***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: This study examined the role of a Medication Event Monitoring System ( MEMS ) to assess pill-taking behavior and enhance compliance within a r and omized trial of bupropion-SR for smoking cessation . Female participants ( N = 97 ) received MEMS bottles containing bupropion-SR 150 mg or placebo , to be taken twice daily . A r and omly selected “ feedback ” group of participants was told about the recording device in the bottle cap and received weekly graphic feedback showing their pill-taking behavior with specific instructions for improving compliance . A “ no-feedback ” group was not informed about the MEMS bottles , and did not receive further instruction or feedback beyond the st and ard dosing instructions . Compliance outcomes were the total doses taken and number of doses taken within the prescribed time interval . Results indicated significantly higher compliance over time for the feedback group . Participation in the feedback group predicted higher compliance beyond demographic , smoking , and health belief variables , suggesting significant benefit in providing brief feedback and instruction throughout the medication regimen Background and Objectives : Older adults ' adherence to antihypertensive medications is far lower than what is considered necessary for clinical effectiveness , despite the risks for adverse cardiovascular events from uncontrolled blood pressure ( BP ) in the elderly . This pilot study tested a novel 8-week behavioral feedback intervention to improve antihypertensive medication adherence ( MA ) and BP control among older adults on existing treatment for hypertension . Methods : Adults 60 years old , or older taking at least 1 antihypertensive medication were r and omized to receive the nurse-delivered adherence intervention or usual care . Medication adherence was monitored continuously using electronic monitoring for 20 weeks . Intervention-group participants received biweekly MA and BP feedback , habit counseling , medication and disease education , a medication instruction card , and were given an electronic medication bottle cap with a digital display that provided daily adherence feedback during the 8-week intervention . Blood pressure was measured by a nurse at 12 and 20 weeks after r and omization . Adherence and BP outcomes were described using descriptive statistics and analyzed for between- and within-group differences using Mann-Whitney U tests . Results : Fifteen participants ( median age , 71 years ; 73 % female ) were eligible for r and omization . Participants took an average of 5.8 prescription medications and 2.93 over-the-counter medications per day . A nonsignificant difference was noted in baseline MA between groups . At the end of the intervention , the treatment group had better antihypertensive MA than did the control group ( median MA : 100 % vs 27.3 % , U = 5.00 , P = .013 ) . Systolic BP improved slightly in the intervention group during the study and was significantly different at week 12 ( median systolic BP : 130 vs 152 mm Hg ; U = 4.50 , P = .008 ) . Diastolic BP was largely unchanged over the course of the study . Conclusion : The results indicate that the intervention had a positive effect on MA . Additional testing is needed to further evaluate the intervention and its effect on adherence behavior and BP control Background Simple nudges such as reminders and feedback reports to either a patient or a partner may facilitate improved medication adherence . Objective To test the impact of a pill bottle used to monitor adherence , deliver a daily alarm , and generate weekly medication adherence feedback reports on statin adherence . Design Three-month , three-arm r and omized clinical trial ( Clinical Trials.gov identifier : NCT02480530 ) . Participants One hundred and twenty-six veterans with known coronary artery disease and poor adherence ( medication possession ratio < 80 % ) .Intervention Patients were r and omized to one of three groups : ( 1 ) a control group ( n = 36 ) that received a pill-monitoring device with no alarms or feedback ; ( 2 ) an individual feedback group ( n = 36 ) that received a daily alarm and a weekly medication adherence feedback report ; and ( 3 ) a partner feedback group ( n = 54 ) that received an alarm and a weekly feedback report that was shared with a friend , family member , or a peer . The intervention continued for 3 months , and participants were followed for an additional 3 months after the intervention period . Main Measures Adherence as measured by pill bottle . Secondary outcomes included change in LDL ( mg/dl ) , patient activation , and social support . Key Results During the 3-month intervention period , medication adherence was higher in both feedback arms than in the control arm ( individual feedback group 89 % , partner feedback group 86 % , control group 67 % ; p < 0.001 and = 0.001 ) . At 6 months , there was no difference in medication adherence between either of the feedback groups and the control ( individual feedback 60 % , partner feedback 52 % , control group 54 % ; p = 0.75 and 0.97 ) . Conclusions Daily alarms combined with individual or partner feedback reports improved statin medication adherence . While neither an individual feedback nor partner feedback strategy created a sustainable medication adherence habit , the intervention itself is relatively easy to implement and low cost Russell C , Conn V , Ashbaugh C , Madsen R , Wakefield M , Webb A , Coffey D , Peace L. Taking immunosuppressive medications effectively ( TIMELink ) : a pilot r and omized controlled trial in adult kidney transplant recipients . Clin Transplant 2011 : 25 : 864–870 . © 2010 John Wiley & Sons This pilot study aim ed to examine the effectiveness of  visual-feedback therapy  for individuals with psychotic disorders .  Visual-feedback therapy combines structured psychodynamic therapy and visual feedback achieved via an electronic monitoring medication cap to increase insight about medication behaviours . Thirty subjects were r and omly assigned either to visual feedback or to a supportive counselling group .  Medication adherence was measured by both electronic monitoring and blood plasma drug concentration levels . The results showed that , at the end of the 3-month , intervention ( bimonthly sessions ) , adherence rates of the visual-feedback group slightly increased , but declined during the course of the study for the supportive counselling control group ( P=0.026 ) Affordable and effective antiretroviral therapy ( ART ) adherence interventions are needed for many patients to promote positive treatment outcomes and prevent viral resistance . We conducted a two-arm r and omized trial ( n = 40 men and women receiving and less than 95 % adherent to ART ) to test a single office session followed by four biweekly cell phone counseling sessions that were grounded in behavioral self-management model of medication adherence using data from phone-based unannounced pill counts to provide feedback-guided adherence strategies . The control condition received usual care and matched office and cell phone/pill count contacts . Participants were baseline assessed and followed with biweekly unannounced pill counts and 4-month from baseline computerized interviews ( 39/40 retained ) . Results showed that the self-regulation counseling delivered by cell phone demonstrated significant improvements in adherence compared to the control condition ; adherence improved from 87 % of pills taken at baseline to 94 % adherence 4 months after baseline , p < 0.01 . The observed effect sizes ranged from moderate ( d = 0.45 ) to large ( d = 0.80 ) . Gains in adherence were paralleled with increased self-efficacy ( p < 0.05 ) and use of behavioral strategies for ART adherence ( p < 0.05 ) . We conclude that the outcomes from this test of concept trial warrant further research on cell phone-delivered self-regulation counseling in a larger and more rigorous trial This study investigates the impact of measuring adherence and providing feedback on medication usage by children with unstable asthma .  Adherence was measured using an electronic monitoring device . Subjects were r and omized to either being told of their adherence during review consultations or for their adherence to remain undisclosed to their parents and treating physician . Subjects were review ed monthly for 4 months . Twenty-six children aged between 6 and 14 years were recruited . Adherence was significantly higher in the intervention group ( 79 % versus 58 % , p < .01 ) . There were significant improvements in clinical measures of disease control compared with baseline in both groups . The change in forced expiratory volume in 1 s ( FEV1 ) ( % predicted ) was greater in those subjects receiving feedback ( 13.8 % versus 9.8 % ) . However , lung function values were lower in the intervention group at baseline and the relative improvement failed to reach statistical significance . Measuring adherence and providing feedback increases the use of preventive medication . A larger study is required to explore implication s for disease control A two-group r and omized experimental design was employed to assess the effects of monitoring and feedback on the compliance of 93 psychiatric out patients treated with lithium . Compliance in both groups was measured using self-report , lithium level , appointment-keeping , and medication refill frequency . The experimental group was also monitored using a unique electronic device that records the time and day pills are removed . At the midpoint of the study , the experimental group received feedback about serum lithium levels and patterns of removing medications from the monitoring device while the control group received feedback about serum lithium levels only . The study demonstrated no sustained effect of the monitoring and feedback interventions on compliance Effective antiretroviral therapy ( ART ) requires excellent adherence . Little is known about how to improve ART adherence in many HIV/AIDS-affected countries , including China . We therefore assessed an adherence intervention among HIV-positive patients in southwestern China . Eighty subjects were enrolled and monitored for 6 months . Sixty-eight remaining subjects were r and omized to intervention/control arms . In months 7–12 , intervention subjects were counseled using EDM feedback ; controls continued with st and ard of care . Among r and omized subjects , mean adherence and CD4 count were 86.8 vs. 83.8 % and 297 vs. 357 cells/μl in intervention vs. control subjects , respectively . At month 12 , among 64 subjects who completed the trial , mean adherence had risen significantly among intervention subjects to 96.5 % but remained unchanged in controls . Mean CD4 count rose by 90 cells/μl and declined by 9 cells/μl among intervention and control subjects , respectively . EDM feedback as a counseling tool appears promising for management of HIV and other chronic diseases This study examined whether a self-management intervention based on feedback of adherence performance and principles of social cognitive theory improves adherence to antiretroviral dosing schedules . Forty-three individuals with HIV/AIDS who were starting or switching to a new protease inhibitor regimen were r and omly assigned to be in a medication self-management program or usual care control group . The self-management program included skills development exercises , three monthly visits for medication consultations , and monthly feedback of adherence performance using electronic monitors on medication bottles . Participants also completed a 40-item question naire that measured self-efficacy to take medications , on schedule , in a variety of situations . Logistic regression analysis indicated that individuals in the self-management group were significantly more likely to take 80 % or more of their doses each week than individuals in the control group ( n=29 , OR=7.8 , 95 % CI=2.2 - 28.1 ) . Self-management training with feedback of adherence performance is a potentially useful model for improving adherence to complex regimens in HIV/AIDS care This study was conducted to replicate and extend initial positive findings on the usefulness of a Medication Event Monitoring System ( MEMS ) to assess pill-taking behavior and enhance compliance with bupropion for smoking cessation . Participants ( N=55 ) received MEMS bottles containing bupropion-SR ( 150 mg ) to be taken twice daily for 7 weeks . For participants r and omly assigned to the  Enhanced Therapy group ( n=27 ) , weekly individual smoking cessation therapy sessions included an additional 10 min of MEMS feedback and compliance enhancement counseling using CBT techniques .  The Usual Care group ( n=28 ) received weekly individual smoking cessation sessions only . Compliance outcomes included total doses taken and number of doses taken within the prescribed time interval . Results indicated significantly higher compliance over time for the Enhanced Therapy group . Smoking abstinence rates did not differ between the two groups , although results from the pooled sample analysis showed a significant association between level of medication compliance and abstinence status at treatment weeks 3 and 6 . Incorporating MEMS-based compliance interventions into smoking pharmacotherapy trials is recommended The hierarchy of evidence in assessing the effectiveness of interventions or treatments is explained , and the gold st and ard for evaluating the effectiveness of interventions , the r and omised controlled trial , is discussed . Issues that need to be considered during the critical appraisal of r and omised controlled trials , such as assessing the validity of trial methodology and the magnitude and precision of the treatment effect , and deciding on the applicability of research results , are discussed . Important terminologies such as r and omisation , allocation concealment , blinding , intention to treat , p values , and confidence intervals are explained BACKGROUND Medication nonadherence contributes to hospitalization and mortality , yet there have been few interventions tested that improve adherence and reduce hospitalization and mortality in heart failure ( HF ) . Our objective was to determine whether an education intervention improved medication adherence and cardiac event-free survival . METHODS AND RESULTS A r and omized controlled trial was conducted on 82 HF patients . The intervention was based on the theory of planned behavior ( TPB ) and included feedback of medication-taking behavior using the Medication Event Monitoring System ( MEMS ) . Patients were assigned to one of three groups : 1 ) theory-based education plus ME 
    Output:
    
Feedback guided by objective or subjective measures of adherence improves adherence and , perhaps more importantly , prevents worsening of adherence over time even when only small absolute improvements in adherence were noted .
Increased use of feedback to improve treatment adherence has the potential to reduce avoidable healthcare costs caused by non-adherence