***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: Background : Medication errors at the time of hospital admission and discharge are common and can lead to preventable adverse drug events . The objective of this study was to describe the potential impact of a medication reconciliation process to identify and rectify medication errors at the time of hospital admission and discharge . Methods : Sixty r and omly selected patients were prospect ively enrolled at the time of admission to a Canadian community hospital . At admission , patients ’ medication orders were compared with pre-admission medication use based on medication vials and interviews with patients , caregivers , and /or outpatient healthcare providers . At discharge , pre-admission and in-patient medications were compared with discharge orders and written instructions . All variances were discussed with the prescribing physician and classified as intended or unintended ; unintended variances were considered to be medication errors . An internist classified the clinical importance of each unintended variance . Results : Overall , 60 % ( 95 % CI 48 to 72 ) of patients had at least one unintended variance and 18 % ( 95 % CI 9 to 28 ) had at least one clinical ly important unintended variance . None of the variances had been detected by usual clinical practice before reconciliation was conducted . Of the 20 clinical ly important variances , 75 % ( 95 % CI 56 to 94 ) were intercepted by medication reconciliation before patients were harmed . Discussion : Unintended medication variances at the time of hospital admission and discharge are common and clinical ly important . The medication reconciliation process identified and addressed most of these unintended variances before harm occurred . In this small study , medication reconciliation was a useful method for identifying and rectifying medication errors at times of transition . Reconciliation warrants broader evaluation 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 Purpose To examine the impact of systematic medication reconciliations upon hospital admission and of a medication review while in hospital on the number of inappropriate medications and unscheduled drug-related hospital revisits in elderly patients . Methods This was a prospect i ve , controlled study in 210 patients , aged 65 years or older , who were admitted to one of three internal medicine wards at a University Hospital in Sweden . Intervention patients received the complete Lund Integrated Medicines Management model ( medication reconciliation upon admission and discharge , and medication review and monitoring ) provided by a multi-professional team , including a clinical pharmacist . Control patients received st and ard care and medication reconciliation upon discharge . Blinded review ers evaluated the appropriateness of the prescribing ( using the Medication Appropriateness Index ) on admission and discharge , and assessed the probability that a drug-related problem was the reason for any patient readmitted to hospital or visiting the emergency department within 3 months of discharge ( using World Health Organisation causality criteria ) . Results There was a greater decrease in the number of inappropriate drugs in the intervention group than in the control group for both the intention-to-treat population { 51 % [ 95 % confidence interval ( CI ) 43–58 % ] vs. 39 % ( 95 % CI 30–48 % ) ; p = 0.0446 } and the per- protocol population [ 60 % ( 95 % CI 51–67 % ) vs. 44 % ( 95 % CI 34–52 % ) ; p = 0.0106 ) ] . There were six revisits to hospital in the intervention group which were judged as ‘ possibly , probably or certainly drug-related ’ , compared with 12 in the control group ( p = 0.0469 ) . Conclusions In this study , medication reconciliation and review provided by a clinical pharmacist in a multi-professional team significantly reduced the number of inappropriate drugs and unscheduled drug-related hospital revisits among elderly patients BACKGROUND Many studies have highlighted the problems associated with different aspects of  medicines reconciliation ( MR ) .  These have been followed by numerous recommendations of good practice shown in published studies to decrease error ; however , there is little to suggest that practice has significantly changed . The study reported here was conducted to review local medicines reconciliation practice and compare it to data within previously published evidence . OBJECTIVES To determine current medicines reconciliation practice in four acute hospitals ( A-D ) in one region of the United Kingdom and compare it to published best practice s. METHOD Quantitative data on key indicators were collected prospect ively from medical wards in the four hospitals using a proforma compiled from existing literature and previous , vali date d audits . Data were collected on : i ) time between admission and MR being undertaken ; ii ) time to conduct MR ; iii ) number and type of sources used to ascertain current medication ; and iv ) number , type and potential severity of unintended discrepancies . The potential severity of the discrepancies was retrospectively dually rated in 10 % of the sample using a professional panel . RESULTS Of the 250 charts review ed ( 54 Hospital A , 61 Hospital B , 69 Hospital C , 66 Hospital D ) , 37.6 % ( 92/245 ) of patients experienced at least one discrepancy on their drug chart , with the majority of these being omissions ( 237/413 , 57.1 % ) . A total of 413 discrepancies were discovered , an overall mean of 1.69 ( 413/245 ) discrepancies per patient . The number of sources used to reconcile medicines varied with 36.8 % ( 91/247 ) only using one source of information and the patient being used as a source in less than half of all medicines reconciliations ( 45.7 % , 113/247 ) . In three out of the four hospitals the discrepancies were most frequently categorized as potentially requiring increased monitoring or intervention . CONCLUSION This study shows higher rates of unintended discrepancies per patient than those in previous studies , with omission being the most frequently occurring type of discrepancy . None of the four centers adhered to current UK guidance on medicines reconciliation . All four centers demonstrated a strong reliance on General Practitioner (GP)-based sources . A minority of discrepancies had the potential to cause injury to patients and to increase utilization of health care re sources . There is a need to review current practice and procedures at transitions in care to improve the accuracy of medication history-taking at admission by doctors and to encourage pharmacy staff to use an increased number of sources to vali date the medication history . Although early research indicates that safety can be improved through patient involvement , this study found that patients were not involved in the majority of reconciliation encounters 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 PURPOSE An inaccurate medication history may prevent the discovery of a pre-admission iatrogenic event or lead to interrupted drug therapy during hospitalization . Medication reconciliation is a process that ensures the transfer of medication information at admission to the hospital . The aims of this prospect i ve study were to evaluate the interest in clinical practice of this concept and the re sources needed for its implementation . METHODS We chose to include patients aged 65 years or over admitted in the internal medicine unit between June and October 2010 . We obtained an accurate list of each patient 's home medications . This list was then compared with medication orders . All medication variances were classified as intended or unintended . An internist and a pharmacist classified the clinical importance of each unintended variance . RESULTS Sixty-one patients ( mean age : 78 ± 7.4 years ) were included in our study . We identified 38 unintended discrepancies . The average number of unintended discrepancies was 0.62 per patient . Twenty-five patients ( 41 % ) had one or more unintended discrepancies at admission . The contact with the community pharmacist permitted us to identify 21 ( 55 % ) unintended discrepancies . The most common errors were the omission of a regularly used medication ( 76 % ) and an incorrect dosage ( 16 % ) . Our intervention result ed in order changes by the physician for 30 ( 79 % ) unintended discrepancies . Fifty percent of the unintended variances were judged by the internist and 76 % by the pharmacist to be clinical ly significant . CONCLUSION The admission to the hospital is a critical transition point for the continuity of care in medication management . Medication reconciliation can identify and resolve errors due to inaccurate medication histories Abstract Objective To ascertain the current burden of adverse drug reactions ( ADRs ) through a prospect i ve analysis of all admissions to hospital . Design Prospect i ve observational study . Setting Two large general hospitals in Merseyside , Engl and . Participants 18 820 patients aged > 16 years admitted over six months and assessed for cause of admission . Main outcome measures Prevalence of admissions due to an ADR , length of stay , avoidability , and outcome . Results There were 1225 admissions related to an ADR , giving a prevalence of 6.5 % , with the ADR directly leading to the admission in 80 % of cases . The median bed stay was eight days , accounting for 4 % of the hospital bed capacity . The projected annual cost of such admissions to the NHS is £ 466 m ( € 706 m , $ 847 m ) . The overall fatality was 0.15 % . Most reactions were either definitely or possibly avoidable . Drugs most commonly implicated in causing these admissions included low dose aspirin , diuretics , warfarin , and non-steroidal anti-inflammatory drugs other than aspirin , the most common reaction being gastrointestinal bleeding . Conclusion The burden of ADRs on the NHS is high , accounting for considerable morbidity , mortality , and extra costs . Although many of the implicated drugs have proved benefit , measures need to be put into place to reduce the burden of ADRs and thereby further improve the benefit : harm ratio of the drugs Background : Limited information exists in regard to drug omissions and unjustified medications in the hospital discharge summary ( DS ) . Objective : To evaluate the incidence and types of drug omissions and unjustified medications in the DS , and to assess their potential impact on patient health . Methods : A prospect i ve observational review of the DSs of all patients discharged from our Internal Medicine Department over a  
    Output:
    
The lack of evidence precluded addressing the effects and costs of MR .