***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVES to investigate the effectiveness of a  pharmacy discharge plan  in elderly hospitalized patients . DESIGN r and omized controlled trial . SUBJECTS AND SETTING S we r and omized patients aged 75 years and older on four or more medicines who had been discharged from three acute general and one long-stay hospital to a pharmacy intervention or usual care . INTERVENTIONS the hospital pharmacist developed discharge plans which gave details of medication and support required by the patient . A copy was given to the patient and to all relevant professionals and carers . This was followed by a domiciliary assessment by a community pharmacist . In the control group , patients were discharged from hospital following st and ard procedures that included a discharge letter to the general practitioner listing current medications . OUTCOMES the primary outcome was re-admission to hospital within 6 months . Secondary outcomes included the number of deaths , attendance at hospital outpatient clinics and general practice and proportion of days in hospital over the follow-up period , together with patients ' general well-being , satisfaction with the service and knowledge of and adherence to prescribed medication . RESULTS we recruited 362 patients , of whom 181 were r and omized to each group . We collected hospital and general practice data on at least 91 and 72 % of patients respectively at each follow-up point and interviewed between 43 and 90 % of the study subjects . There were no significant differences between the groups in the proportion of patients re-admitted to hospital between baseline and 3 months or 3 and 6 months . There were no significant differences in any of the secondary outcomes . CONCLUSIONS we found no evidence to suggest that the co-ordinated hospital and community pharmacy care discharge plans in elderly patients in this study influence outcomes Background : Urgent , unplanned hospital readmissions are increasingly being used to gauge the quality of care . We review ed urgent readmissions to determine which were potentially avoidable and compared rates of all-cause and avoidable readmissions . Methods : In a multicentre , prospect i ve cohort study , we review ed all urgent readmissions that occurred within six months among patients discharged to the community from 11 teaching and community hospitals between October 2002 and July 2006 . Summaries of the readmissions were review ed by at least four practising physicians using st and ardized methods to judge whether the readmission was an adverse event ( poor clinical outcome due to medical care ) and whether the adverse event could have been avoided . We used a latent class model to determine whether the probability that each readmission was truly avoidable exceeded 50 % . Results : Of the 4812 patients included in the study , 649 ( 13.5 % , 95 % confidence interval [ CI ] 12.5%–14.5 % ) had an urgent readmission within six months after discharge . We considered 104 of them ( 16.0 % of those readmitted , 95 % CI 13.3%–19.1 % ; 2.2 % of those discharged , 95 % CI 1.8%–2.6 % ) to have had a potentially avoidable readmission . The proportion of patients who had an urgent readmission varied significantly by hospital ( range 7.5%–22.5 % ; χ2 = 92.9 , p < 0.001 ) ; the proportion of readmissions deemed avoidable did not show significant variation by hospital ( range 1.2%–3.7 % ; χ2 = 12.5 , p < 0.25 ) . We found no association between the proportion of patients who had an urgent readmission and the proportion of patients who had an avoidable readmission ( Pearson correlation 0.294 ; p = 0.38 ) . In addition , we found no association between hospital rankings by proportion of patients readmitted and rankings by proportion of patients with an avoidable readmission ( Spearman correlation coefficient 0.28 , p = 0.41 ) . Interpretation : Urgent readmissions deemed potentially avoidable were relatively uncommon , comprising less than 20 % of all urgent readmissions following hospital discharge . Hospital-specific proportions of patients who were readmitted were not related to proportions with a potentially avoidable readmission BACKGROUND AND OBJECTIVES Adverse drug events ( ADEs ) may occur after discharge from acute care hospitalization because of limited instruction on medications at discharge . The right instructions given to patients may reduce the risk of ADEs . The objective of our study was to assess a program involving comprehensive medication counseling provided by pharmacists at the time of discharge from a tertiary hospital in Riyadh , Saudi Arabia . DESIGN AND SETTING A prospect i ve , nonr and omized observational study over a period of 3 months in a 1000-bed tertiary hospital . PATIENTS AND METHODS Patients discharged from the internal medicine wards with more than three medications received comprehensive pharmacist counseling . The intervention pharmacist counseled patients about their discharge medications and provided written material s as needed . Topics discussed with the patients included the importance of following prescribed medication regimens and the indications , directions , and any potential side effects of discharge medications . The control group included similar patients who received routine discharge counseling by nurses . Two weeks after discharge , the same pharmacist called the patients and assessed the frequency of ADEs . Two independent clinicians review ed each ADEs and judged its severity and preventability . RESULTS Out of 200 patients included in the study ( 100 patients from the intervention group and 100 patients from the control group ) , 175 patients ( 87.5 % ) were successfully contacted two weeks after discharge ( 88 patients from the intervention group and 87 patients from the control group ) . ADEs occurred in 2 patients ( 2.3 % ) in the intervention group and in 21 patients ( 24 % ; 23 incidents in 21 patients ) in the control group ( P<.001 ) . In the control group , 14 ADEs ( 61 % ) were judged as preventable , and 9 ( 39 % ) were judged as serious . CONCLUSIONS A comprehensive medication counseling program at hospital discharge reduced the incidence of ADEs two weeks after discharge from a tertiary hospital in Riyadh , Saudi Arabia . Further studies assessing the long-term outcomes of such a program are needed 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 Context Research on patient safety has focused on adverse events in hospitalized patients .  Adverse events following hospitalization have received little attention . Contribution Among 400 consecutive patients discharged from the general medical service of an academic hospital , 76 had adverse events during the 2 weeks following hospital discharge . Of the adverse events , the research ers categorized 23 as preventable , 24 as ameliorable , and the remainder as neither . Adverse drug events were the most frequent occurrence . Implication s Interventions to maximize patient safety should consider the vulnerable transition from hospital to home . The Editors Patient safety is a public concern that has received substantial attention , especially since the release of two reports from the U.S. Institute of Medicine . The first of these , To Err Is Human , review ed the literature on adverse events , or injuries result ing from medical care ( 1 ) . On the basis of data from two large population -based chart review studies , the report estimated that adverse events occur in 2.9 % ( 2 ) to 3.7 % ( 3 ) of hospitalizations . The first of these studies ( 2 ) found that although most injuries are minor , approximately 1 in 10 results in death . The research ers determined that approximately half of the adverse events were caused by errors ( 1 , 3 , 4 ) . The second report , Crossing the Quality Chasm , which proposes strategies for improving the health system , declared patient safety a fundamental component of care quality ( 5 ) . However , the estimated incidence of adverse events quoted in To Err Is Human may underestimate the overall safety problem , since injuries occurring after discharge were not included in the evaluation . Patients may be especially vulnerable to injuries during this period because they may still have functional impairments and because discontinuities may occur at the interface of acute and ambulatory care ( 6 ) . These discontinuities may be worsened by the current health care environment , in which patients are leaving the hospital quicker and sicker ( 7 ) and may receive care from hospitalists rather than their primary care physicians ( 8) . Despite these theoretical concerns , few studies are available to estimate the extent of the problem . Several studies have determined the risk for postdischarge wound infections in surgical patients ( 9 , 10 ) , but this is a specific type of safety problem and the risk can not be generalized . Other studies have used readmission rates to identify poor- quality hospital care ( 11 ) . However , this outcome is an insensitive and nonspecific marker of quality in general ( 11 ) and safety in particular . Information on the incidence and type of adverse events is vital for improving postdischarge safety . We wanted to determine the incidence and severity of adverse events affecting patients after discharge from the hospital to home . In addition , we wanted to identify the incidence of preventable and ameliorable adverse events , classify types of adverse events , and identify system improvements to reduce the incidence and severity of adverse events after discharge . Methods Overview To determine the rate of adverse events , we first created a case summary of every patient 's posthospital course by performing a medical record review and a telephone interview approximately 3 weeks after discharge . Using this information , we created event summaries , which two board-certified internists independently review ed to determine whether medical management caused an injury and , if so , whether it was preventable or ameliorable . The institutional review board at the study hospital approved the protocol . Definitions Adverse outcomes were any of the following patient experiences after discharge : new or worsening symptoms , unanticipated visits to health facilities for tests or treatments , or death . An adverse event was an injury result ing from medical management rather than the underlying disease . We evaluated all injuries result ing in symptoms after discharge , regardless of when the events occurred . Thus , we included adverse events that occurred in the hospital and after discharge as long as symptoms persisted until the patient went home . A preventable adverse event was an injury that could have been avoided , that is , an injury judged to probably be the result of an error or a system design flaw . An ameliorable adverse event was an injury whose severity could have been substantially reduced if different actions or procedures had been performed or followed . Patient Sample We used a prospect i ve cohort design to study adult medical patients at an 800-bed urban academic teaching hospital . Patients were included if they went home from the general medical service during a sequential 81-day period , had telephone service , and could complete a telephone interview in English . Patient surrogates were permitted to complete the interview if the patient could not . Telephone Interview A board-certified internist contacted patients by telephone within 2 to 5 weeks of discharge . If the patient was eligible and consented , he or she underwent a semi-structured interview over the telephone . If the patient was not available , we made up to 20 attempts to contact him or her at different times of the day and week . If the patient declined to participate or we were unable to contact him or her after 5 weeks , we rated the patient as a nonresponder . Responders underwent a telephone interview that had several components ( Appendix Figure ) . The principal component assessed the patient 's condition since discharge by using a full review of organ systems . If patients answered yes to any question , the interviewer asked them to elaborate about the symptom 's severity , timing in relation to hospitalization and treatments , and resolution . The survey also determined patients ' use of health services since discharge , including home care services , physician services , visits to laboratories , and readmissions to the hospital . Preparation of Case Summaries To create a case summary , the internist combined the information from the telephone interview with information obtained from a review of the patient 's electronic medical record . This computerized clinical record contains h and over notes from the hospitalization ; discharge summaries ; previous orders and written instructions ; emergency department and clinic notes ; operative and procedure notes ; and all laboratory results , including results of radiography , electrocardiography , and pathologic examination . If necessary , the paper chart was also review ed to clarify information that was in the discharge summary or h and over notes . If patients returned to the study hospital after discharge , we were able to vali date their history by review ing their records . However , for patients receiving 
    Output:
    
Because of scant evidence , no conclusions could be reached on methods to prevent postdischarge AEs .