***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 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 BACKGROUND It is generally recognized that adverse drug reactions ( ADRs ) represent a major concern of health systems in terms of early recognition , proper management and prevention . The aims of this study were to identify the most frequent ADRs recognized by the attending physicians , study their nature and target these ADRs in order to take future preventive measures . METHODS A prospect i ve study was conducted over a 12-month period in an internal medicine department using stimulated spontaneous reporting for identifying ADRs . All ADRs reported by physicians were followed up to the patient 's discharge and evaluated by an independent group of pharmacologists . Causality , severity and preventability were assessed . RESULTS Of the 1854 admissions , 112 ADRs in 94 patients ( 5.07 % ) were vali date d from the total of 118 ADRs reported . The overall incidence of serious ADRs in the hospitalized patients was 4.7 % . According to the MedDRA classification , the most frequent ADRs affected the gastrointestinal system , followed by metabolic and vascular systems . The drugs most frequently involved were cardiovascular agents , anticoagulants and NSAIDs . Drug interactions were responsible for 25.9 % of ADRs . According to the selected preventability scale , 40.18 % ADRs were classified as ' potentially preventable ' and 9.82 % ' definitely preventable ' . Most of the ADRs were ' type A ' reactions and as such could have been avoided simply by adjusting the doses or by avoiding drug interactions . CONCLUSIONS Serious ADRs in hospitalized patients are common and often preventable . Preventing strategies should target drug prescription . Adequate training regarding pharmacology and optimization of drug therapy might help reduce ADRs ' morbidity and mortality OBJECTIVE Computerized medical decision support tools have been shown to improve the quality of care and have been cited by the Institute of Medicine as one method to reduce pharmaceutical errors . We evaluated the impact of an antiinfective decision support tool in a pediatric intensive care unit ( PICU ) . METHODS We enhanced an existing adult antiinfective management tool by adding and changing medical logic to make it appropriate for pediatric patients . Process and outcomes measures were monitored prospect ively during a 6-month control and a 6-month intervention period . M and atory use of the decision support tool was initiated for all antiinfective orders in a 26-bed PICU during the intervention period . Clinician opinions of the decision support tool were surveyed via question naire . RESULTS The rate of pharmacy interventions for erroneous drug doses declined by 59 % . The rate of anti-infective subtherapeutic patient days decreased by 36 % , and the rate of excessive-dose days declined by 28 % . The number of orders placed per antiinfective course decreased 11.5 % , and the robust estimate of the antiinfective costs per patient decreased 9 % . The type of anti-infectives ordered and the number of antiinfective doses per patient remained similar , as did the rates of adverse drug events and antibiotic-bacterial susceptibility mismatches . The surveyed clinicians reported that use of the program improved their antiinfective agent choices as well as their awareness of impairments in renal function and reduced the likelihood of adverse drug events . CONCLUSIONS Use of the pediatric antiinfective decision support tool in a PICU was considered beneficial to patient care by the clinicians and reduced the rates of erroneous drug orders , improved therapeutic dosage targets , and was associated with a decreased robust estimate of antiinfective costs per patient . antiinfective agents , decision support systems , drug therapy , medication errors , child , infant BACKGROUND About 6.5 % of admissions to hospital are related to an adverse drug reaction ( ADR ) . There are no recent large studies , which explore the burden of ADRs on hospital in- patients . The aim of this pilot study was to assess the feasibility of , and establish the methodology for , conducting a large prospect i ve study to fully assess the impact of ADRs on in- patients and the National Health Service ( NHS ) . METHODS Patients admitted to five wards in a university hospital over a 2-week period were assessed for ADRs through a daily ward visit by a pharmacist . Suspected ADRs were analysed for causality , severity and avoidability using appropriate scales . RESULTS Twenty-four of 125 patients ( 19.2 % , 95 % CI 12 - 26 % ) were categorized as having suffered one or more ADRs . A total of 27 ADRs were identified . Patients with ADRs spent longer in hospital than those without ADRs . Causality assessment showed that 17 ( 63 % ) ADRs were possibly drug-related , whereas 10 ( 37 % ) were classified as probably or definitely related to the drug . Almost two-thirds of reactions were potentially avoidable . Intervention was required in all ADRs and reactions indirectly contributed to the death of two patients . CONCLUSIONS Almost one-fifth of patients suffered an ADR as an inpatient . Methodology tested using this pilot will enable the design of a larger study , involving over 3000 patients , which will allow the ADR burden and vulnerable patient groups , to be more accurately characterized . This study will aid the development of interventions to reduce the impact of ADRs in hospital in- patients Background : There is widespread interest in improving medication safety , particularly in the hospital setting . Numerous suggestions have been made as to how this should be done , but there is a paucity of data demonstrating the effectiveness of any of the interventions that have been proposed . Objectives : To assess the impact of a wide ranging , community hospital based patient safety program on patient harm as measured by the rate of adverse drug events . Design : An audit of discharged hospital patients was conducted from January 2001 to December 2003 . Baseline data were collected for the first 6 months and multiple drug protocol s and other interventions were instituted on the nursing units and in the pharmacy department over the subsequent 9 months ( transition period ) . These interventions were largely based on information about medication risks acquired from internal medication event reporting . Each month of the study adverse drug events ( ADE ) were sought from a r and om sample of inpatient charts . A trigger tool was used to detect clues to ADEs , the presence of which was confirmed or excluded by detailed manual chart review . The severity of these events was categorized using the classification system of the National Coordinating Council for Medication Error and Reporting and Prevention . Main outcome measures and results : Median ADEs per 1000 doses of medication dispensed declined significantly from 2.04 to 0.65 ( p<0.001 ) . Median ADEs per 100 patient days declined significantly from 5.07 to 1.30 ( p<0.001 ) . The proportion of in patients with one or more ADE in the baseline period was 31 % and declined threefold ( p<0.001 ) . The severity of reported medication events also declined . The number of ADEs associated conclusively with patient harm was 1.67 per total doses delivered in the baseline period and declined eightfold ( p<0.001 ) . Conclusion : The implementation of a carefully planned series of low cost interventions focused on high risk medications , driven by information largely from internal event reporting , and design ed to improve a hospital ’s medication safety leads to a significant decrease in patient harm The number of published systematic review s of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions . Systematic review s are subject to a range of biases and increasingly include non-r and omised studies of interventions . It is important that users can distinguish high quality review s. Many instruments have been design ed to evaluate different aspects of review s , but there are few comprehensive critical appraisal instruments . AMSTAR was developed to evaluate systematic review s of r and omised trials . In this paper , we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic review s that include r and omised or non-r and omised studies of healthcare interventions , or both . With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic review s , including those based on non-r and omised studies of healthcare interventions ABSTRACT BACKGROUND The epidemiology of adverse drug events ( ADEs ) and medication errors has received little evaluation outside the U.S. and Europe , and extrapolating from these data might not be valid , especially regarding selecting and prioritizing solutions . OBJECTIVE To assess the incidence and preventability of ADEs and medication errors in Japan . DESIGN The Japan Adverse Drug Events ( JADE ) study was a prospect i ve cohort study . PATIENTS A cohort of 3,459 adults admitted to a stratified r and om sample of seven medical and eight surgical wards and three intensive care units in three tertiary care hospitals over 6 months . MAIN MEASURES We measured ADE and medication error rates from daily review s of charts , laboratories , incident reports , and prescription queries by on-site review ers ; presence of a signal was considered an incident . Two independent physicians review ed incidents to determine whether they were ADEs or medication errors and to assess severity and preventability . KEY RESULTS We identified 1,010 ADEs and 514 medication errors ( incidence : 17.0 and 8.7 per 1,000 patient-days , respectively ) during the study period . Among ADEs , 1.6 % , 4.9 % and 33 % were fatal , life-threatening and serious , respectively . Among ADEs , 14 % were preventable . The rate per admission was 29 per 100 admissions , higher than in U.S. studies because associated with of the long length of hospital stay in Japan ( mean , 17 days ) . CONCLUSIONS The epidemiology and nature of ADEs and medication errors in Japan were similar to other countries , although more frequent per admission . Solutions that worked in these countries might thus improve medication safety in Japan , as could shortening hospital length of stay Introduction Medication errors in the intensive care unit ( ICU ) are frequent and lead to attributable patient morbidity and mortality , increased length of ICU stay and substantial extra costs . We investigated if the introduction of a computerized ICU system ( Centricity Critical Care Clinisoft , GE Healthcare ) reduced the incidence and severity of  medication prescription errors  (  MPEs  ) . Methods A prospect i ve trial was conducted in a  paper-based unit ( PB-U ) versus a computerized unit ( C-U ) in a 22-bed ICU of a tertiary university hospital . Every medication order and medication prescription error was vali date d by a clinical pharmacist . The registration of different classes of MPE was done according to the National Coordinating Council for Medication Error Reporting and Prevention guidelines . An independent panel evaluated the severity of MPEs . We identified three groups : minor MPEs ( no potential to cause harm ) ; intercepted MPEs ( potential to cause harm but intercepted on time ) ; and serious MPEs ( non-intercepted potential adverse drug events ( ADE ) or ADEs , being MPEs with potential to cause , or actually causing , patient harm ) . Results The C-U and the PB-U each contained 80 patient-days , and a total of 2,510 medication prescriptions were evaluated . The clinical pharmacist identified 375 MPEs . The incidence of MPEs was significantly lower in the C-U compared with the PB-U ( 44/1286 ( 3.4 % ) versus 331/1224 ( 27.0 % ) ; P < 0.001 ) . There were significantly less minor MPEs in the C-U than in the PB-U ( 9 versus 225 ; P < 0.001 ) . Intercepted MPEs were also lower in the C-U ( 12 versus 46 ; P < 0.001 ) , as well as the non-intercepted potential ADEs ( 21 versus 48 ; P < 0.001 ) . There was also a reduction of ADEs ( 2 in the C-U versus 12 in the PB-U ; P < 0.01 ) . No fatal errors occurred . The most frequent drug classes involved were cardiovascular medication and antibiotics 
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DISCUSSION The method of event detection appeared to significantly influence PADR incidence , with prospect i ve methods having the highest reported PADR rate .
High method ological and statistical heterogeneity across primary studies evaluating adverse drug events reduces the validity of the overall PADR incidence derived from the meta-analyses of the pooled data .