***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 Hospitalization and subsequent discharge home often involve discontinuity of care , multiple changes in medication regimens , and inadequate patient education , which can lead to adverse drug events ( ADEs ) and avoidable health care utilization . Our objectives were to identify drug-related problems during and after hospitalization and to determine the effect of patient counseling and follow-up by pharmacists on preventable ADEs . METHODS We conducted a r and omized trial of 178 patients being discharged home from the general medicine service at a large teaching hospital . Patients in the intervention group received pharmacist counseling at discharge and a follow-up telephone call 3 to 5 days later . Interventions focused on clarifying medication regimens ; review ing indications , directions , and potential side effects of medications ; screening for barriers to adherence and early side effects ; and providing patient counseling and /or physician feedback when appropriate . The primary outcome was rate of preventable ADEs . RESULTS Pharmacists observed the following drug-related problems in the intervention group : unexplained discrepancies between patients ' preadmission medication regimens and discharge medication orders in 49 % of patients , unexplained discrepancies between discharge medication lists and postdischarge regimens in 29 % of patients , and medication nonadherence in 23 % . Comparing trial outcomes 30 days after discharge , preventable ADEs were detected in 11 % of patients in the control group and 1 % of patients in the intervention group ( P = .01 ) . No differences were found between groups in total ADEs or total health care utilization . CONCLUSIONS Pharmacist medication review , patient counseling , and telephone follow-up were associated with a lower rate of preventable ADEs 30 days after hospital discharge . Medication discrepancies before and after discharge were common targets of intervention 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 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 Heading Abstract Objective . To estimate incidence rates of drug-related hospitalizations ( DRHs ) in a longitudinal population -based study with prospect i ve event assessment . Design . Cohort study and time – trend analysis . Setting . All departments of internal medicine and emergency departments in the urban regions of Jena and Rostock , Germany , serving about 520,000 residents . Participants . All patients admitted between October 1997 and March 2000 . Patients with severe cutaneous reactions were excluded . Main outcome measures . Incidence of DRH was defined by symptoms or diagnoses at admission that were very likely , likely , or possibly caused by prescription medications , according to a st and ardized assessment . Results . The incidence of DRH was 9.4 admissions per 10,000 treated patients [ 95 % confidence interval ( CI ) 9.0–9.9 ] . Rates were highest for antithrombotics with 26.9 admissions per 10,000 treated patients ( 95 % CI 23.6 , 30.1 ) . Most frequent events were gastroduodenal lesions and bleeding ( 45 % ) . Digitalis preparations showed a linearly increasing trend from 2/10,000 to 14/10,000 during ten quarters ( P<0.0001 ) , which was exclusively attributable to digitoxin , the major source of digitalis in the study area ( 93 % ) . The incidence of DRH increased with age ( 4/10,000 to 20/10,000 ) . The mean length of stays in patients with DRH was 13±10.6 days . Cumulative direct costs for hospitalization were Euro 4 million in the two urban study areas . The annual direct costs for Germany were estimated to be Euro 400 million . Conclusions . DRHs are a considerable public health and economic burden . A longitudinal design can observe changes in population -based incidence over time . This approach can be used for public-health planning or to evaluate outcomes of quality management programs design ed to reduce drug-induced illness 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 explore the advice giving role of pharmacists during consultation for medication review with patients aged 80 or more . Design Discourse analysis . Setting Participants ' homes . Participants Sub sample of consultations within a large r and omised trial of home medication review among patients aged 80 or more who had been admitted to hospital . Main outcome measures Extent to which advice given by pharmacists was accepted and acknowledged by patients . Results Pharmacists found many opportunities to offer advice , information , and instruction . These advice giving modes were rarely initiated by the patients and were given despite a no problem response and deliberate displays of competence and knowledge by patients . Advice was often resisted or rejected and created interactional difficulties and awkward moments during the consultations . Conclusions The advice giving role of pharmacists during consultations with patients aged 80 or more has the potential to undermine and threaten the patients ' assumed competence , integrity , and self governance . Caution is needed in assuming that commonsense interventions necessarily lead to health gain Inappropriate prescribing is particularly common in older patients and is associated with adverse drug events ( ADEs ) , hospitalization , and wasteful utilization of re sources . We r and omized 400 hospitalized patients aged ≥65 years to receive either the usual pharmaceutical care ( control ) or screening with STOPP/START criteria followed up with recommendations to their attending physicians ( intervention ) . The Medication Appropriateness Index ( MAI ) and Assessment of Underutilization ( AOU ) index were used to assess prescribing appropriateness , both at the time of discharge and for 6 months after discharge . Unnecessary polypharmacy , the use of drugs at incorrect doses , and potential drug – drug and drug – disease interactions were significantly lower in the intervention group at discharge ( absolute risk reduction 35.7 % , number needed to screen to yield improvement in MAI = 2.8 ( 95 % confidence interval 2.2–3.8 ) ) . Underutilization of clinical ly indicated medications was also reduced ( absolute risk reduction 21.2 % , number needed to screen to yield reduction in AOU = 4.7 ( 95 % confidence interval 3.4–7.5 ) ) . Significant improvements in prescribing appropriateness were sustained for 6 months after discharge Background Acute admission to hospitals , age and number of drugs are associated with an increased risk of adverse drug events due to morbidity , poly-pharmacy and inappropriate interactions . Thus , the objective of the present study was to investigate if systematic medication review and drug counseling on admission to hospitals would have a significant impact at clinical ly health-related outcomes in elderly patients admitted acutely to an orthopaedic ward . Methods A r and omised controlled study comprising 108 patients aged 65 years or older admitted acutely to an orthopaedic ward in Denmark was conducted . Intervention : a clinical pharmacist collected information regarding the patient ’s medication and medical history in the medical record , the electronic drug order system , the registry of drug purchase and interview with the patient ’s . Subsequently , this was discussed with a clinical pharmacologist and an advisory note with drug recommendations were h and ed directly to the ward physicians . Control : the usual medication routine in the ward . The primary outcome measure was time to first unscheduled contact to a physician post-discharge limited to emergency department visit , readmission and general practitioner . Secondary outcomes were admission time , time to first re-admission , number of re-admissions , emergency department visits , ambulatory care visits , contact to general practitioner , physicians outside working hours , medical specialist and finally , quality of life at three-month follow up . Results In the intervention group time to first unscheduled contact to a physician post-discharge was 16.3 days(95%CI : 10.522.2 ) and in the control group 25.6 days ( 95%CI:17.8 - 33.4 ) , which was not a statistically significant difference . No overall differences between study groups were seen in the secondary outcome measures . The physicians complied with 41 of 222 drug recommendations . Subgroup analysis indicated that physicians were more prone to accept recommendations in the very old treated with numerous of drugs . Conclusion The findings do not lead to the recommendation of an extra medication review in a general population of elderly admitted acutely to an orthopaedic ward . Considering the physicians marked hesitation to comply with drug recommendations future studies should explore the impact of a differentiated medication review in acute admitted patients based on the individual patient ’s risk of adverse drug events 
    Output:
    
It is uncertain whether medication review reduces mortality or hospital readmissions , but medication review seems to reduce emergency department contacts .
However , the cost-effectiveness of this intervention is not known and due to the uncertainty of the estimates of mortality and readmissions and the short follow-up , important treatment effects may have been overlooked .