***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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    Input: BACKGROUND Self-management improves oral anticoagulation control . Here we provide data of a preplanned interim analysis of very low-dose early self-controlled anticoagulation . METHODS In a prospect i ve , r and omized , multicenter trial , 1,137 patients performed low-dose international normalized ratio ( INR ) self-management with a target INR range of 1.8 . to 2.8 for aortic valve replacement recipients and 2.5 to 3.5 for mitral or double valve replacement recipients for the first six postoperative months . Thereafter , 379 patients continued to achieve the aforementioned INR target range ( LOW group ) , whereas the INR target value was set at 2.0 ( range , 1.6 to 2.1 ) for the remaining patients with aortic valve replacement and 2.3 ( range , 2.0 to 2.5 ) for the remaining patients with mitral valve or double valve replacement . One half of this latter group had to check their INR values once a week ( VL1 group ) the other half twice a week ( VL2 group ) . Patients were followed up for 24 months . RESULTS Beyond study month six , the incidence of thromboembolic events that required hospital admission was 0.58 % , 0.0 % , and 0.58 % in the LOW , VL1 , and VL2 groups , respectively ( p = 0.368 ) . The incidence of bleeding events per patient-year was 1.16 % , 1.07 % , and 0.58 % in the LOW , VL1 , and VL2 groups , respectively ( p = 0.665 ) . Mortality rate did not differ among study groups . CONCLUSIONS Data demonstrate the efficacy and safety of very low-dose INR self-management Background Computer-assistance and self-monitoring lower the cost and may improve the quality of anticoagulation therapy . The main purpose of this clinical investigation was to use computer-assisted oral anticoagulant therapy to improve the time to reach and the time spent within the therapeutic target range compared to traditional oral anticoagulant therapy by physicians . Methods 54 patients were r and omized equally into 3 groups . Patients in two groups used CoaguChek ® systems to measure international normalized ratio ( INR ) values  and had dosages of anticoagulation treatment calculated in a computer system by an algorithm specific to each group . The third group received traditional anticoagulation treatment by physicians . The obtained INR values were compared regarding the time to reach , and the time spent within , the therapeutic target range , corresponding to INR values from 2 to 3 . Results Patients r and omized to computer-assisted anticoagulation and the CoaguChek ® system reached the therapeutic target range after 8 days compared to 14 days by prescriptions from physicians ( p = 0.04 ) . Time spent in the therapeutic target range did not differ between groups . The median INR value measured throughout the study from all patients by CoaguChek ® at 2.5 ( 2.42–2.62 ) was lower than measured by a hospital-based Clinical and Biochemical Laboratory at 2.6 ( 2.45–2.76 ) , ( p = 0.02 ) . Conclusions The therapeutic target range was reached faster by the use of computer-assisted anticoagulation treatment than prescribed by physicians , and the total time spent within the therapeutic target range was similar . Thus computer-assisted oral anticoagulant therapy may reduce the cost of anticoagulation therapy without lowering the quality . INR values measured by CoaguChek ® were reliable compared to measurements by a clinical and biochemical laboratory Self-management is safe and reliable in patients with long-term oral anticoagulation ( OAC ) . However , no study has yet assessed the safety and efficacy of OAC self-management in elderly patients with major thromboembolic and haemorrhagic complications as primary outcomes . In this multi-centre , open , r and omised controlled trial , patients aged 60 years or more were r and omised into the self-management group ( SMG ) ( N = 99 ) or routine care group ( RCG ) ( N = 96 ) . We describe the rationale , design , baseline characteristics and interim analyses of oral anticoagulation control quality within the first year of follow-up . The medians of the squared international normalised ratio ( INR ) value deviations after six and 12 months were significantly lower in the SMG with medians of 0.16 and 0.16 compared to the RCG with medians of 0.25 and 0.25 . The percentage of time within target range and the percentage of INR measurements within target range were significantly higher in the SMG versus the RCG within the first six months ( medians 71 % vs. 58 % and 69 % vs. 57 % ) , and during the second six months of the study ( 75 % vs. 67 % and 72 % vs. 57 % ) . The numbers of all thromboembolic events requiring hospitalisation , major bleeding events , and deaths were similar in both groups . These preliminary results suggest that  self-management of oral anticoagulation is safe and feasible for elderly patients willing to participate in a structured training programme 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 OBJECTIVE Self-management of oral anticoagulant therapy ( OAT ) has shown good results on a short-term basis . We hypothesize that self-management of OAT provides a better quality of treatment than conventional management also on a long-term basis . The aim of this study was to assess the quality of self-management of OAT  in patients with mechanical heart valve prostheses on a 4-year perspective in a prospect i ve , non-r and omized study . DESIGN Twenty-four patients with mechanical heart valves and on self-managed OAT  were followed for up to 4 years . A matched , retrospectively selected group of  conventionally managed heart valve patients ( control group )  was used as reference . RESULTS The median observation time was 1175 days ( range : 174 - 1428 days ) . The self-managed patients were within therapeutic INR target range for a mean of 78.0 % ( range : 36.1%-93.9 % ) of the time compared with 61.0 % ( range 37.4%-2.9 % ) for the control group . CONCLUSION Self-management of OAT is a feasible and safe concept for selected patients with mechanical heart valve prostheses also on a long-term basis . It provides at least as good and most likely better quality of anticoagulant therapy than conventional management assessed by time within the therapeutic International Normalized Ratio ( INR ) target range Background Point of care testing ( PoCT ) may be a useful adjunct in the management of chronic conditions in general practice ( GP ) . The provision of pathology test results at the time of the consultation could lead to enhanced clinical management , better health outcomes , greater convenience and satisfaction for patients and general practitioners ( GPs ) , and savings in costs and time . It could also result in inappropriate testing , increased consultations and poor health outcomes result ing from inaccurate results . Currently there are very few r and omised controlled trials ( RCTs ) in GP that have investigated these aspects of PoCT . Design / Methods The Point of Care Testing in General Practice Trial ( PoCT Trial ) was an Australian Government funded multi-centre , cluster r and omised controlled trial to determine the safety , clinical effectiveness , cost effectiveness and satisfaction of PoCT in a GP setting .The PoCT Trial covered an 18 month period with the intervention consisting of the use of PoCT for seven tests used in the management of patients with diabetes , hyperlipidaemia and patients on anticoagulant therapy .  The primary outcome measure was the proportion of patients within target range , a measure of therapeutic control . In addition , the PoCT Trial investigated the safety of PoCT , impact of PoCT on patient compliance to medication , stakeholder satisfaction , cost effectiveness of PoCT versus laboratory testing , and influence of geographic location . Discussion The paper provides an overview of the Trial Design , the rationale for the research methodology chosen and how the Trial was implemented in a GP environment . The evaluation protocol and data collection processes took into account the large number of patients , the broad range of practice types distributed over a large geographic area , and the inclusion of pathology test results from multiple pathology laboratories . The evaluation protocol developed reflects the complexity of the Trial setting , the Trial Design and the approach taken within the funding provided . The PoCT Trial is regarded as a pragmatic RCT , evaluating the effectiveness of implementing PoCT in GP and every effort was made to ensure that , in these circumstances , internal and external validity was maintained . Trial Registration Background Stroke prevention in atrial fibrillation ( AF ) , most commonly with warfarin , requires maintenance of a narrow therapeutic target ( INR 2.0 to 3.0 ) and is often poorly controlled in practice . Poor patient-underst and ing surrounding AF and its treatment may contribute to the patient ’s willingness to adhere to recommendations . Method A theory-driven intervention , developed using patient interviews and focus groups , consisting of a one-off  group session ( 1–6 patients ) utilising an “ expert-patient ” focussed DVD , educational booklet , self-monitoring diary and worksheet , was compared in a r and omised controlled trial ( IS RCT N93952605 ) against usual care , with patient postal follow-ups at 1 , 2 , 6 , and 12-months . Ninety-seven warfarin-naïve AF patients were r and omised to intervention ( n=46 , mean age ( SD ) 72.0 ( 8.2 ) , 67.4 % men ) , or usual care ( n=51 , mean age ( SD ) 73.7 ( 8.1 ) , 62.7 % men ) , stratified by age , sex , and recruitment centre . Primary endpoint was time within therapeutic range ( TTR ) ; secondary endpoints included knowledge , quality of life , anxiety/depression , beliefs about medication , and illness perceptions . Main Findings Intervention patients had significantly higher TTR than usual care at 6-months ( 76.2 % vs. 71.3 % ; p=0.035 ) ; at 12-months these differences were not significant ( 76.0 % vs. 70.0 % ; p=0.44 ) . Knowledge increased significantly across time ( F ( 3 , 47 ) = 6.4 ; p<0.01 ) , but there were no differences between groups ( F ( 1 , 47 ) = 3.3 ; p = 0.07 ) . At 6-months , knowledge scores predicted TTR ( r=0.245 ; p=0.04 ) . Patients ’ scores on subscales representing their perception of the general harm and overuse of medication , as well as the perceived necessity of their AF specific medications predicted TTR at 6- and 12-months . Conclusions A theory-driven educational intervention significantly improves TTR in AF patients initiating warfarin during the first 6-months . Adverse clinical outcomes may potentially be reduced by improving patients ’ underst and ing of the necessity of warfarin and reducing their perception of treatment harm . Improving education provision for AF patients is essential to ensure efficacious and safe treatment . The trial is registered with Current Controlled Trials , IS RCT N93952605 , and details are available at www.controlled-trials.com/IS RCT N93952605 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 
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Participants  who self-monitor or self-manage can improve the quality of their oral anticoagulation therapy .
Thromboembolic events were reduced , for both those self-monitoring or self-managing oral anticoagulation therapy .
A reduction in all-cause mortality was observed in trials of self-management but not in self-monitoring , with no effects on major haemorrhage