***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: 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 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 : 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 SUMMARY The cost-effectiveness of treating hypertension at the patient 's place of work was compared in a r and omized controlled trial with care delivered in the community . The average total cost per patient for worksite care in this 12-month study was not significantly different from that for regular care ( $ 242.86 ± 6.94 vs $ 211.34 ± 18.66 , mean ± SEM ) . The worksite health system cost was significantly more expensive ( $ 197.36 ± 4.99 vs $ 129.33 ± 13.34 , p < 0.001 ) but the patient cost was significantly less ( $ 45.40 ± 3.23 vs $ 82.00 ± 6.20 , p < 0.01 ) . The mean reduction in diastolic blood pressure ( BP ) at tbe year-end assessment was significantly greater in the worksite group ( 12.1 ± 0.6 vs 6.5 ± 0.6 mm Hg , p < 0.001 ) . The incremental costeffectiveness ratio of $ 5.63 per mm Hg for worksite care was less than the base cost-effectiveness ratio of $ 32.51 per mm Hg for regular care , indicating that the worksite program was substantially more costeffective . Our findings support health policies that favor allocating re sources to work-based hypertension treatment programs for the target group identified in this study BACKGROUND With the decrease in junior doctor hours , the advent of specialist registrars , and the availability of highly trained and experienced nursing personnel , the service needs of patients with chronic respiratory diseases attending routine outpatient clinics may be better provided by appropriately trained nurse practitioners . METHODS A r and omised controlled crossover trial was used to compare nurse practitioner led care with doctor led care in a bronchiectasis outpatient clinic . Eighty patients were recruited and r and omised to receive 1 year of nurse led care and 1 year of doctor led care in r and om order . Patients were followed up for 2 years to ensure patient safety and acceptability and to assess differences in lung function . Outcome measures were forced expiratory volume in 1 second ( FEV(1 ) ) , 12 minute walk test , health related quality of life , and re source use . RESULTS The mean difference in FEV(1 ) was 0.2 % predicted ( 95 % confidence interval -1.6 to 2.0 % , p=0.83 ) . There were no significant differences in the other clinical or health related quality of life measures . Nurse led care result ed in significantly increased re source use compared with doctor led care ( mean difference pound 1497 , 95 % confidence interval pound 688 to pound 2674 , p<0.001 ) , a large part of which result ed from the number and duration of hospital admissions . The mean difference in re source use was greater in the first year ( pound 2625 ) than in the second year ( pound 411 ) . CONCLUSIONS Nurse practitioner led care for stable patients within a chronic chest clinic is safe and is as effective as doctor led care , but may use more re sources OBJECTIVE To compare the adverse effects and treatment adherence between 2 months of rifampin plus pyrazinamide ( 2RZ ) and 6 months of isoniazid ( 6H ) . BACKGROUND Patients with silicosis in Hong Kong are at high risk of acquiring tuberculosis . A previous study showed that treatment with 6H reduced the risk of silico-tuberculosis by one half . METHOD Patients with silicosis and a Mantoux skin test reaction > or = 10 mm were r and omized to receive either 2RZ or 6H daily .  Liver function testing was done monthly during the initial 2 months . The adverse effects and treatment adherence were compared between the two regimens . RESULTS Forty patients ( mean age , 61.6 + /- 9.1 years ) and 36 patients ( mean age , 57.6 + /- 9.7 years ) were r and omized to the 2RZ and 6H arms , respectively ( p > 0.05 ) [ + /- SD ] . Baseline characteristics were comparable . Nineteen patients in the 2RZ arm had peak alanine transaminase ( ALT ) levels > 1.5 times the upper limit of normal ( ULN ) in comparison with only five study subjects of the 6H arm ( 47.5 % vs 13.9 % , p < 0.01 ) . Fourteen patients ( 35 % ) in the 2RZ arm and 1 patient ( 2.8 % ) in the 6H arm had peak ALT levels more than five times the ULN ( p < 0.001 ) . Only seven patients had symptoms suggestive of hepatitis ; none of the patients had jaundice . All recovered after withholding treatment . In the 2RZ study arm , none of the baseline characteristics predicted hepatotoxicity . Other adverse effects were generally mild and comparable between both study arms . Treatment was stopped prematurely in 45 % and 36.1 % of patients in the 2RZ and 6H arms , respectively ( p = 0.43 ) . The main reasons were hepatotoxicity for the 2RZ arm and voluntary withdrawal after experiencing other minor adverse effects for the 6H arm . CONCLUSION A higher incidence of hepatotoxicity was associated with rifampin plus pyrazinamide than isoniazid in the treatment 
    Output:
    
Almost all of the interventions that were effective for long-term care were complex , including combinations of more convenient care , information , reminders , self-monitoring , reinforcement , counseling , family therapy , psychological therapy , crisis intervention , manual telephone follow-up , and supportive care .
Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes .
AUTHORS ' CONCLUSIONS Improving short-term adherence is relatively successful with a variety of simple interventions .
Current methods of improving adherence for chronic health problems are mostly complex and not very effective , so that the full benefits of treatment can not be realized .