***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: OBJECTIVES To evaluate the effect of pharmaceutical care provided in addition to acute Geriatric Evaluation and Management ( GEM ) care on the appropriateness of prescribing . DESIGN R and omized , controlled trial , with the patient as unit of r and omization . SETTING Acute GEM unit . PARTICIPANTS Two hundred three patients aged 70 and older . INTERVENTION Pharmaceutical care provided from admission to discharge by a specialist clinical pharmacist who had direct contacts with the GEM team and patients . MEASUREMENTS Appropriateness of prescribing on admission , at discharge , and 3 months after discharge , using the Medication Appropriateness Index ( MAI ) , Beers criteria , and Assessing Care of Vulnerable Elders ( ACOVE ) underuse criteria and mortality , readmission , and emergency visits up to 12 months after discharge . RESULTS Intervention patients were significantly more likely than control patients to have an improvement in the MAI and in the ACOVE underuse criteria from admission to discharge ( odds ratio (OR)=9.1 , 95 % confidence interval (CI)=4.2 - 21.6 and OR=6.1 , 95 % CI=2.2 - 17.0 , respectively ) . The control and intervention groups had comparable improvements in the Beers criteria . CONCLUSION Pharmaceutical care provided in the context of acute GEM care improved the appropriate use of medicines during the hospital stay and after discharge . This is an important finding , because only limited data exist on the effect of various strategies to improve medication use in elderly in patients . The present approach has the potential to minimize risk and improve patient outcomes STUDY OBJECTIVE Our objectives are to describe the outcomes of patients presenting to the emergency department ( ED ) because of an adverse drug event and to compare them with outcomes of patients presenting for other reasons . METHODS This prospect i ve observational study was conducted at Vancouver General Hospital , a 955-bed tertiary care hospital . We prospect ively enrolled adults presenting to the ED between March and June 2006 , using a systematic sampling algorithm .  Pharmacists and physicians independently evaluated patients for adverse drug events . An independent committee review ed and adjudicated cases in which assessment s were discordant or uncertain . Data from the index visit were linked to vital statistics , administrative health services utilization , and cost of care data . RESULTS Of 1,000 patients , 122 ( 12.2 % ; 95 % confidence interval [ CI ] 10.3 % to 14.4 % ) presented to the ED because of an adverse drug event . Of these , 48 presented because of an adverse drug reaction ( one type of adverse drug event defined as an unintended response that occurred despite use of an appropriate drug dosage ) . We found no difference in mortality among patients presenting with and without adverse drug reactions ( 14.6 % versus 5.9 % ; hazard ratio 1.57 ; 95 % CI 0.70 to 3.52 ) . After adjustment , patients with adverse drug events had a higher risk of spending additional days in the hospital per month ( 6.3 % versus 3.4 % ; odds ratio 1.52 ; 95 % CI 1.43 to 1.62 ) and higher rate of outpatient health care encounters ( 1.73 versus 1.22 ; rate ratio 1.20 ; 95 % CI 1.03 to 1.40 ) . The adjusted median monthly cost of care was 1.90 times higher ( Can $ 325 versus $ 96 ; 95 % CI 1.18 to 3.08 ) . CONCLUSION ED patients presenting with an adverse drug event incurred greater health services utilization and costs during a 6-month follow-up period compared with patients presenting for other reasons BACKGROUND Patients 80 years or older are underrepresented in scientific studies . The objective of this study was to investigate the effectiveness of interventions performed by ward-based pharmacists in reducing morbidity and use of hospital care among older patients . METHODS A r and omized controlled study of patients 80 years or older was conducted at the University Hospital of Uppsala , Uppsala , Sweden . Four hundred patients were recruited consecutively between October 1 , 2005 , and June 30 , 2006 , and were r and omized to control ( n = 201 ) and intervention ( n = 199 ) groups . The interventions were performed by ward-based pharmacists . The control group received st and ard care without direct involvement of pharmacists at the ward level . The primary outcome measure was the frequency of hospital visits ( emergency department and readmissions [ total and drug-related ] ) during the 12-month follow-up period . RESULTS Three hundred sixty-eight patients ( 182 in the intervention group and 186 in the control group ) were analyzed . For the intervention group , there was a 16 % reduction in all visits to the hospital ( quotient , 1.88 vs 2.24 ; estimate , 0.84 ; 95 % confidence interval [ CI ] , 0.72 - 0.99 ) and a 47 % reduction in visits to the emergency department ( quotient , 0.35 vs 0.66 ; estimate , 0.53 ; 95 % CI , 0.37 - 0.75 ) . Drug-related readmissions were reduced by 80 % ( quotient , 0.06 vs 0.32 ; estimate , 0.20 ; 95 % CI , 0.10 - 0.41 ) . After inclusion of the intervention costs , the total cost per patient in the intervention group was $ 230 lower than that in the control group . CONCLUSION If implemented on a population basis , the addition of pharmacists to health care teams would lead to major reductions in morbidity and health care costs Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more RATIONALE , AIMS AND OBJECTIVES To determine whether an increased input by clinical pharmacists at each stage of the patient 's hospital journey , from admission through discharge , result ed in an enhanced level of patient care as measured by a number of clinical and economic outcomes . METHODS This project was design ed to address medicines management issues in patients deemed at risk of drug-related problems . During the project , these latter patients at the time of admission were r and omly assigned to an integrated medicines management ( IMM ) service group ( n = 371 ) or regular hospital care group ( n = 391 ) . The IMM service involved comprehensive pharmaceutical care provided by a pharmacy team throughout each of three stages : patient admission , inpatient monitoring and counselling , and patient discharge . RESULTS Patients who received the IMM service benefited from a reduced length of hospital stay [ by 2 days ( P = 0.003 ; independent sample s t-test log(e ) ) ] . IMM patients also had a decreased rate of readmission over a 12-month follow-up period ( 40.8 % vs. 49.3 % ; p = 0.027 ; Fisher 's exact test ) and an increased time to readmission [ 20 days longer ( P = 0.0356 ; log rank test ) ] . A numbers-needed-to-treat calculation indicated that for approximately every 12 patients receiving the IMM service , one readmission to hospital , within 12 months of discharge , would be prevented . The new service was welcomed by cognate health care professionals . CONCLUSION The IMM service proved very effective and can be used as a template to support the implementation of comprehensive pharmaceutical care as a routine service across Northern Irel and and beyond Elderly patients are vulnerable to medication errors and adverse drug events due to increased morbidity , polypharmacy and inappropriate interactions . The objective of this study was to investigate whether systematic medication review and counselling performed by a clinical pharmacist and clinical pharmacologist would reduce length of in-hospital stay in elderly patients admitted to an acute ward of internal medicine . A r and omized , controlled study of 100 patients aged 70 years or older was conducted in an acute ward of internal medicine in Denmark . Intervention arm : a clinical pharmacist conducted systematic medication review s after an experienced medical physician had prescribed the patients ' medication . Information was collected from medical charts , interview with the patients and data base registration s of drug purchase . Subsequently , medication histories were conferred with a clinical pharmacologist and advisory notes recommending medication changes were completed . Physicians were not obliged to comply with the recommendations . Control arm : medication was review ed by usual routine in the ward . Primary end-point was length of in-hospital stay . In addition , readmissions , mortality , contact to primary healthcare and quality of life were measured at 3-month follow-up . In the intervention arm , the mean length of in-hospital stay was 239.9 hr ( 95 % CI : 190.2 - 289.6 ) and in the control arm : 238.6 hr ( 95 % CI : 137.6 - 339.6 ) , which was neither a statistical significant nor a clinical ly relevant difference . Moreover , no differences were observed for any of the secondary end-points . Systematic medication review and medication counselling did not show any effect on in-hospital length of stay in elderly patients when admitted to an acute ward of internal medicine Objective To evaluate the effects of a clinical pharmacist service on health-related quality of life ( HRQL ) and prescribing of drugs . Methods A r and omised controlled study was performed in two internal medicine wards . The intervention consisted of medication review s with feedback to the physicians , drug treatment discussion with patients at discharge and medication reports .  HRQL was evaluated at inclusion and after six months by self-rated global health ( 1 : very poor ; 5 : very good ) and by the EuroQol 5-dimension question naire ( EQ-5D ) . Prescribing of drugs was analysed regarding three established drug-specific quality indicators ( intervention and control patients ) and potential drug-related problems ( DRPs ) during in-hospital care ( intervention patients ) . Results 345 patients ( 61 % female ; median age : 82 ) were analysed , 204 of whom ( 59 % ) completed the six-month HRQL follow-up . A total of 87 patients ( 53 % of the intervention patients ) received all parts of the intervention . Intention-to-treat analysis revealed no significant findings for any of the HRQL measures . Per- protocol analysis revealed significantly better HRQL in the intervention group at six-month follow-up as measured by global health ( mean : 3.14 ( SD : 0.87 ) vs 2.77 ( 0.94 ) , p=0.020 ) , but not as measured by summarised EQ-5D index ( 0.48 ( 0.36 ) vs 0.43 ( 0.37 ) , p=0.57 ) . The number of potentially inappropriate prescribings per patient according to the quality indicators ( admission vs discharge ) was 0.35 ( 0.73 ) versus 0.38 ( 0.72 ) , p=0.47 ( control patients ) , and 0.39 ( 0.83 ) versus 0.26 ( 0.56 ) , p=0.039 ( intervention patients who received the intervention ) . In the intervention group , 133 relevant potential DRPs were identified in 81 patients , 55 of which ( 41 % ) were acted upon by the attending physician . Conclusion A clinical pharmacist service during inpatient care may improve quality of prescribing and patients ' HRQL . Trial registration clinical trials.gov Identifier : NCT01016301 Background : Medication-related visits to the emergency department are an important but poorly understood phenomenon . We sought to evaluate the frequency , severity and preventability of drug-related visits to the emergency department . Methods : We performed a prospect i ve observational study of r and omly selected adults presenting to the emergency department over a 12-week period . Emergency department visits were identified as drug-related on the basis of assessment by a pharmacist research assistant and an emergency physician ; discrepancies were adjudicated by 2 independent review ers . Results : Among the 1017 patients included in the study , the emergency department visit was identified as drug-related for 122 patients ( 12.0 % , 95 % confidence interval [ CI ] 10.1%–14.2 % ) ; of these , 83 visits ( 68.0 % , 95 % CI 59.0%–76.2 % ) were deemed preventable . Severity was classified as mild in 15.6 % of the 122 cases , moderate in 74.6 % and severe in 9.8 % . The most common reasons for drug-related visits were adverse drug reactions ( 39.3 % ) , nonadherence ( 27.9 % ) and use of the wrong or suboptimal drug ( 11.5 % ) . The probability of admission was significantly higher among patients who had a drug-related visit than among those whose visit was not drug-related ( OR 2.18 , 95 % CI 1.46–3.27 , p < 0.001 ) , and among those admitted , the median length of stay was longer ( 8.0 [ interquartile range 23.5 ] v. 5.5 [ interquartile range 10.0 ] days , p = 0.06 ) . Interpretation : More than 1 in 9 emergency department visits are due to drug-related adverse events , a potentially preventable problem in our health care system Inappropriate prescribing is particularly common 
    Output:
    
This systematic review failed to identify an effect of pharmacist-led medication review on health outcomes