention , medication adherence increased to 96.9 % ( 5.2 % ; P<.001 ) and was associated with significant improvements in systolic BP ( 133.2 [ 14.9 ] to 129.9 [ 16.0 ] mm Hg ; P = .02 ) and LDL-C ( 91.7 [ 26.1 ] to 86.8 [ 23.4 ] mg/dL ; P = .001 ) . Six months after r and omization , the persistence of medication adherence decreased to 69.1 % ( 16.4 % ) among those patients assigned to usual care , whereas it was sustained at 95.5 % ( 7.7 % ) in pharmacy care ( P<.001 ) . This was associated with significant reductions in systolic BP in the pharmacy care group ( -6.9 mm Hg ; 95 % CI , -10.7 to -3.1 mm Hg ) vs the usual care group ( -1.0 mm Hg ; 95 % CI , -5.9 to 3.9 mm Hg ; P = .04 ) , but no significant between-group differences in LDL-C levels or reductions . CONCLUSIONS A pharmacy care program led to increases in medication adherence , medication persistence , and clinical ly meaningful reductions in BP , whereas discontinuation of the program was associated with decreased medication adherence and persistence . TRIAL REGISTRATION clinical trials.gov Identifier : Background : Poor adherence to warfarin therapy is a major contributor to subtherapeutic anticoagulation . Objective : To determine whether use of a monthly medication organizer , filled at each clinic visit , improves anticoagulation control among warfarin-treated patients . Methods : Patients who had a history of nonadherence to warfarin and were attending an inner-city anticoagulation clinic were enrolled in this prospect i ve cohort study and provided with a 28-day medication organizer . Patients were instructed to bring their organizers and warfarin tablets to each anticoagulation clinic visit over the following 3 months . At each visit , the international normalized ratio ( INR ) was measured , warfarin adherence was assessed , and the organizer was filled with the prescribed warfarin regimen until the next scheduled visit . Data on  warfarin adherence and INR values during the 3 months prior to enrollment were collected from medical records and compared with postenrollment data . Results : Thirteen patients were enrolled and completed at least one postenrollment clinic visit . Adherence to warfarin therapy improved with use of the medication organizer ( mean ± SD preenrollment 55 ± 25 % , postenrollment 67 ± 21 % ; p = 0.06 ) . There was a significant decrease in the proportion of subtherapeutic INR values ( 60 ± 25 % to 35 ± 29 % ; p = 0.04 ) and a significant improvement in the percent of time spent within the therapeutic INR range ( 32 ± 22 % to 56 ± 28 % ; p = 0.03 ) after enrollment . Conclusions : Use of a monthly medication organizer significantly reduced the percent of subtherapeutic INR values and improved the time spent within the therapeutic anticoagulation range among previously nonadherent patients managed in an inner-city anticoagulation clinic A study was design ed for practitioners wishing to provide comprehensive educational services to the elderly . The effectiveness of four methods ( i.e. , oral instructions alone or in combination with written information , a medication reminder calendar , or a medication reminder package ) of changing patient attitudes , drug knowledge , and compliance behavior was measured in 158 ambulatory cardiovascular patients using a r and omized , controlled , single-blind design . The results indicate that drug knowledge will most likely be improved by a strategy that provides small amounts of specific information , thereby reducing the possibility of overwhelming the patient . Noncompliance behavior caused by forgetfulness can be best improved by combining a reminder aid with oral reinforcement . The high levels of motivation present in these patients indicate that improving patient attitudes toward medication taking may be unnecessary An estimated 20 million Americans suffer from diabetes . Patients with non-insulin-dependent diabetes mellitus ( NIDDM ) comprise approximately 90 % of the diabetic population . An estimated 10 - 30 % of patients with NIDDM withdraw from their prescribed regimen within 1 year of diagnosis , and of the remainder , nearly 20 % administer insufficient medication to facilitate an adequate reduction in blood glucose . A r and omized trial was undertaken to discern the effect of pharmacy-based value-added utilities on prescription-refill compliance with sulfonylurea therapy and health service utilization . The subjects were 258 Medicaid beneficiaries from the state of South Carolina , previously untreated for NIDDM , prescribed 5 mg of the second-generation sulfonylurea glyburide twice daily  , and monitored with regard to prescription-refill compliance and health service utilization for 1 year . Subjects provided informed consent and were r and omly assigned to one of four experimental groups : ( i ) the control cohort received st and ard pharmaceutical care with each dispensing of glyburide ; ( ii ) the second cohort received st and ard pharmaceutical care and was mailed a medication-refill reminder 10 days prior to each sequential refill date ; ( iii ) the third cohort received st and ard pharmaceutical care and was provided unit-of-use packaging with each prescription-refill request ; ( iv ) the fourth cohort received st and ard pharmaceutical care , mailed medication-refill reminders , and unit-of-use packaging . Analysis of variance ( ANOVA ) procedures revealed that patients receiving mailed prescription-refill reminders , unit-of-use packaging , or a combination of both interventions achieved a significant ( P < or = 0.05 ) increase in the Medication Possession Ratio ( MPR ) for sulfonylurea therapy relative to controls . ( ABSTRACT TRUNCATED AT 250 WORDS Adequate reporting of r and omized , controlled trials ( RCTs ) is necessary to allow accurate critical appraisal of the validity and applicability of the results . The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement , a 22-item checklist and flow diagram , is intended to address this problem by improving the reporting of RCTs . However , some specific issues that apply to trials of nonpharmacologic treatments ( for example , surgery , technical interventions , devices , rehabilitation , psychotherapy , and behavioral intervention ) are not specifically addressed in the CONSORT Statement . Furthermore , considerable evidence suggests that the reporting of nonpharmacologic trials still needs improvement . Therefore , the CONSORT group developed an extension of the CONSORT Statement for trials assessing nonpharmacologic treatments . A consensus meeting of 33 experts was organized in Paris , France , in February 2006 , to develop an extension of the CONSORT Statement for trials of nonpharmacologic treatments . The participants extended 11 items from the CONSORT Statement , added 1 item , and developed a modified flow diagram . To allow adequate underst and ing and implementation of the CONSORT extension , the CONSORT group developed this elaboration and explanation document from a review of the literature to provide examples of adequate reporting . This extension , in conjunction with the main CONSORT Statement and other CONSORT extensions , should help to improve the reporting of RCTs performed in this field OBJECTIVES To determine whether an enhanced compliance program ( ECP ) improves patient compliance with bismuth subsalicylate , metronidazole , and tetracycline hydrochloride ( BMT ) triple therapy for the treatment of Helicobacter pylori infection and to identify factors that affect compliance with therapy . DESIGN A r and omized controlled trial conducted in 4 staff-model health centers of a health maintenance organization in Massachusetts . PATIENTS AND METHODS A total of 125 patients 18 years of age or older with peptic ulcer disease or dyspepsia whose clinicians prescribed BMT triple therapy for 14 days were r and omized to a control group or to the ECP group . The ECP group received medication counseling ( written and oral ) from a pharmacist , along with a medication calendar and a minipillbox , as well as a follow-up telephone call after initiation of therapy . Compliance was assessed by a pill count , and factors affecting adherence to the regimen were identified by patients ' reports . RESULTS There was no statistically significant difference between the 2 groups in the number of patients taking more than 60 % of the medications ( 89 % of the control group vs 95 % of the ECP group ; P>.30 ) . However , there was a statistically significant difference in the number of patients taking more than 90 % of the medications ( 67 % of the control group vs 89 % of the ECP group ; P<.01 ) . An intention-to-treat analysis confirmed these results . The most frequently reported adverse effect was gastrointestinal intolerance . Other factors reported to affect compliance included the frequency of dosing and the number of pills . CONCLUSIONS These findings suggest that although adverse effects were common , most patients were able to complete 60 % or more of the 2-week regimen . An ECP further improved the percentage of medications taken Background : Similar to patients with other chronic disorders , patients with serious mental illness ( SMI ) are often poorly adherent with prescribed medications . Objective : We conducted a r and omized controlled trial examining the effectiveness of a pharmacy-based intervention ( Meds-Help ) in increasing antipsychotic medication adherence among Department of Veterans Affairs ( VA ) patients with SMI . We also examined the impact of Meds-Help on psychiatric symptoms , quality of life , and satisfaction with care . Methods : We enrolled 118 patients from 4 VA facilities 
    Output:
    
Conclusions Overall , the studies showed a positive effect of drug reminder packaging on adherence and clinical outcomes .