***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 evaluate the effect of a video decision support tool on the preferences for future medical care in older people if they develop advanced dementia , and the stability of those preferences after six weeks . Design R and omised controlled trial conducted between 1 September 2007 and 30 May 2008 . Setting Four primary care clinics ( two geriatric and two adult medicine ) affiliated with three academic medical centres in Boston . Participants Convenience sample of 200 older people ( ≥65 years ) living in the community with previously scheduled appointments at one of the clinics . Mean age was 75 and 58 % were women . Intervention Verbal narrative alone ( n=106 ) or with a video decision support tool ( n=94 ) . Main outcome measures Preferred goal of care : life prolonging care ( cardiopulmonary resuscitation , mechanical ventilation ) , limited care ( admission to hospital , antibiotics , but not cardiopulmonary resuscitation ) , or comfort care ( treatment only to relieve symptoms ) . Preferences after six weeks . The principal category for analysis was the difference in proportions of participants in each group who preferred comfort care . Results Among participants receiving the verbal narrative alone , 68 ( 64 % ) chose comfort care , 20 ( 19 % ) chose limited care , 15 ( 14 % ) chose life prolonging care , and three ( 3 % ) were uncertain . In the video group , 81 ( 86 % ) chose comfort care , eight ( 9 % ) chose limited care , four ( 4 % ) chose life prolonging care , and one ( 1 % ) was uncertain ( χ2=13.0 , df=3 , P=0.003 ) . Among all participants the factors associated with a greater likelihood of opting for comfort care were being a college graduate or higher , good or better health status , greater health literacy , white race , and r and omisation to the video arm . In multivariable analysis , participants in the video group were more likely to prefer comfort care than those in the verbal group ( adjusted odds ratio 3.9 , 95 % confidence interval 1.8 to 8.6 ) . Participants were re-interviewed after six weeks . Among the 94/106 ( 89 % ) participants re-interviewed in the verbal group , 27 ( 29 % ) changed their preferences ( κ=0.35 ) . Among the 84/94 ( 89 % ) participants re-interviewed in the video group , five ( 6 % ) changed their preferences ( κ=0.79 ) ( P<0.001 for difference ) . Conclusion Older people who view a video depiction of a patient with advanced dementia after hearing a verbal description of the condition are more likely to opt for comfort as their goal of care compared with those who solely listen to a verbal description . They also have more stable preferences over time . Trial registration Clinical trials.gov NCT00704886 OBJECTIVES To study the feasibility and effectiveness of a  discharge planning intervention . DESIGN Quasi-experimental pre-post study design . SETTING General medicine wards at three hospitals : an academic medical center , a community teaching hospital , and a community-based nonteaching hospital . PARTICIPANTS All patients aged 65 and older admitted to the hospitalist services . INTERVENTION The intervention toolkit had five core elements : admission form with geriatric cues , facsimile to the primary care provider , interdisciplinary worksheet to identify barriers to discharge , pharmacist-physician collaborative medication reconciliation , and predischarge planning appointments . MEASUREMENTS Thirty-day readmission and return to emergency department rates and patient satisfaction with discharge . Odds ratios were determined , and site effects were examined accordig to interaction terms and Breslow Day statistics . RESULTS Two hundred thirty-seven patients were followed during the preintervention period , and 185 were exposed to the intervention . Patients characteristics were similar across the two time periods . The proportion of patients with high- quality transitions home , measured according to Coleman 's Care Transition Measures , increased from 68 % to 89 % ( odds ratio (OR)=3.49 , 95 % confidence interval (CI)=2.06 - 5.92 ) . Return to the emergency department within 3 days of discharge was lower in the intervention period ( 10 % vs 3 % , OR=0.25 , 95 % CI=0.10 - 0.62 ) . At 30 days , there was a lower rate of readmission ( 22 % vs 14 % , OR=0.59 , 95 % CI=0.34 - 0.97 ) and fewer visits to the emergency department ( 21 % vs 14 % , OR=0.61 , 95 % CI=0.36 - 1.03 ) ( P=.06 ) . CONCLUSION When hospitalized elderly patients are treated with consideration of their specific needs , healthcare outcomes can be improved Abstract BACKGROUND : Little is known about the relative advantages of video versus internet-based decision aids to facilitate shared medical decision making . This study compared internet and video patient education modalities for men considering the prostate specific antigen ( PSA ) test . METHODS : Two hundred and twenty-six men , aged 50 years or older , and scheduled to complete a physical examination at an HMO Health Appraisal Clinic were r and omly assigned to access a website ( N=114 ) or view a 23-minute videotape in the clinic ( N=112 ) prior to deciding whether they wanted to be screened for prostate cancer . RESULTS : There were no between-groups differences in participants ’ ratings of convenience , effort , or satisfaction following exposure to the decision aid . Participants assigned to the video group were more likely to review the material s than individuals assigned to the internet group ( 98.2 % vs 53.5 % ) . Participants in the video group showed significantly greater increases in PSA knowledge and were more likely to decline the PSA test than individuals assigned to the internet group . However , participants in the internet group who review ed the entire online presentation showed similar increases in PSA knowledge as video participants . Only 5 % of all participants visited other websites to inform themselves about the PSA test . CONCLUSIONS : Overall , the video was significantly more effective than the Internet in educating participants about benefits and risks of PSA screening OBJECTIVE To determine the impact of a hospital-coordinated discharge care plan , involving a multidisciplinary team of primary health care providers , on hospital length of stay , quality of life , and both patient and general practitioner inclusion in , and satisfaction with , discharge procedures . DESIGN This investigation comprised a prospect i ve , r and omized , controlled , clinical trial . SETTING This multicentre and cross-jurisdictional study focused on areas of tertiary and primary health care as well as community allied health in Western Australia . PARTICIPANTS Patients ( n = 189 ) with chronic cardiorespiratory diagnoses were recruited from respiratory , cardiovascular , and general medical wards at two tertiary hospitals . INTERVENTION Subjects were r and omly assigned to one of two groups . Intervention group patients received a discharge care plan in accordance with that outlined in the Australian Enhanced Primary Care Package , completed before discharge and sent to the patient 's general practitioner and other community service providers for review . Control patients were discharged under existing hospital processes . Outcome measures . Patients and general practitioners were surveyed pre-discharge and 7 days post-discharge for quality of life and opinion of discharge procedures . Hospital length of stay was also determined . RESULTS Significant improvements in discharge planning involvement , health service access , confidence with discharge procedures , and opinion of discharge based on previous experience were seen for patients who received the discharge care plan . Further , improved perceptions of mental quality of life were observed within the first week post-discharge for intervention patients . Length of stay showed no difference between groups . Extent and speed of hospital-general practitioner communication were significantly improved via the intervention . CONCLUSIONS Our results indicate that a multidisciplinary discharge care plan , initiated before separation , improves quality of life , involvement , and satisfaction with discharge care , and hospital-general practitioner integration . As such , it possesses benefits over current Western Australian hospital discharge procedures for the care of chronically ill population ABSTRACT BACKGROUND Adverse drug events after hospital discharge are common and often serious . These events may result from provider errors or patient misunderst and ing . OBJECTIVE To determine the prevalence of medication reconciliation errors and patient misunderst and ing of discharge medications . DESIGN Prospect i ve cohort study SUBJECTS Patients over 64 years of age admitted with heart failure , acute coronary syndrome or pneumonia and discharged to home . MAIN MEASURES We assessed medication reconciliation accuracy by comparing admission to discharge medication lists and review ing charts to resolve discrepancies . Medication reconciliation changes that did not appear intentional were classified as suspected provider errors . We assessed patient underst and ing of intended medication changes through post-discharge interviews . Underst and ing was scored as full , partial or absent . We tested the association of relevance of the medication to the primary diagnosis with medication accuracy and with patient underst and ing , accounting for patient demographics , medical team and primary diagnosis . KEY RESULTS A total of 377 patients were enrolled in the study . A total of 565/2534 ( 22.3 % ) of admission medications were redosed or stopped at discharge . Of these , 137 ( 24.2 % ) were classified as suspected provider errors . Excluding suspected errors , patients had no underst and ing of 142/205 ( 69.3 % ) of redosed medications , 182/223 ( 81.6 % ) of stopped medications , and 493 ( 62.0 % ) of new medications . Altogether , 307 patients ( 81.4 % ) either experienced a provider error , or had no underst and ing of at least one intended medication change . Providers were significantly more likely to make an error on a medication unrelated to the primary diagnosis than on a medication related to the primary diagnosis ( odds ratio ( OR ) 4.56 , 95 % confidence interval ( CI ) 2.65 , 7.85 , p < 0.001 ) . Patients were also significantly more likely to misunderst and medication changes unrelated to the primary diagnosis ( OR 2.45 , 95 % CI 1.68 , 3.55 ) , p < 0.001 ) . CONCLUSIONS Medication reconciliation and patient underst and ing are inadequate in older patients post-discharge . Errors and misunderst and ings are particularly common in medications unrelated to the primary diagnosis . Efforts to improve medication reconciliation and patient underst and ing should not be disease-specific , but should be focused on the whole patient IMPORTANCE With growing national focus on reducing readmissions , there is a need to comprehensively assess the quality of transitional care , including discharge practice s , patient perspectives , and patient underst and ing . OBJECTIVE To conduct a multifaceted evaluation of transitional care from a patient-centered perspective . DESIGN Prospect i ve observational cohort study , May 2009 through April 2010 . SETTING Urban , academic medical center . PARTICIPANTS Patients 65 years and older discharged home after hospitalization for acute coronary syndrome , heart failure , or pneumonia . MAIN OUTCOMES AND MEASURES  Discharge practice s , including presence of follow-up appointment and patient-friendly discharge instructions ; patient underst and ing of diagnosis and follow-up appointment ; and patient perceptions of and satisfaction with discharge care . RESULTS The 395 enrolled patients ( 66.7 % of those eligible ) had a mean age of 77.2 years . Although 349 patients ( 95.6 % ) reported underst and ing the reason they had been in the hospital , only 218 patients ( 59.6 % ) were able to accurately describe their diagnosis in postdischarge interviews . Discharge instructions routinely included symptoms to watch out for ( 98.4 % ) , activity instructions ( 97.3 % ) , and  diet advice ( 89.7 % ) in lay language ; however , 99 written reasons for hospitalization ( 26.3 % ) did not use language likely to be intelligible to patients . Of the 123 patients ( 32.6 % ) discharged with a scheduled primary care or cardiology appointment , 54 ( 43.9 % ) accurately recalled details of either appointment . During postdischarge interviews , 118 patients ( 30.0 % ) reported receiving less than 1 day ’s advance notice of discharge , and 246 ( 66.1 % ) reported that staff asked whether they would have the support they needed at home before discharge . CONCLUSIONS AND RELEVANCE Patient perceptions of discharge care quality and self-rated underst and ing were high , and written discharge instructions were generally comprehensive although not consistently clear . However , follow-up appointments and advance discharge planning were deficient , and patient underst and ing of key aspects of postdischarge care was poor . Patient perceptions and written documentation do not adequately reflect patient underst and ing of discharge care OBJECTIVE To examine the effectiveness of delivering of computer-generated discharge summaries to general practice by email , fax , post and patient h and delivery . DESIGN Blinded , r and omized controlled trial . A pre- study audit ascertaining baseline statistics and a follow-up survey were conducted with general practice to determine preferred medium for receiving discharge communication . PARTICIPANTS AND SETTING 196 geriatric patients who were admitted to the aged care ward of a 300-bed metropolitan teaching hospital . Twenty-eight patients were lost to follow-up and 52 general practice s participated in the final survey . The pre- study audit followed 63 discharges from the same ward . INTERVENTION 168 eligible patients were r and omly assigned to have their electronic discharge summary sent by email ( n=40 ) 
    Output:
    
Several studies have examined the use of information technology ( IT ) such as computer-generated and video-based discharge communication practice s. Utilizing technology to deliver discharge information is preferred by healthcare providers and patients , and improves patients ' underst and ing of their medical condition and discharge instructions .
Conclusion Well- design ed IT solutions may improve communication , coordination and retention of information , and lead to improved outcomes for patients , their families , caregivers and primary healthcare providers as well as expediting the task for hospital staff