***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 In patients with chronic kidney disease ( CKD ) , anemia is associated with left ventricular hypertrophy and adverse cardiovascular and clinical outcomes . Moreover , anemia is associated with a reduction in quality of life , particularly when the hemoglobin level drops below 100 g/l . 1 Thus , the goal of treating anemia in iron-replete patients with erythropoietic-stimulating agents ( ESAs ) is to reduce the likelihood of cardiovascular events , improve patients ’ survival , and improve patients ’ quality of life while minimizing any deleterious effects of the drug . Given that ESAs increase blood pressure and have other potential side effects , it is also important to assess whether the quantity of the ESA used might contribute to adverse events such as more rapid deterioration of kidney function , earlier requirement for dialysis , and vascular access failure . It is acknowledged that , if left untreated , patients with severe anemia may require blood transfusions , which have associated risks and costs , and possible implication s for patients awaiting a kidney transplant . In light of this , in most developed countries , the question for CKD patients with significant anemia has often not been whether to use ESAs , but when to use them and what target hemoglobin level to aim for . 2 The earliest anemia correction studies in nondialysischronic kidney disease ( ND-CKD ) and hemodialysis-chronic kidney disease ( HD-CKD ) patients compared the use of erythropoietin a with placebo . 3–5 Most early studies were not design ed and powered to examine clinical outcomes other than quality of life , and no differences were apparent in such other outcomes . Several of the studies showed improvements in quality of life compared with placebo . 3–5 Subsequent r and omized control trials ( RCTs ) have tended to examine the impact of using ESAs to achieve different target hemoglobin level ranges on surrogate endpoints , such as left ventricular ( LV ) mass , where patients with the lower hemoglobin target would be less likely to require the use of an ESA or would require lower doses to maintain the prespecified lower target hemoglobin . Two RCTs 6,7 in HDCKD patients compared with the use of ESAs to achieve intermediate hemoglobin and high hemoglobin targets . Although both studies showed no difference in progression of LV mass , the higher target hemoglobin led to improved quality of life in some of the domains , but the size of BACKGROUND Although recent consensus guidelines proposed more aggressive vancomycin troughs of > 10 or 15 - 20 mg/L for complicated Staphylococcus aureus infections , dosing information to achieve these targets in patients undergoing hemodialysis ( HD ) is scarce . METHODS We used Monte Carlo simulation ( MCS ) methods with a previously published population -pharmacokinetic model and relevant patient demographics to evaluate and revise our existing vancomycin dosing protocol ( 1000-mg load followed by 500-mg maintenance dose , with doses infused during the last hour of dialysis ) . A new protocol ( 1000-mg load followed by 500-mg maintenance dose for patients < 70 kg , 1250-mg followed by 750-mg for those 70 - 100 kg , and 1500-mg followed by 1000-mg for those > 100 kg ) was developed and prospect ively vali date d to achieve therapeutic serum troughs in patients undergoing high-flux HD . RESULTS MCSs predicted that our existing protocol would be suboptimal in more than one-third of patients . Simulations predicted that the new vancomycin dosing protocol would achieve maintenance ( pre-HD ) troughs of 10 - 20 mg/L in 86.0 % of cases including 15 - 20 mg/L in 35.2 % . In prospect i ve validation , the observed postload trough ( pre-HD session 2 ) was 13.5 ± 3.4 mg/L with 76.9 % of levels ( 20 of 26 ) between 10 and 20 mg/L. The observed maintenance trough was 17.3 ± 4.0 mg/L with 65.5 % ( 19 of 29 ) between 10 and 20 mg/L and 89.7 % ( 26 of 29 ) within 10 % of the upper limit ( ie , 10 - 22 mg/L ) . CONCLUSIONS In this study , a practical vancomycin dosing protocol for patients undergoing HD was developed and prospect ively vali date d to achieve therapeutic serum concentrations in the clinical setting 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 Background : Medical in patients are at risk for suboptimal health outcomes from adverse drug events and under-use of evidence -based therapies . We sought to determine whether collaborative care including a team-based clinical pharmacist improves the quality of prescribed drug therapy and reduces hospital readmission . Methods : Multicenter , quasi-r and omized , controlled clinical trial . Consecutive patients admitted to 2 internal and 2 family medicine teams in 3 teaching hospitals between January 30 , 2006 and February 2 , 2007 were included . Team care patients received proactive clinical pharmacist services ( medication history , patient-care round participation , resolution of drug-related issues , and discharge counseling ) . Usual care patients received traditional reactive clinical pharmacist services . The primary outcome was the overall quality score measured retrospectively by a blinded chart review er using 20 indicators targeting 5 conditions . Secondary outcomes included 3- and 6-month readmission . Results : A total of 452 patients ( 220 team care , 231 usual care , mean age : 74 years , 46 % male ) met eligibility criteria . Team care patients were more likely than usual care patients to receive care specified by the indicators overall ( 56.4 % vs. 45.3 % ; adjusted mean difference : 10.4 % ; 95 % confidence interval [ CI ] : 4.9 % , 15.7 % ) and for each targeted disease state except for heart failure . Team care patients experienced fewer readmissions at 3 months ( 36.2 % vs. 45.5 % ; adjusted OR : 0.63 ; 95 % CI : 0.42 , 0.94 ) but not at 6 months ( 50.7 % vs. 56.3 % ; adjusted OR ; 0.78 ; 95 % CI : 0.53 , 1.15 ) . Conclusions : In patients admitted to internal and family medicine teams , team-based care including a clinical pharmacist , improved the overall quality of medication use and reduced rates of readmission BACKGROUND Explicit criteria for judging medication safety and use issues in patients with chronic kidney disease ( CKD ) are lacking . STUDY DESIGN Quality improvement report . SETTING & PARTICIPANTS Nephrologists ( n = 4 ) , primary care physicians ( n = 2 ) , hospital pharmacists with expertise in nephrology ( n = 4 ) , and community pharmacists ( n = 2 ) . The PAIR ( Pharmacotherapy Assessment in Chronic Renal Disease ) criteria were applied retrospectively to 90 patients with CKD in a r and omized study . QUALITY IMPROVEMENT PLAN Development of an explicit set of criteria to enable rapid and systematic detection of drug-related problems ( DRPs ) . Using a R AND method , experts judged the clinical significance of DRPs and the appropriateness of a community pharmacist intervention . The PAIR criteria include 50 DRPs grouped into 6 categories . OUTCOMES DRPs detected using the PAIR criteria compared with implicit clinical judgment by nephrology pharmacists . MEASUREMENTS Prevalence of DRPs and reliability , validity , and responsiveness of the PAIR criteria . RESULTS A mean of 2.5 DRPs/patient ( 95 % CI , 2.0 - 3.1 ) was identified based on the PAIR criteria compared with 3.9 DRPs/patient ( 95 % CI , 3.4 - 4.5 ) based on clinical judgment of nephrology pharmacists . Inter-rater reliability coefficients ( κ ) by PAIR category varied from 0.80 - 1.00 , with an intraclass correlation coefficient ( ICC ) of 0.93 ( 95 % CI , 0.89 - 0.95 ) for total DRPs per patient . Test-retest reliability coefficients by category varied from 0.74 - 1.00 , with an ICC of 0.91 ( 95 % CI , 0.82 - 0.96 ) for total DRPs per patient . During the study , the mean number of DRPs per patient did not change significantly when assessed using the PAIR criteria and clinical judgment . LIMITATION The prevalence of PAIR DRPs may be underestimated due to the retrospective nature of the validation . CONCLUSION The prevalence of DRPs requiring the intervention of community pharmacists is high in patients with CKD . The PAIR criteria are reliable , but their responsiveness remains to be shown 
    Output:
    
5 A systematic review of 8 controlled trials involving patients with CKD showed that clinical pharmacist interventions improved management of anemia , blood pressure , and lipids , as well as calcium and phosphate parameters .
8 In this patient population , clinical pharmacists ’ interventions reduced hospital admissions , length of hospital stay , and incidence of end-stage renal disease or death .
