***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: This study compares patient compliance with once- and twice-daily formulations of 5-isosorbide mononitrate . A total of 31 patients ( 20 men and 11 women ) with stable angina pectoris were r and omized to receive either 60 mg 5-isosorbide mononitrate in a controlled release formulation once daily , or 20 mg 5-isosorbide mononitrate twice daily . The results indicated that compliance assessed using the electronic Medication Event Monitoring System ( MEMS ® ) was better with the once-daily than with the twice-daily formulation ; patients on the once-daily regimen performed better with respect to the total number of bottle openings , the number of openings per day , the timing of openings and the intervals between openings . The apparently superior compliance with the once-daily regimen appeared to be reflected in better efficacy ; patients on the once-daily regimen experienced fewer angina attacks ( a mean of 1.7 per 7 days , compared with 3.3 per 7 days for patients on the twice-daily regimen ) and used fewer nitroglycerin tablets than those on the twice-daily regimen PURPOSE We conducted a prospect i ve study to determine the effects of nonadherence with mesalamine among patients with quiescent ulcerative colitis . METHODS We followed a cohort of 99 consecutive patients who had ulcerative colitis in remission for more than 6 months and who were taking maintenance mesalamine .  Medication adherence rates were calculated based on pharmacy records and a vali date d formula . Nonadherence was defined as refilling less than 80 % of prescribed medication . Patients were followed prospect ively and evaluated either in clinic or via telephone at 6 , 12 , and 24 months . The primary outcome was clinical recurrence of ulcerative colitis . Proportional hazards models were used to adjust for confounders . RESULTS At 6 months , 12 patients ( 12 % ) had clinical recurrence of disease symptoms , all of whom were nonadherent with medication . At 12 months , 19 of 86 patients had recurrent disease , 13 ( 68 % ) of whom were nonadherent . Patients who were not adherent with medication had more than a fivefold greater risk of recurrence than adherent patients ( hazard ratio = 5.5 ; 95 % confidence interval : 2.3 to 13 ; P < 0.001 ) . CONCLUSION Nonadherence with medication increases the risk of clinical relapse among patients with quiescent ulcerative colitis . Future research should be directed at behavioral interventions to improve adherence BACKGROUND & AIMS This study was conducted to assess , in a small sample , the short-term outcomes of once-daily mesalamine versus conventional dosing in maintaining quiescent ulcerative colitis ( UC ) and to assess adherence rates with both regimens . METHODS Consecutive patients were r and omly assigned to either a once-daily regimen , or they continued current conventional regimen ( twice daily or 3 times daily ) . Patients were assessed at 3 months and 6 months . At each point , a clinical symptom disease score was obtained using patient question naires , and medication rates via pharmacy data . Adherence was defined as consumption of > 80 % of prescribed medication . Information was collected by an investigator blinded to treatment regimen . RESULTS Twenty-two patients were enrolled in the study , 12 in the once-daily group ( QD ) and 10 in the conventional group ( CD ) . At 3 months , no patients had experienced a relapse . All of the patients in the QD group and 70 % of patients in the CD group were adherent ( P = 0.04 ) . The average amount of medication consumed in the QD group was significantly higher than in the CD group ( 90 % vs. 75 % , P = 0.02 ) . At 6 months , 2 patients ( 1 patient from each group ) experienced a clinical relapse ( P = 0.76 ) . Seventy-five percent vs. 70 % of patients were adherent ( P = 0.8 ) ; the amount of medication taken approached significance ( 90 % vs. 76 % , P = 0.07 ) . All patients in the QD group reported being either " very satisfied " or " satisfied " with their regimen . CONCLUSIONS In this r and omized pilot trial , patients taking once-daily mesalamine had outcomes similar to those for patients on conventional regimens . A larger trial is warranted to assess whether true differences between regimens exist A large , Internet‐based survey of a r and om sample of members of the Crohn 's and Colitis Foundation of America was undertaken to gain knowledge and underst and ing of patients ' experiences with ulcerative colitis and first‐line therapies . From 49,410 invitations to participate , 1,595 usable responses were received from patients with ulcerative colitis . Patients were prescribed a range of aminosalicylates for their ulcerative colitis . Treatments with the highest proportion of satisfied patients were associated with highest remission rates . Forty‐three percent of patients considered their disease to be in remission ; however , 74 % reported disease relapse during the previous 12 months . Over 60 % of patients reported that they were noncompliant with prescribed aminosalicylate dosing schedules , with reasons attributed to frequency of dosing , the number of pills , and the inconvenience of the medication . Many respondents reported that they had made significant lifestyle changes because of their ulcerative colitis , including spending more time at home ( 46 % ) and participating in fewer social activities ( 37 % ) . When asked to describe their ideal treatment , patients considered high efficacy ( 97 % ) , lack of side effects ( 74 % ) , nonparenteral dosing ( 46 % ) , nonrectal dosing ( 36 % ) , low cost ( 23 % ) , fewer pills ( 23 % ) , and less frequent dosing ( 23 % ) as “ very important . ” This study demonstrates that continuous symptomatic remission is central to patient satisfaction and that patients find currently available aminosalicylates to be inconvenient . Patients ' ideal therapy would be an effective , oral formulation with fewer tablets , less frequent dosing , and minimal side effects . Development of such a therapy would , therefore , potentially improve both patient compliance and overall treatment success OBJECTIVE : The aim of this study was to identify determinants of nonadherence to medication  in out patients with established inflammatory bowel disease ( IBD ) . METHODS : Ten gastroenterologists and 153 of their IBD patients participated in this prospect i ve study . Demographic , clinical , and psychosocial characteristics , as well as patient-physician discordance , were assessed at an office visit .  Nonadherence to medication was assessed 2 wk later . Separate generalized estimating equations were used to identify determinants of nonadherence . RESULTS : Physicians averaged 47.9 yr in age ( range 30.1–57.5 yr ) , and 90 % were male . Patients averaged 37.0 yr ( SD = 15.1 ) , and 87 ( 56.9 % ) were female . In all , 63 patients ( 41.2 % ) were nonadherent to medication ; of these , 51 ( 81.0 % ) indicated unintentional nonadherence , 23 ( 36.5 % ) intentional nonadherence , and 11 ( 17.5 % ) both . Overall nonadherence was predicted by disease activity ( OR = 0.55 , p = 0.0022 ) , new patient status ( OR = 2.14 , p = 0.0394 ) , disease duration ( OR = 0.50 , p = 0.0001 ) , and scheduling a follow-up appointment ( OR = 0.30 , p = 0.0059 ) , whereas higher discordance on well-being was predictive only in psychologically nondistressed patients ( p = 0.0026 for interaction ) . Unintentional nonadherence was predicted by age ( OR = 0.97 , p = 0.0072 ) , new patient status ( OR = 2.80 , p = 0239 ) , and higher discordance on well-being in psychologically nondistressed patients ( p = 0.0504 ) . Intentional nonadherence was predicted by disease duration ( OR = 0.55 , p = 0032 ) , scheduling a follow-up appointment ( OR = 0.12 , p = 0.0001 ) , certainty that medication would be helpful ( OR = 0.99 , p = 0.0409 ) , and total patient-physician discordance ( OR = 1.59 , p = .0120 ) . CONCLUSIONS : These findings suggest that the therapeutic relationship , as well as individual clinical and psychosocial characteristics , influence adherence to medication The objective of this study was to determine the relationship between prescribed daily dose frequency and  patient medication compliance .  The medication compliance of 105 patients receiving antihypertensive medications  was monitored by analyzing data obtained from special pill containers that electronically record the date and time of medication removal . Inaccurate compliance estimates derived using the simple pill count method were thereby avoided . Compliance was defined as the percent of days during which the prescribed number of doses were removed . Compliance improved from 59.0 % on a three-time daily regimen to 83.6 % on a once-daily regimen . Thus , compliance improves dramatically as prescribed dose frequency decreases . Probably the single most important action that health care providers can take to improve compliance is to select medications that permit the lowest daily prescribed dose frequency Recent studies have shown a low adherence rate to maintenance treatment in patients with inflammatory bowel disease ( IBD ) . We sought to assess the medication-taking behavior in a cohort of patients with IBD . We prospect ively included IBD patients from the outpatient clinic who agreed to answer a question naire about prescribed treatment and adherence . Physicians registered clinical data including prescribed medications . Two hundred fourteen patients ( 115 Crohn 's disease/99 ulcerative colitis ) were included . The most prescribed medications were oral mesalazine ( 56.5 % ) and immunomodulators ( 41.1 % ) . Forty-three percent of patients admitted to occasionally forgetting to take their medication but only 7.5 % of them did it voluntary . Oral mesalazine and azathioprine were the drugs with the poorest compliance , with nonadherence rates of 45 % and 25 % of the total prescribed doses , respectively . The only factor associated with a better adherence was a more complicated course of the disease — steroid dependency , steroid refractoriness , need for infliximab treatment , hospitalization , or surgery ( P=.02 ) . Twenty percent of patients admitted to self-medicating . An important proportion of patients with IBD admit to forget some doses of the prescribed medication in the setting of a specialized unit of a referral centre BACKGROUND Patients with inflammatory bowel disease ( IBD ) suffer physical dysfunction and impaired quality of life ( QOL ) , and need frequent health care . They often lack knowledge about their disease and desire more education . Educational interventions for other chronic diseases have demonstrated reduced health care use and increased knowledge , medication adherence and QOL . METHOD Sixty-nine participants were r and omly assigned to formal IBD education and st and ard of care ( pamphlets and ad hoc physician education ) or st and ard of care alone . Assessment of IBD knowledge and QOL occurred at baseline , immediately posteducation and eight weeks posteducation . Participants documented medication adherence and health care use in diaries . Patient satisfaction was assessed at the end of the study . RESULTS The education group had higher knowledge scores ( P=0.000 ) , perceived knowledge ratings ( P=0.01 ) and patient satisfaction ( P=0.001 ) . There was a lower rate of medication nonadherence and health care use for the education group , but the differences were not significant . QOL indices did not change . Significant correlations were found for increased health care use in patients with poorer medication adherence ( P=0.01 ) and lower perceived health ( P=0.05 ) . CONCLUSION Formal IBD patient education improves knowledge , perceived knowledge and patient satisfaction . Further study of long-term effects may better demonstrate potential benefits for QOL , medication adherence and health care use 
    Output:
    
A substantial proportion of UC flares and medical costs of UC are attributable to 5-ASA non-adherence .