***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 develop an empirically based framework of the aspects of r and omised controlled trials addressed by qualitative research . Design Systematic mapping review of qualitative research undertaken with r and omised controlled trials and published in peer- review ed journals . Data sources MEDLINE , Pre MEDLINE , EMBASE , the Cochrane Library , Health Technology Assessment , PsycINFO , CINAHL , British Nursing Index , Social Sciences Citation Index and ASSIA . Eligibility criteria Articles reporting qualitative research undertaken with trials published between 2008 and September 2010 ; health research , reported in English . Results 296 articles met the inclusion criteria . Articles focused on 22 aspects of the trial within five broad categories . Some articles focused on more than one aspect of the trial , totalling 356 examples . The qualitative research focused on the intervention being trialled ( 71 % , 254/356 ) ; the design , process and conduct of the trial ( 15 % , 54/356 ) ; the outcomes of the trial ( 1 % , 5/356 ) ; the measures used in the trial ( 3 % , 10/356 ) ; and the target condition for the trial ( 9 % , 33/356 ) . A minority of the qualitative research was undertaken at the pretrial stage ( 28 % , 82/296 ) . The value of the qualitative research to the trial itself was not always made explicit within the articles . The potential value included optimising the intervention and trial conduct , facilitating interpretation of the trial findings , helping trialists to be sensitive to the human beings involved in trials , and saving money by steering research ers towards interventions more likely to be effective in future trials . Conclusions A large amount of qualitative research undertaken with specific trials has been published , addressing a wide range of aspects of trials , with the potential to improve the endeavour of generating evidence of effectiveness of health interventions . Research ers can increase the impact of this work on trials by undertaking more of it at the pretrial stage and being explicit within their articles about the learning for trials and evidence -based practice Background In the past , clinical study participants have suffered from the experiments that they were subjected to . Study subjects may not underst and the study process or may participate in clinical studies because they do not have access to medical care . The objectives of the present study were 1 . to analyze the motives that might cause a volunteer to participate as a study subject ; 2 . to identify the social-demographic profile of this study subjects ; and 3 . to determine whether the motives to volunteer as a study subject are in accordance with the established legal and ethical principles for research in Brazil . Methods Mixed- methods research was used ( a qualitative-quantitative approach ) . A sample of 80 volunteers underwent a semi-structured interview  , which was based on a survey script that was elaborated from discussion s with key informants . The sample was r and omly selected from a data base of clinical study volunteers that was provided by Brazilian clinical study centers . The interviews were recorded and transcribed . Descriptive statistics were used for content analysis , including contingency tables with hypothesis testing . Results The motivations for clinical study participation were linked to types of benefit . The most frequently encountered motivations were financial gain and therapeutic alternative . Altruism was not a common motivator , and when altruism was present , it was observed as a secondary motivator . All participants reported that they understood the Informed Consent Statement ( ICS ) . However , only two parts of the form were remembered by all of the volunteers : the section on being able to leave the study at any point and the section that stated that there would be some responsible professional at their disposal for the entirety of the study . Conclusions The present study shows that study participants are primarily motivated by personal benefit when volunteering to participate in clinical studies . Whether these study participants had an integral underst and ing of the ICS is not clear Abstract Objectives : To measure quality of care at general practice consultations in diverse geographical areas , and to determine the principal correlates associated with enablement as an outcome measure . Design : Cross sectional multi practice question naire based study . Setting : R and om sample of practice s in four participating regions : Lothian , Coventry , Oxfordshire , and west London . Participants : 25 994 adults attending 53 practice s over two weeks in March and April 1998 . Main outcome measures : Patient enablement , duration of consultation , how well patients know their doctor , and the size of the practice list . Results : A hierarchy of needs or reasons for consultation was created . Similar overall enablement scores were achieved for most casemix presentations ( mean 3.1 , 95 % confidence interval 3.1 to 3.1 ) . Mean duration of consultation for all patients was 8.0 minutes ( 8.0 to 8.1 ) ; however , duration of consultation increased for patients with psychological problems or where psychological and social problems coexisted ( mean 9.1 , 9.0 to 9.2 ) . The 2195 patients who spoke language s other than English at home were analysed separately as they had generally higher enablement scores ( mean 4.5 , 4.3 to 4.7 ) than those patients who spoke English only despite having shorter consultations ( mean 7.1 ( 6.9 to 7.3 ) minutes . At individual consultations , enablement score was most closely correlated with duration of consultation and knowing the doctor well . Individual doctors had a wide range of mean enablement scores ( 1.1 - 5.3 ) and mean duration s of consultation ( 3.8 - 14.4 minutes ) . Doctors ' ability to enable was linked to the duration of their consultation and the percentage of their patients who knew them well and was inversely related to the size of their practice . At practice level , mean enablement scores ranged from 2.3 to 4.4 and duration of consultation ranged from 4.9 to 12.2 minutes . Correlations between ranks at practice level were not significant . Conclusions : It may be time to reward doctors who have longer consultations , provide greater continuity of care , and both enable more patients and enable patients more . Key messages 38 % of practice s approached on a r and om basis in four areas of the United Kingdom collected data for 2 weeks showing the feasibility of surveying the content and outcome of routine consultations in general practice At consultation level , enablement correlates best with the duration of consultations and how well the patient knows the doctor These correlates apply at doctor level as well — more enabling doctors work in smaller practice s than less enabling doctors Case mix does not seem to be a determinant of enablement scores , but patients with more complex problems require longer consultations to achieve equal enablement Patterns of duration of consultation and enablement in patients who speak language s other than English are different and require further Manual dexterity is frequently evaluated in rehabilitation services to estimate h and function . Several tests have been developed for this purpose , including the Purdue Pegboard , which measures fine manual dexterity . The goals of the study were to verify the test-retest reliability with subjects aged 60 and over without upper limb impairment , and to develop normative data based on a r and om sample of healthy older community-living individuals . The results show that the test-retest reliability is good ( intra-class correlation coefficients from 0.66 to 0.90 , depending on the subtest ) . Norms are presented to help clinicians involved in rehabilitation services to better differentiate real dexterity deficits from those that may be attributed to normal ageing The Nine Hole Peg Test is commonly used by occupational therapists as a simple , quick assessment for finger dexterity . The purpose of this study was to evaluate the interrater and test-retest reliability of the commercially available Smith & Nephew Rehabilitation Division version of the Nine Hole Peg Test , and to establish new adult norms for the Nine Hole Peg Test for finger dexterity utilizing this particular version . Two of the research ers established interrater and test-retest reliability by evaluating 25 occupational therapy student volunteers . Seven hundred and three subjects , ranging in age from 21 to 71 + years , were tested to establish norms , using the st and ard protocol . Results showed high interrater reliability and only moderate test-retest reliability . Scores obtained by using the commercially available version were not statistically different from previously published norms ( Mathiowetz , Weber , Kashman , & Voll and , 1985 ) . This study supports the original norms and further assists occupational therapists to evaluate dexterity accurately Background The cost-effectiveness acceptability curve ( CEAC ) is a method for summarizing the uncertainty in estimates of cost-effectiveness . The CEAC , derived from the joint distribution of costs and effects , illustrates the ( Bayesian ) probability that the data are consistent with a true cost-effectiveness ratio falling below a specified ceiling ratio . The objective of the paper is to illustrate how to construct and interpret a CEAC . Methods A retrospective cost-effectiveness analysis of the Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) r and omized controlled trial with 4060 patients followed for 3.5 years . The target population was patients with atrial fibrillation who were 65 years of age or had other risk factors for stroke or death similar to those enrolled in AFFIRM . The intervention involved the management of patients with atrial fibrillation with antiarrhythmic drugs ( rhythm-control ) compared with drugs that control heart rate ( rate-control ) . Measurements of mean survival , mean costs and incremental cost-effectiveness were made . The uncertainty surrounding the estimates of cost-effectiveness was illustrated through a cost-effectiveness acceptability curve . Results The base case point estimate for the difference in effects and costs between rate and rhythm-control is 0.08 years ( 95 % CI : -0.1 years to 0.24 years ) and -US$5,077 ( 95 % CI : -$1,100 to -$11,006 ) . The CEAC shows that the decision uncertainty surrounding the adoption of  rate-control strategies is less than 1.7 % regardless of the maximum acceptable ceiling ratio . Thus , there is very little uncertainty surrounding the decision to adopt rate-control compared to rhythm-control for patients with atrial fibrillation from a re source point of view . Conclusion The CEAC is straightforward to calculate , construct and interpret . The CEAC is useful to a decision maker faced with the choice of whether or not to adopt a technology because it provides a measure of the decision uncertainty surrounding the choice BACKGROUND : Concordance , which involves prescribing with rather than for patients , should result in less drug wastage ( non-use ) , but is proving hard to put into practice . One possible way of easing elderly people and prescribers toward concordance is to use a medicines organizer ( MO ) . OBJECTIVE : To document medication wastage , using a pharmacy-prepared reusable MO , and explore , using a qualitative approach , use of this information on communication of individuals ' drug regimens . METHODS : Sixty-two sheltered housing residents , aged ⩾60 years , participated in an exploratory controlled , matched study . The intervention group received medication in the MO , and the control group continued with st and ard packaging . Community pharmacists recorded details of wasted drugs returned during the 3-month study and , for the intervention group , 6 , 9 , and 12 months after the study . Medicines management data were collected from participants . Qualitative interviews were conducted with a sample of general practitioners ( GPs ) and community pharmacists to explore views on the role of the MO . RESULTS : Intervention group wastage was reduced from 18.1 % ( pre study ) to 1 % at 12 months . No data on wastage were collected for the control group after the pre study assessment . Sixty-one percent more prescription changes , including significant decreases in the number of prescribed drugs and dosages , were reported for the intervention group . GPs and pharmacists reported improvements in communication concerning medication-related dialog . CONCLUSIONS : This small exploratory study has shown that a pharmacy-prepared reusable MO provided visual , objective insights into medication wastage . This result ed in improved communication of drug needs and reduced wastage — the foundation for concordance This article reports a r and omized controlled trial design ed to test the effects of special packaging of antihypertensive medication on compliance and blood pressure control . One hundred eighty subjects who had exhibited elevated blood pressure greater than 90 mmHg in the two years prior to the study were recruited from patients receiving care at a community hospital-based family medicine practice . After completing preenrollment interviews and blood pressure measurements , subjects were r and omly assigned to receive their antihypertensive medications either in the usual vials or in special unit dose-reminder packaging . Follow-up interviews  , pill counts , and blood pressure measurements were performed at three-month intervals . There were no statistically significant differences between the control and experimental groups with regard to age , sex , race , employment , education , marital status , insurance coverage , or blood pressure regimens . Prior to the intervention , the experimental group had slightly lower diastolic blood pressure and reported better compliance than the control group . Analyses performed on 165 subjects completing the first follow-up visit revealed no significant improvements in blood pressure control or compliance for patients receiving special medication packaging . While some patients found it easy to remember to take pills packaged using this format , they also found the packages somewhat more difficult and inconvenient to use . In contrast to previously reported work , this study did not demonstrate any significant improvement in compliance with special packaging of antihypertensive medications BACKGROUND : Non-adherence in hypertension is a global problem and promoting adherence is necessary to decrease cardiovascular mortality . AIMS : The purpose of this paper is to examine the measurement of adherence to medication taking in hypertensive patients . Adherence was evaluated primarily by means of MEMS ( Medication Event Monitoring System , Aprex Corporation , Fremont , California ) an electronic system that records the date and time of opening of the study medication container . Additional measurements such as change in urinary potassium level , capsule count , client self report and physician estimate of adherence were recorded . METHODS : A r and omised clinical trial was used to assign patients to receive the study medication ( potassium ) or placebo . Descriptive statistics were used to answer the research questions . Frequency and percentage of responses to different measures of adherence were carried out as well as correlation between the measures . RESULTS : One hundred and seven subjects between the ages of 26 and 80 participated in the clinical trial 
    Output:
    
Of the limited studies reporting health outcomes , some reported a positive relationship while some reported increased hospitalisations associated with MODs .
Active recruitment yielded a higher consent rate , but passive recruitment was more cost-effective .
Participants reported a high level of satisfaction with the design .
MOD provision to unintentionally non-adherent older people may cause medication-related adverse events .