***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 
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    ***EXAMPLES*** 
    Input: CONTEXT Control of oral anticoagulation therapy has been reported to often be inadequate . Previous retrospective investigations suggest that patients ' self-adjustment of oral anticoagulants may lead to improved control . OBJECTIVE To investigate the effects of patients ' self-management of oral anticoagulation therapy on accuracy of control and measures of treatment-related quality of life . DESIGN R and omized , single-blind , multicenter trial . SETTING AND PARTICIPANTS A total of 179 patients receiving long-term oral anticoagulation treatment were enrolled at 5 referral centers in Germany . INTERVENTION Patients were r and omized to an oral anticoagulation self-management group based on a structured treatment and teaching program and international normalized ratio ( INR ) self-monitoring . The control group received conventional care as provided by family physicians , including referral to specialists if necessary . MAIN OUTCOME MEASURES Deviation of INR values from the individual INR target range ( squared ) and the 5 categories of treatment-related quality of life . RESULTS Deviation of INR value from the mean of the INR target range was significantly lower in the intervention group at 3-month ( squared INR deviation , 0.59 vs 0.95 ; P<.001 ) and 6-month follow-up ( 0.65 vs 0.83 ; P=.03 ) compared with the control group . Also , the intervention group had INR values within the target range more often ( repeated measurement analysis for categorical data , P=.006 ) . The results were mainly due to less frequent suboptimal INR values in the intervention group ( 32.8 % vs 50.0 % [ P=.03 ] at 3-month , and 33.7 % vs 48.2 % [ P=.08 ] at 6-month follow-up ) . Treatment-related quality -of-life measures , especially treatment satisfaction scores , were significantly higher in the intervention group compared with controls . CONCLUSIONS An anticoagulation education program that includes self-management of anticoagulation therapy results in improved accuracy of anticoagulation control and in treatment-related quality -of-life measures . Further studies are needed to describe whether the program will reduce risk of bleeding or thromboembolism AIMS In Belgium , general practitioners ( GPs ) mainly manage oral anticoagulation therapy . To improve the quality of oral anticoagulation management by GPs and to compare different models and interventions , a r and omized clinical trial was performed . METHODS AND RESULTS Stratified r and omization divided 66 GP- practice s into four groups . A 6-month retrospective analysis assessed the baseline quality . In the prospect i ve study , each group received education on oral anticoagulation , anticoagulation files , and patient information booklets ( groups A , B , C , and D ) . Group B additionally received feedback every 2 months on their anticoagulation performance ; group C determined the international normalized ratio ( INR ) with a CoaguChek device in the doctor 's office or at the patient 's home ; and group D received Dawn AC computer assisted advice for adapting oral anticoagulation . For the different groups , the time spent in target INR range ( Rosendaal 's method ) and adverse events related to anticoagulation were determined and compared with the same quality indicators at baseline . There was a significant increase in per cent of time within 0.5 INR from target , from 49.5 % at baseline to 60 % after implementing the different interventions . However , neither the per cent in target range nor the event rates differed among the four groups . CONCLUSION The interventions significantly improved the quality of management of oral anticoagulation by Belgian GPs , mainly as a result of an education and support programme Background : The increase in numbers of patients receiving warfarin treatment has led to the development of alternative models of service delivery for oral anticoagulant monitoring . Patient self management for oral anticoagulation is a model new to the UK . This r and omised trial was the first to compare routine primary care management of oral anticoagulation with patient self management . Aim : To test whether patient self management is as safe , in terms of clinical effectiveness , as primary care management within the UK , as assessed by therapeutic international normalised ratio ( INR ) control . Method : Patients receiving warfarin from six general practice s who satisfied study entry criteria were eligible to enter the study . Eligible patients were r and omised to either intervention ( patient self management ) or control ( routine primary care management ) for six months . The intervention comprised two training sessions of one to two hours duration . Patients were allowed to undertake patient self management on successful completion of training . INR testing was undertaken using a Coaguchek device and regular internal/external quality control tests were performed . Patients were advised to perform INR tests every two weeks , or weekly if a dose adjustment was made . Dosage adjustment was undertaken using a simple dosing algorithm . Results : Seventy eight of 206 ( 38 % ) patients were eligible for inclusion and , of these , 35 ( 45 % ) declined involvement or withdrew from the study . Altogether , 23 intervention and 26 control patients entered the study . There were no significant differences in INR control ( per cent time in range : intervention , 74 % ; control , 77 % ) . There were no serious adverse events in the intervention group , with one fatal retroperitoneal haemorrhage in the control group . Costs of patient self management were significantly greater than for routine care ( £ 90 v £ 425/patient/year ) . Conclusion : These are the first UK data to demonstrate that patient self management is as safe as primary care management for a selected population . Further studies are needed to eluci date whether this model of care is suitable for a larger population BACKGROUND Vitamin K antagonist treatment is effective for prevention and treatment of thromboembolic events but frequent laboratory control and dose-adjustment are essential . Small portable devices have enabled patient self-monitoring of anticoagulation and self-adjustment of the dose . We compared this self-management of oral anticoagulant therapy with conventional management by a specialist anticoagulation clinic in a r and omised cross-over study . METHODS 50 patients on long-term oral anticoagulant treatment were included in a r and omised controlled crossover study . Patients were self-managed or were managed by the anticoagulation clinic for a period of 3 months . After this period the alternative strategy was followed for each patient . Prothrombin time ( expressed as international normalised ratio [ INR ] ) were measured at intervals of 1 - 2 weeks in both periods without knowledge of type of management . The primary endpoint was the number of measurements within the therapeutic range ( therapeutic target value + /-50.5 INR units ) . FINDINGS There was no significant difference in the overall quality of control of anticoagulation between the two study periods . Patients were for 55 % and for 49 % of the treatment period within a range of + /-0.5 from the therapeutic target INR during self-management and anticoagulation clinic management , respectively ( p=0.06 ) . The proportion of patients who spent most time in the therapeutic target range was larger during self-management than during anticoagulation clinic-guided management . The odds ratio for a better control of anticoagulation ( defined as the period of time in the therapeutic target range ) during self-management compared with anticoagulation clinic-guided management was 4.6 ( 95 % CI 2.1 - 10.2 ) . A patient-satisfaction assessment showed superiority of self-management over conventional care . INTERPRETATION Self-management of INR in the population in this study is feasible and appears to result in control of anticoagulation that is at least equivalent to management by a specialist anticoagulation clinic . It is also better appreciated by patients . Larger studies are required to assess the effect of this novel management strategy on the incidence of thromboembolic or bleeding complications BACKGROUND Self-management ( SM ) of warfarin by patients is an attractive strategy , particularly if it improves anticoagulation control and can be done safely under minimal physician supervision . OBJECTIVE To compare the effect of SM with physician-management ( PM ) on the maintenance of therapeutic anticoagulation . METHODS A r and omized , open-label eight-month trial was performed . Patients 18 years of age and older were eligible if they were receiving warfarin for at least one month before enrolment and required anticoagulation for at least one year to a target international normalized ratio ( INR ) of 2.0 to 3.0 or 2.5 to 3.5 . Exclusion criteria were a known hypercoaguable disorder , mental incompetence , a language barrier or an inability to attend training sessions . Patients r and omly assigned to SM tested their INR using a point-of-care device ( Pro Time Microcogulation System , International Technidyne Corporation , USA ) and adjusted their warfarin doses using a nomogram . Patients r and omly assigned to PM received usual care from their general practitioner . The primary outcome was to demonstrate 20 % improvement in anticoagulation control by SM . RESULTS One hundred forty patients were r and omly assigned ( 70 per group ) . Thirteen patients dropped out of SM early due to an inability to self-manage . Based on intention-to-treat analysis , there was no difference in the proportion of INR in range ( SM 64.8 % versus PM 58.7 % , P=0.23 ) or time in target range ( SM 71.8 % versus PM 63.2 % , P=0.14 ) . Patients managing their own therapy spent less time below the therapeutic range ( 15.0 % versus 27.3 % , P=0.04 ) . There were three major complications of thrombosis or bleeding , all occurring in the PM arm . All patients who completed SM preferred to continue with that strategy . CONCLUSIONS SM was not significantly better than PM in maintaining therapeutic anticoagulation . SM was feasible and appeared safe in the present study population Background Antithrombotic treatment is a continuous therapy that is often performed in general practice and requires careful safety management . The aim of this study is to investigate whether a best- practice model that applies major elements of case management and patient education , can improve antithrombotic management in primary healthcare in terms of reducing major thromboembolic and bleeding events . Methods This 24-month cluster-r and omized trial will be performed with 690 adult patients from 46 practice s. The trial intervention will be a complex intervention involving general practitioners , healthcare assistants , and patients with an indication for oral anticoagulation . To assess adherence to medication and symptoms in patients , as well as to detect complications early , healthcare assistants will be trained in case management and will use the Coagulation-Monitoring List ( Co-MoL ) to regularly monitor patients . Patients will receive information ( leaflets and a video ) , treatment monitoring via the Co-MoL and be motivated to perform self-management . Patients in the control group will continue to receive treatment as usual from their general practitioners . The primary endpoint is the combined endpoint of all thromboembolic events requiring hospitalization and all major bleeding complications . Secondary endpoints are mortality , hospitalization , strokes , major bleeding and thromboembolic complications , severe treatment interactions , the number of adverse events , quality of anticoagulation , health-related quality of life , and costs . Further secondary objectives will be investigated to explain the mechanism by which the intervention is effective : patients ’ assessment of chronic illness care , self-reported adherence to medication , general practitioners ’ and healthcare assistants ’ knowledge , and patients ’ knowledge and satisfaction with shared decision making . Practice recruitment is expected to take place between July and December 2012 . Recruitment of eligible patients will start in July 2012 . Assessment will occur at three time points : baseline and follow-up after 12 months and after 24 months . Discussion The efficacy and effectiveness of individual elements of the intervention , such as antithrombotic interventions , self-management concepts in orally anticoagulated patients , and the method ological tool of case management , have already been extensively demonstrated . This project foresees the combination of several proven instruments , as a result of which we expect to profit from a reduction in the major complications associated with antithrombotic treatment . Trial registration Current Controlled Trials IS RCT Background Self management of oral anticoagulation ( OAC ) decreases complication rates and improves quality of life . Manual and cognitive abilities of patients and patient training in a structured format are a precondition for this concept . Up to now , there is no evidence about knowledge increase from teaching programs . Methods Seventy-six patients ( mean age , 57.4 years , 71 % male ) who started long-term OAC were included in the prospect i ve multi-center study at three teaching centers representing different population s of anticoagulation patients : a department of cardiovascular surgery , an inpatient rehabilitation center and an anticoagulation clinic . The patients were trained in a structured education program for two days . For the evaluation , the patients performed st and ardized tests including 16 questions prior to start ( T0 ) , after each training unit ( T1/T2 ) and 6 weeks later ( T3 ) . The primary endpoint was the percentage of > 75 % of patients who could answer > 50 % of questions correctly at T3 . Secondary endpoints were the overall and item-specific percentages of correct answers at the end of each training unit ( T1 , T2 ) and at T3 . In addition , the teaching program was rated by the patients on a six-point rating scale . Results Seventy-four out of 76 patients gave at least 50 % correct answers at T3 ( 97.4 % ; 95 % confidence interval , 90.8–99.7 % ) . The average rates of correct answers developed from 40 % ( T0 ) , 86 % ( T1 ) , 94 % ( T2 ) to 96 % ( T3 ) . The greatest increase of knowledge was observed with blood components , interpretation of International Normalized Ratio ( INR ) value , and the interaction of anticoagulation with other variables ( e.g. drugs or infection ) 
    Output:
    
None of the review articles revealed any difference in the frequency of severe hemorrhagic events .
Adults with an indication for long-term oral anticoagulation benefit from self-management , as compared to st and ard treatment with management of dosing by a physician .