***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 Previous studies found that medication errors result from lack of sufficient information during the prescribing step . Therefore , it is proposed that having a pharmacist available when patients are evaluated during the rounding process may reduce the likelihood of preventable adverse drug events ( ADEs ) . The objectives of this study were to evaluate the impact of having a pharmacist participate with a physician rounding team on preventable ADEs in general medicine units and to document pharmacist interventions made during the rounding process . METHODS A single-blind , st and ard care-controlled study design was used to compare  patients receiving care from a rounding team including a pharmacist with patients receiving st and ard care ( no pharmacist on rounding team ) . Patients admitted to and discharged from the same general medicine unit were included in the study . The main outcome measure of this study was preventable ADEs . Patient records were r and omly selected and evaluated by a blinded process involving independent senior pharmacist specialists and a senior staff physician . Interventions made by the pharmacists in the treatment group were documented . RESULTS The rate of preventable ADEs was reduced by 78 % , from 26.5 per 1000 hospital days to 5.7 per 1000 hospital days . There were 150 documented interventions recommended during the rounding process , 147 of which were accepted by the team . The most common interventions were ( 1 ) dosing-related changes and ( 2 ) recommendations to add a drug to therapy . CONCLUSION Pharmacist participation with the medical rounding team on a general medicine unit contributes to a significant reduction in preventable ADEs Objective Heart failure patients are regularly admitted to hospital and frequently use multiple medication . Besides intentional changes in pharmacotherapy , unintentional changes may occur during hospitalisation . The aim of this study was to investigate the effect of a clinical pharmacist discharge service on medication discrepancies and prescription errors in patients with heart failure . Setting A general teaching hospital in Tilburg , the Netherl and s. Method An open r and omized intervention study was performed comparing an intervention group , with a  control group receiving regular care by doctors and nurses .  The clinical pharmacist discharge service consisted of review of discharge medication , communicating prescribing errors with the cardiologist , giving patients information , preparation of a written overview of the discharge medication and communication to both the community pharmacist and the general practitioner about this medication . Within 6 weeks after discharge all patients were routinely scheduled to visit the outpatient clinic and medication discrepancies were measured . Main outcome measure The primary endpoint was the frequency of prescription errors in the discharge medication and medication discrepancies after discharge combined . Results Forty-four patients were included in the control group and 41 in the intervention group . Sixty-eight percent of patients in the control group had at least one discrepancy or prescription error against 39 % in the intervention group ( RR 0.57 ( 95 % CI 0.37–0.88 ) ) . The percentage of medications with a discrepancy or prescription error in the control group was 14.6 % and in the intervention group it was 6.1 % ( RR 0.42 ( 95 % CI 0.27–0.66 ) ) . Conclusion This clinical pharmacist discharge service significantly reduces the risk of discrepancies and prescription errors in medication of patients with heart failure in the 1st month after discharge 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 OF THE STUDY To determine the prevalence of delayed discharges of elderly in patients and associated costs . DESIGN AND METHODS We search ed Medline , Embase , Global Health , CAB Abstract s , Econlit , Web of Knowledge , EBSCO - CINAHL , The Cochrane Library , Health Management Information Consortium , and SCIE - Social Care Online for evidence published between 1990 and 2015 on number of days or proportion of delayed discharges for elderly in patients in acute hospitals . Descriptive and regression analyses were conducted . Data on proportions of delayed discharges were pooled using a r and om effects logistic model and the association of relevant factors was assessed . Mean costs of delayed discharge were calculated in USD adjusted for Purchasing Power Parity ( PPP ) . RESULTS Of 64 studies included , 52 ( 81.3 % ) reported delayed discharges as proportions of total hospital stay and 9 ( 14.1 % ) estimated the respective costs for these delays . Proportions of delayed discharges varied widely , from 1.6 % to 91.3 % with a weighted mean of 22.8 % . This variation was also seen in studies from the same country , for example , in the United Kingdom , they ranged between 1.6 % and 60.0 % . No factor was found to be significantly associated with delays . The mean costs of delayed discharge also varied widely ( between 142 and 31,935 USD PPP adjusted ) , reflecting the variability in mean days of delay per patient . IMPLICATION S Delayed discharges occur in most countries and the associated costs are significant . However , the variability in prevalence of delayed discharges and available data on costs limit our knowledge of the full impact of delayed discharges . A st and ardization of methods is necessary to allow comparisons to be made , and additional studies are required-preferably by disease area-to determine the postdischarge needs of specific patient groups and the estimated costs of delays Background Pharmacists may improve medication-related outcomes during transitions of care . The aim of the Iowa Continuity of Care Study was to determine if a pharmacist case manager ( PCM ) providing a faxed discharge medication care plan from a tertiary care institution to primary care could improve medication appropriateness and reduce adverse events , rehospitalization and emergency department visits . Methods Design . R and omized , controlled trial of 945 participants assigned to enhanced , minimal and usual care groups conducted 2007 to 2012 . Subjects . Participants with cardiovascular-related conditions and /or asthma or chronic obstructive pulmonary disease were recruited from the University of Iowa Hospital and Clinics following admission to general medicine , family medicine , cardiology or orthopedics . Intervention . The minimal group received admission history , medication reconciliation , patient education , discharge medication list and medication recommendations to inpatient team . The enhanced group also received a faxed medication care plan to their community physician and pharmacy and telephone call 3–5 days post-discharge . Participants were followed for 90 days post-discharge . Main Outcomes and Measures . Medication appropriateness index ( MAI ) , adverse events , adverse drug events and post-discharge healthcare utilization were compared by study group using linear and logistic regression , as models accommodating r and om effects due to pharmacists indicated little clustering . Results Study groups were similar at baseline and the intervention fidelity was high . There were no statistically significant differences by study group in medication appropriateness , adverse events or adverse drug events at discharge , 30-day and 90-day post-discharge . The average MAI per medication as 0.53 at discharge and increased to 0.75 at 90 days , and this was true across all study groups . Post-discharge , about 16 % of all participants experienced an adverse event , and this did not differ by study group ( p > 0.05 ) . Almost one-third of all participants had any type of healthcare utilization within 30 days post-discharge , where 15 % of all participants had a 30-day readmission . Healthcare utilization post-discharge was not statistically significant different at 30 or 90 days by study group . Conclusion The pharmacist case manager did not affect medication use outcomes post-discharge perhaps because quality of care measures were high in all study groups . Trial registration Clinical trials.gov registration : NCT00513903 , August 7 , 2007 BACKGROUND Adverse events related to drugs occur frequently among in patients , and many of these events are preventable . However , few data are available on adverse drug events among out patients . We conducted a study to determine the rates , types , severity , and preventability of such events among out patients and to identify preventive strategies . METHODS We performed a prospect i ve cohort study , including a survey of patients and a chart review , at four adult primary care practice s in Boston ( two hospital-based and two community-based ) , involving a total of 1202 out patients who received at least one prescription during a four-week period .  Prescriptions were computerized at two of the practice s and h and written at the other two . RESULTS Of the 661 patients who responded to the survey ( response rate , 55 percent ) , 162 had adverse drug events ( 25 percent ; 95 percent confidence interval , 20 to 29 percent ) , with a total of 181 events ( 27 per 100 patients ) . Twenty-four of the events ( 13 percent ) were serious , 51 ( 28 percent ) were ameliorable , and 20 ( 11 percent ) were preventable . Of the 51 ameliorable events , 32 ( 63 percent ) were attributed to the physician 's failure to respond to medication-related symptoms and 19 ( 37 percent ) to the patient 's failure to inform the physician of the symptoms . The medication classes most frequently involved in adverse drug events were selective serotonin-reuptake inhibitors ( 10 percent ) , beta-blockers ( 9 percent ) , angiotensin-converting-enzyme inhibitors ( 8 percent ) , and nonsteroidal antiinflammatory agents ( 8 percent ) . On multivariate analysis , only the number of medications taken was significantly associated with adverse events . CONCLUSIONS Adverse events related to drugs are common in primary care , and many are preventable or ameliorable . Monitoring for and acting on symptoms are important . Improving communication between out patients and providers may help prevent adverse events related to drugs 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 
    Output:
    
The RCTs were from USA ( n = 3 ) , Sweden ( n = 2 ) , Belgium ( n = 2 ) , China ( n = 2 ) , Australia ( n = 2 ) , Denmark ( n = 2 ) , Northern Irel and , Norway , Canada , UK and Netherl and s. The economic studies were from UK ( n = 2 ) , Sweden ( n = 2 ) , Belgium and Netherl and s. The results showed that regular pharmacist input was most cost effective .
No evidence was found for 7-day pharmacist presence .
CONCLUSIONS Pharmacist inclusion in the ward multidisciplinary team improves patient safety and satisfaction and is cost-effective when regularly provided throughout the ward stay .
Research is needed to determine whether the provision of 7-day service is cost-effective