***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: Rivaroxaban , an oral , direct factor Xa inhibitor , has been approved for the treatment of deep-vein thrombosis ( DVT ) and pulmonary embolism ( PE ) and the prevention of recurrent DVT and PE as a fixed-dose , single-drug regimen that does not require initial heparinisation , routine coagulation monitoring or dose adjustment . This study evaluated patient-reported treatment satisfaction in EINSTEIN DVT -- a large , open-label , r and omised study that compared rivaroxaban with enoxaparin/vitamin K antagonist ( VKA ) therapy in patients with acute symptomatic DVT without PE . As part of EINSTEIN DVT , a total of 1,472 patients in seven countries were asked to complete a new , vali date d measure of treatment satisfaction -- the Anti-Clot Treatment Scale (ACTS)--at scheduled visits throughout 12 months of treatment . ACTS scores were compared between study groups in the intention-to-treat population . Patients reported greater satisfaction in the rivaroxaban group compared with the enoxaparin/VKA group , with higher mean ACTS scores across visits . Mean ACTS Burdens scores were 55.2 vs 52.6 ( p<0.0001 ) in favour of rivaroxaban , equivalent to a moderate effect size of 0.42 . The treatment effect was consistent over time , with the mean score difference ranging from 2.18 ( month 2 ) to 3.18 ( month 12 ) . Overall mean ACTS Benefits scores were 11.7 vs 11.5 in favour of rivaroxaban ( p=0.006 ) . This was associated with a small overall effect size of 0.12 . The improvement in ACTS Benefits for rivaroxaban became apparent at month 2 and subsequent visits . Rivaroxaban results in improved treatment satisfaction compared with enoxaparin/VKA among patients with DVT , particularly in reducing patient-reported anticoagulation burden PURPOSE To compare whether health-related quality of life ( HRQoL ) is altered in patients undergoing a treatment strategy guided by changes in dietary vitamin K.  METHODS This study is a r and omized clinical trial carried out with chronic oral anticoagulation out patients r and omized into a  control group ( conventional dose adjustment of oral anticoagulants )  ( n = 66 ) and an  intervention group ( strategy based on changes in dietary vitamin K intake )  ( n = 66 ) .  HRQoL was measured using the Duke Anticoagulation Satisfaction Scale ( DASS ) at baseline and 90 days of follow-up . RESULTS Patients with worse HRQoL were younger ( p = 0.005 ) and were using a higher dose of baseline oral anticoagulants ( p = 0.008 ) , while those with better HRQoL scores had a higher level of education ( p = 0.01 ) . Both groups had significant improvements in HRQoL from baseline to 90 days in the global DASS score ( p < 0.001 ) , as well as in the negative and positive psychological impact ( p < 0.001 ) domains . We did not observe differences in the variations of HRQoL scores in any of the DASS domains ( p values > 0.05 ) between groups of interventions . Patients who achieved oral anticoagulation stability ( n = 23 ) had significantly better HRQoL scores than patients who did not achieve stability ( p = 0.003 ) . CONCLUSION Patients receiving the treatment strategy based on  changes in dietary vitamin K intake did not have better HRQoL scores ; however , both treatment approaches to manage oral anticoagulation improved HRQoL. Patients with greater oral anticoagulation stability had better HRQoL scores INTRODUCTION Rivaroxaban is an oral , direct Factor Xa inhibitor , approved for the treatment of pulmonary embolism ( PE ) and deep vein thrombosis ( DVT ) and the secondary prevention of recurrent PE and DVT as a fixed-dose , monotherapy regimen that does not require initial heparinisation , routine coagulation monitoring or dose adjustment . Approval in this indication was supported by results from EINSTEIN PE , a large , r and omised , open-label study that compared rivaroxaban with enoxaparin/vitamin K antagonist ( VKA ) therapy in patients with acute symptomatic PE with or without DVT . MATERIAL S AND METHODS Patient-reported treatment satisfaction was evaluated in a predefined sub analysis of EINSTEIN PE to enable monitoring and optimisation of patient-reported outcomes and , therefore , patient compliance . As part of EINSTEIN PE , 2,397 patients in seven countries were asked to complete a vali date d measure of treatment satisfaction , the Anti-Clot Treatment Scale ( ACTS ) throughout the duration of treatment ( up to 12 months ) . RESULTS Patients reported greater satisfaction in the rivaroxaban treatment arm as compared with the enoxaparin/VKA treatment arm . Treatment with rivaroxaban was reported as being significantly less burdensome than enoxaparin/VKA therapy , and the benefits of treatment were significantly greater . CONCLUSION Rivaroxaban treatment result ed in improved treatment satisfaction compared with enoxaparin/VKA in PE patients , particularly in reducing patient-reported anticoagulation burden Background The Anti-Clot Treatment Scale ( ACTS ) is a 15-item patient-reported instrument of satisfaction with anticoagulant treatment . It includes a 12-item ACTS Burdens scale and a 3-item ACTS Benefits scale . Its role in clinical trials and other setting s should be supported by evidence that it is both clinical ly meaningful and scientifically sound . The aim of the study was to evaluate the measurement performance of the ACTS ( Dutch , Italian , French , German and English language versions ) in patients with venous thromboembolism based on traditional psychometric methods . Methods ACTS Burdens and Benefits scale data from a large clinical trial ( EINSTEIN DVT ) involving 1336 people with venous thromboembolism were analysed at both the scale and item level . Five key psychometric properties were examined using traditional psychometric methods : acceptability , scaling assumptions , reliability ( including internal consistency reliability , test-retest reproducibility ) ; validity ( including known groups and discriminant validity ) ; and responsiveness . These methods of examination underpin the US Food and Drug Administration recommendations for patient-reported outcome instrument evaluation . Results Overall , the 12-item ACTS Burdens scale and 3-item ACTS Benefits scale met the psychometric criteria evaluated at both item and scale levels , with the exception of some relatively minor issues in the Dutch language version , which were just below reliability criteria ( i.e. alpha = 0.72 , test-retest intraclass correlation = 0.79 ) . A consistent finding from item-level evaluations of aggregate endorsement frequencies and skewness suggested that response scales may be improved by reducing the number of response options from five to four . Conclusions Both the ACTS Burdens and ACTS Benefits scales consistently satisfied traditional reliability and validity criteria across multiple language data sets , supporting it as a clinical ly useful patient-reported instrument of satisfaction with anticoagulant treatment in clinical trials . Trial registration The Hill-Bone Compliance to High Blood Pressure Therapy Scale assesses patient behaviors for three important behavioral domains of high blood pressure treatment : 1 ) reduced sodium intake ; 2 ) appointment keeping ; and 3 ) medication taking . This scale is comprised of 14 items in three subscales . Each item is a four point Likert type scale . The content validity of the scale was assessed by a relevant literature review and an expert panel , which focused on cultural sensitivity and appropriateness of the instrument for low literacy . Internal consistency reliability and predictive validity of the scale were evaluated using two community based sample s of hypertensive adults enrolled in clinical trials of high blood pressure care and control . The st and ardized alpha for the total scale were 0.74 and 0.84 , and the average interitem correlations of the 14 items were 0.18 and 0.28 , respectively . The construct and predictive validity of the scale was assessed by factor analysis and by testing of theoretically derived hypotheses regarding whether the scale demonstrated consistent and expected relationships with related variables . In this study , high compliance scale scores predicted significantly lower levels of blood pressure and blood pressure control . Moreover , high compliance scale scores at the baseline were significantly associated with blood pressure control at both baseline and at follow up in the two independent sample s. This brief instrument provides a simple method for clinicians in various setting s to use to assess patients ' self reported compliance levels and to plan appropriate interventions STUDY OBJECTIVE International normalized ratio self-testing with online remote monitoring and management ( STORM₂ ) is an alternative to anticoagulation clinic management , but the patient 's perspective of this method has not been evaluated in the United States ; thus we sought to evaluate the impact of STORM₂ on patient satisfaction , time , and cost . DESIGN Prospect i ve pre- and postintervention study . SETTING Freest and ing clinical research center . PATIENTS Forty-three patients treated with long-term warfarin therapy and monitored initially in the anticoagulation clinic setting and then with STORM₂ , referred from 11 medical practice s. INTERVENTION Patients were asked to complete a  survey and the Duke Anticoagulation Satisfaction Scale ( DASS ) before ( at baseline ) and after at least 3 months of STORM₂ ( at follow-up ) . MEASUREMENTS AND MAIN RESULTS Patient satisfaction and time were assessed by survey and the DASS . Costs were measured from the patient 's perspective . Overall 90 % of responders preferred STORM₂ to traditional clinic management . The DASS questions indicated that patients were more satisfied with their anticoagulation treatment and more likely to recommend oral anticoagulation to a friend after experiencing STORM₂. In addition , patients found STORM₂ to be less complicated and more convenient than traditional clinic management . For each traditional monthly visit , patients drove 20 miles and expended a total of 1.8 hours ; using 55¢/mile for mileage reimbursement and $ 15/hour for lost wages , the cost for each visit was $ 38 . The total cost for four STORM₂ visits per month was $ 10 , for a net savings of $ 28 per patient per month . A total of 76 % of patients were willing to pay additional money to eliminate a monthly clinic visit . CONCLUSION STORM₂ is more convenient , less complicated , preferred by patients , and saves patients time and money compared with clinic management Extended-interval monitoring of warfarin has been proposed to reduce follow-up burden and improve patient satisfaction . We aim ed to make an initial assessment of anticoagulation satisfaction before and after an extended-interval warfarin monitoring intervention . We conducted a translational prospect i ve single-arm pilot study of extended-interval warfarin monitoring in five pharmacist-managed anticoagulation clinics . Patients meeting CHEST guideline criteria for extended-interval warfarin monitoring began progressive extended-interval follow-up ( 6 , 8 , and 12 weeks thereafter ) . The Duke Anticoagulation Satisfaction Scale ( DASS ) was administered at baseline and at end-of- study or study removal ( in patients no longer appropriate for extended interval follow-up ) . Forty-six patients had evaluable pre- and post-intervention DASS survey data . Mean age of patients was 66.5 years , 74 % were non-Hispanic whites , and 48 % were men . Patients completed a mean ± SD of 34 ± 22 weeks of follow-up . Mean ± SD total DASS score at baseline was 45.2 ± 14.2 versus 49.1 ± 14.9 at end-of- study ( mean change , + 3.9 [ 95 % CI −0.6–8.4 ; p = 0.09 ] ) , indicating no benefit— and trending toward decrement — to anticoagulation satisfaction . Change in anticoagulation satisfaction varied substantially following extended-interval monitoring , with no evidence of improved satisfaction . Plausible reasons for patients not preferring extended-interval monitoring include increased anxiety and disengagement from self-management activities , both potentially related to less frequent feedback and reassurance during extended interval-monitoring . Additional research is needed to identify who is likely to benefit most from extended-interval monitoring . Anticoagulation satisfaction should be considered with clinical factors and shared-decision making when implementing extended-interval warfarin monitoring 
    Output:
    
Generic question naires and those specific to adherence to hypertension treatment are the most numerous .