***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: Background : No r and omised studies have addressed whether self-management for asthma can be successfully delivered by community pharmacists . Most r and omised trials of asthma self-management have recruited participants from secondary care ; there is uncertainty regarding its effectiveness in primary care . A r and omised controlled study was undertaken to determine whether a community pharmacist could improve asthma control using self-management advice for individuals recruited during attendance at a community pharmacy . Methods : Twenty four adults attending a community pharmacy in Tower Hamlets , east London for routine asthma medication were r and omised into two groups : the intervention group received self-management advice from the pharmacist with weekly telephone follow up for 3 months and the control group received no input from the pharmacist . Participants self-completed the North of Engl and asthma symptom scale at baseline and 3 months later . Results : The groups were well matched at baseline for demographic characteristics and mean ( SD ) symptom scores ( 26.3 ( 4.8 ) and 27.8 ( 3.7 ) in the intervention and control groups , respectively ) . Symptom scores improved in the intervention group and marginally worsened in the control group to 20.3 ( 4.2 ) and 28.1 ( 3.5 ) , respectively ( p<0.001 ; difference adjusted for baseline scores = 7.0 ( 95 % CI 4.4 to 9.5 ) . Conclusions : A self-management programme delivered by a community pharmacist can improve asthma control in individuals recruited at a community pharmacy . Further studies should attempt to confirm these findings using larger sample s and a wider range of outcome measures The complex intervention methodology framework defines the iterative process for developing and evaluating complex interventions in healthcare , but advice on implementation research was not included until the 2008 up date . Our recent systematic review of implementation studies identified significant problems with reporting st and ards , including inconsistent terminology and crucial information that was missing or unclear . Introduction of reporting checklists has st and ardized the reporting of r and omized controlled trials and other types of studies , and there is a need for similar guidance for reporting implementation studies . Key st and ards might include an explicit evidence base from a r and omized controlled trial or guideline recommendation ; recruitment to the clinical service , not the research ; at least some outcomes at the population level using routinely collected data ; and a description of the setting and the process of implementing the service . The complex intervention framework currently illustrates a cycle of development and evaluation , which includes implementation as a final step . We propose that the research underpinning implementation should be visualized as a second interrelated cycle . Just as the " phase III cycle " includes the iterative steps of development and piloting , a similar process may be needed to translate the intervention into a practical service that can be tested in a phase IV implementation study OBJECTIVES Despite advances in recent years , asthma morbidity and mortality have been noted to be on the increase in the past decade . The present study examined the failures and recommendations of past studies and introduced a new milieu for asthma care -- the community pharmacy . The study incorporated a care protocol with the important ingredients of asthma education on medications , triggers , self-monitoring and an asthma plan , with pharmacists taking responsibility for outcomes , assessment of a patient 's readiness to change and tailoring education to that readiness , compliance monitoring and physician consultation to achieve asthma prescribing guidelines . METHODS Thirty-three pharmacists in British Columbia , specially trained and certified in asthma care , agreed to participate in a study in which experienced pharmacists would have asthma patients allocated to enhanced ( pharmaceutical ) care ( EC ) or usual care ( UC ) . Pharmacists less experienced were clustered by geography and had their pharmacies r and omized to two levels of care ; each pharmacy then had patients r and omized to EC versus control , UC versus control or EC versus UC depending on their pharmacy r and omization . Six hundred thirty-one patients provided consent , of which 225 in EC or UC were analyzed for all outcomes . Patients were followed for one year . RESULTS Compared with patients in the UC group , the results of those in the EC group were as follows : symptom scores decreased by 50 % ; peak flow readings increased by 11 % ; days off work or school were reduced by approximately 0.6 days/month ; use of inhaled beta-agonists was reduced by 50 % ; overall quality of life improved by 19 % , and the specific domains of activity limitations , symptoms and emotional function also improved ; initial knowledge scores doubled ; emergency room visits decreased by 75 % ; and medical visits decreased by 75 % . A patient satisfaction survey revealed that the population was extremely pleased with their pharmacy services . Cost analysis reinforces the EC model , which is more cost effective than UC in terms of most direct and indirect costs in asthma patients . CONCLUSION Specially trained community pharmacists in Canada , using a pharmaceutical care-based protocol , can produce impressive improvements in clinical , economic and humanistic outcome measures in asthma patients . The health care system needs to produce incentives for such care Background : Despite national disease management plans , optimal asthma management remains a challenge in Australia . Community pharmacists are ideally placed to implement new strategies that aim to ensure asthma care meets current st and ards of best practice . The impact of the Pharmacy Asthma Care Program ( PACP ) on asthma control was assessed using a multi-site r and omised intervention versus control repeated measures study design . Methods : Fifty Australian pharmacies were r and omised into two groups : intervention pharmacies  implemented the PACP ( an ongoing cycle of assessment , goal setting , monitoring and review )  to 191 patients over 6 months , while control pharmacies gave their usual care to 205 control patients . Both groups administered question naires and conducted spirometric testing at baseline and 6 months later . The main outcome measure was asthma severity/control status . Results : 186 of 205 control patients ( 91 % ) and 165 of 191 intervention patients ( 86 % ) completed the study . The intervention result ed in improved asthma control : patients receiving the intervention were 2.7 times more likely to improve from “ severe ” to “ not severe ” than control patients ( OR 2.68 , 95 % CI 1.64 to 4.37 ; p<0.001 ) . The intervention also result ed in improved adherence to preventer medication ( OR 1.89 , 95 % CI 1.08 to 3.30 ; p = 0.03 ) , decreased mean daily dose of reliever medication ( difference −149.11 μg , 95 % CI −283.87 to −14.36 ; p = 0.03 ) , a shift in medication profile from reliever only to a combination of preventer , reliever with or without long-acting β agonist ( OR 3.80 , 95 % CI 1.40 to 10.32 ; p = 0.01 ) and improved scores on risk of non-adherence ( difference −0.44 , 95 % CI −0.69 to −0.18 ; p = 0.04 ) , quality of life ( difference −0.23 , 95 % CI −0.46 to 0.00 ; p = 0.05 ) , asthma knowledge ( difference 1.18 , 95 % CI 0.73 to 1.63 ; p<0.01 ) and perceived control of asthma question naires ( difference −1.39 , 95 % CI −2.44 to −0.35 ; p<0.01 ) . No significant change in spirometric measures occurred in either group . Conclusions : A pharmacist-delivered asthma care programme based on national guidelines improves asthma control . The sustainability and implementation of the programme within the healthcare system remains to be investigated Education on optimal medication use is an essential strategy to improve asthma control . The current authors investigated whether pharmacist interventions , focused on appropriate use of asthma medication and tailor-made to the patient 's current asthma control , would improve asthma control in adult patients . A 6-month r and omised , controlled , parallel-group trial was conducted in 66 community pharmacies in Belgium . Patients were r and omly assigned to receive usual pharmacist care ( n = 94 ) or a pre-defined pharmacist intervention ( n = 107 ) . This intervention mainly focused on improving inhalation technique and medication adherence . Primary outcome was the level of asthma control , as assessed by the Asthma Control Test ® ( ACT ) . Mean ACT scores did not change from baseline for both study groups . However , a pre-defined subgroup analysis of patients having insufficiently controlled asthma at baseline showed that the intervention had significantly increased the ACT score after 6 months compared with usual care . The intervention also reduced , for the complete study group , reliever medication use and the frequency of night-time awakenings due to asthma . Inhalation technique and adherence to controller medication were significantly better in the intervention group . In conclusion , pragmatic community pharmacy-based programmes can significantly improve therapeutic outcomes in adult asthma patients RATIONALE , AIMS AND OBJECTIVES DEPICT ( Descriptive Elements of Pharmacist Intervention Characterization Tool ) was created in response to the frequently reported issue of poor intervention description across studies assessing the impact of clinical pharmacy activities . The aim of this study was to create an improved version of DEPICT ( i.e. DEPICT 2 ) to better characterize clinical pharmacy services in order to ensure consistent reporting , therefore enhancing reproducibility of interventions in practice . METHOD A qualitative approach through a thematic content analysis was performed to identify components of pharmacist interventions described in 269 r and omized controlled trials . A preliminary version of DEPICT 2 was applied independently by two authors to a r and om sample of 85 of the 269 RCTs and reliability determined by the prevalence-adjusted bias-adjusted kappa ( PABAK ) or the intraclass correlation coefficient ( ICC ) . The final version of DEPICT 2 was compared against DEPICT 1 . RESULTS The final version of DEPICT 2 comprised 146 items and 11 domains . The inter-rater agreement analysis showed that DEPICT presented good to optimal reproducibility , with a mean PABAK value of 0.87 ( 95 % CI 0.85 - 0.89 ) and a mean ICC value of 0.88 ( 95 % CI 0.62 - 1.14 ) . The mean difference between items checked in the two versions ( DEPICT 2 - DEPICT 1 ) was 10.58 ( 95 % CI 9.55 - 11.61 ) , meaning that approximately 11 more components were identified in the new version of DEPICT . CONCLUSIONS DEPICT 2 is a reliable tool to characterize components of clinical pharmacy services , which should be used to ensure consistent reporting of interventions to allow their reproducibility in practice Objective To assess the impact of an intervention initiated by community pharmacists , involving the provision of educational material and general practitioner ( GP ) referral , on asthma knowledge and self-reported asthma control and asthma-related quality of life ( QOL ) in patients who may have suboptimal management of their asthma , as evidence d by pharmacy dispensing records . Setting Community pharmacies throughout Tasmania , Australia . Methods Forty-two pharmacies installed a  software application  that data mined dispensing records and generated a list of patients with suboptimal asthma management , as indicated by having three or more canisters of inhaled short-acting beta-2-agonists dispensed in the preceding 6 months . Identified patients were r and omised to an intervention or control group . At baseline , intervention patients were mailed intervention packs consisting of a letter encouraging them to see their GP for a review , educational material , asthma knowledge , asthma control and asthma-related QOL question naires , and a letter with a dispensing history to give to their GP . Pharmacists were blinded to the control patients ’ identities for 6 months , after which time intervention patients were sent repeat question naires , and control patients were sent intervention packs . Main outcome measures Asthma knowledge , asthma control and asthma-related QOL scores . Results Thirty-five pharmacies completed the study , providing 706 intervention and 427 control patients who were eligible to receive intervention packs . Intervention patients ’ asthma control and asthma-related QOL scores at 6 months were significantly higher compared to the control patients ( P < 0.01 and P < 0.05 , respectively ) and to the intervention patients ’ baseline scores ( P < 0.001 and P < 0.05 , respectively ) . Symptom-related QOL was significantly higher compared to the control patients ( P < 0.01 ) and activities-related QOL significantly improved compared to baseline ( P < 0.05 ) . No significant change was observed in asthma knowledge . Conclusion The results suggest that community pharmacists are ideally placed to identify patients with suboptimal asthma management and refer such patients for a review by their GP . This type of collaborative intervention can significantly improve self-reported asthma control and asthma-related QOL in patients identified as having suboptimal management of their asthma . A larger trial is needed to confirm the effects are real and sustained Objectives To implement and assess hospital-based pharmaceutical care services for patients with asthma . Methods A prospect i ve , r and omized , controlled study was conducted in Shaab teaching hospital , Khartoum , Sudan . Patients were allocated r and omly either in the intervention group ( 60 ) or control group ( 40 ) patients . The drug therapy of asthma for the patients in the intervention group was review ed by a trained pharmacist , and interventions were suggested to the attending physicians for the identified problems . Intervention patients received comprehensive medication couns 
    Output:
    
Pharmacists ' interventions in asthma management are complex .
Structured educational programs and patient counseling appear to be the most frequent core components of pharmacists ' interventions .
However , most studies failed to report the intervention dose sufficiently to be reproduced .