***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 STUDY OBJECTIVE Our objectives are to describe the outcomes of patients presenting to the emergency department ( ED ) because of an adverse drug event and to compare them with outcomes of patients presenting for other reasons . METHODS This prospect i ve observational study was conducted at Vancouver General Hospital , a 955-bed tertiary care hospital . We prospect ively enrolled adults presenting to the ED between March and June 2006 , using a systematic sampling algorithm .  Pharmacists and physicians independently evaluated patients for adverse drug events . An independent committee review ed and adjudicated cases in which assessment s were discordant or uncertain . Data from the index visit were linked to vital statistics , administrative health services utilization , and cost of care data . RESULTS Of 1,000 patients , 122 ( 12.2 % ; 95 % confidence interval [ CI ] 10.3 % to 14.4 % ) presented to the ED because of an adverse drug event . Of these , 48 presented because of an adverse drug reaction ( one type of adverse drug event defined as an unintended response that occurred despite use of an appropriate drug dosage ) . We found no difference in mortality among patients presenting with and without adverse drug reactions ( 14.6 % versus 5.9 % ; hazard ratio 1.57 ; 95 % CI 0.70 to 3.52 ) . After adjustment , patients with adverse drug events had a higher risk of spending additional days in the hospital per month ( 6.3 % versus 3.4 % ; odds ratio 1.52 ; 95 % CI 1.43 to 1.62 ) and higher rate of outpatient health care encounters ( 1.73 versus 1.22 ; rate ratio 1.20 ; 95 % CI 1.03 to 1.40 ) . The adjusted median monthly cost of care was 1.90 times higher ( Can $ 325 versus $ 96 ; 95 % CI 1.18 to 3.08 ) . CONCLUSION ED patients presenting with an adverse drug event incurred greater health services utilization and costs during a 6-month follow-up period compared with patients presenting for other reasons Summary Background Medication errors are common in primary care and are associated with considerable risk of patient harm . We tested whether a pharmacist-led , information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to hazardous prescribing and inadequate blood-test monitoring of medicines 6 months after the intervention . Methods In this pragmatic , cluster r and omised trial general practice s in the UK were stratified by research site and list size , and r and omly assigned by a web-based r and omisation service in block sizes of two or four to one of two groups . The practice s were allocated to either computer-generated simple feedback for at-risk patients ( control ) or a pharmacist-led information technology intervention ( PINCER ) , composed of feedback , educational outreach , and dedicated support . The allocation was masked to general practice s , patients , pharmacists , research ers , and statisticians . Primary outcomes were the proportions of patients at 6 months after the intervention who had had any of three clinical ly important errors : non-selective non-steroidal anti-inflammatory drugs ( NSAIDs ) prescribed to those with a history of peptic ulcer without co-prescription of a proton-pump inhibitor ; β blockers prescribed to those with a history of asthma ; long-term prescription of angiotensin converting enzyme ( ACE ) inhibitor or loop diuretics to those 75 years or older without assessment of urea and electrolytes in the preceding 15 months . The cost per error avoided was estimated by incremental cost-effectiveness analysis . This study is registered with Controlled-Trials.com , number IS RCT N21785299 . Findings 72 general practice s with a combined list size of 480 942 patients were r and omised . At 6 months ' follow-up , patients in the PINCER group were significantly less likely to have been prescribed a non-selective NSAID if they had a history of peptic ulcer without gastroprotection ( OR 0·58 , 95 % CI 0·38–0·89 ) ; a β blocker if they had asthma ( 0·73 , 0·58–0·91 ) ; or an ACE inhibitor or loop diuretic without appropriate monitoring ( 0·51 , 0·34–0·78 ) . PINCER has a 95 % probability of being cost effective if the decision-maker 's ceiling willingness to pay reaches £ 75 per error avoided at 6 months . Interpretation The PINCER intervention is an effective method for reducing a range of medication errors in general practice s with computerised clinical records . Funding Patient Safety Research Portfolio , Department of Health , Engl and Background Potentially inappropriate prescribing ( PIP ) is common in older people in primary care and can result in increased morbidity , adverse drug events and hospitalisations . We previously demonstrated the success of a multifaceted intervention in decreasing PIP in primary care in a cluster r and omised controlled trial ( RCT ) . Objective We sought to determine whether the improvement in PIP in the short term was sustained at 1-year follow-up . Methods A cluster RCT was conducted with 21 GP practice s and 196 patients ( aged ≥70 ) with PIP in Irish primary care . Intervention participants received a complex multifaceted intervention incorporating academic detailing , medicine review with web-based pharmaceutical treatment algorithms that provide recommended alternative treatment options , and tailored patient information leaflets . Control practice s delivered usual care and received simple , patient-level PIP feedback . Primary outcomes were the proportion of patients with PIP and the mean number of potentially inappropriate prescriptions at 1-year follow-up . Intention-to-treat analysis using r and om effects regression was used . Results All 21 GP practice s and 186 ( 95 % ) patients were followed up . We found that at 1-year follow-up , the significant reduction in the odds of PIP exposure achieved during the intervention was sustained after its discontinuation ( adjusted OR 0.28 , 95 % CI 0.11 to 0.76 , P = 0.01 ) . Intervention participants had significantly lower odds of having a potentially inappropriate proton pump inhibitor compared to controls ( adjusted OR 0.40 , 95 % CI 0.17 to 0.94 , P = 0.04 ) . Conclusion The significant reduction in the odds of PIP achieved during the intervention was sustained after its discontinuation . These results indicate that improvements in prescribing quality can be maintained over time . Trial registration Current controlled trials IS RCT N41694007 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 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 OBJECTIVES To assess the effect of a Screening Tool of Older Persons potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment ( STOPP/START ) medication intervention on clinical and economic outcomes . DESIGN Parallel-group r and omized trial . SETTING Chronic care geriatric facility . PARTICIPANTS Residents aged 65 and older prescribed with at least one medication ( N = 359 ) were r and omized to receive usual pharmaceutical care or undergo medication intervention . INTERVENTION Screening medications with STOPP/START criteria followed up with recommendations to the chief physician . MEASUREMENTS The outcome measures assessed at the initiation of the intervention and 1 year later were number of hospitalizations and falls , Functional Independence Measure ( FIM ) , quality of life ( measured using the Medical Outcomes Study 12-item Short-Form Health Survey ) , and costs of medications . RESULTS The average number of drugs prescribed was significantly lower in the intervention than in the control group after 1 year ( P < .001 ) . The average drug costs in the intervention group decreased by 103 shekels ( US$ 29 ) per participant per month ( P < .001 ) . The average number of falls in the intervention group dropped significantly ( P = .006 ) . Rates of hospitalization , FIM scores , and quality of life measurements were similar for both groups . CONCLUSION Implementation of STOPP/START criteria reduced the number of medications , falls , and costs in a geriatric facility . Their incorporation in those and similar setting s is recommended OBJECTIVES The objectives of this study were ( 1 ) to investigate the effect of  nurse training  on the use of potentially harmful medications ; and ( 2 ) to explore the effect of  nurse training on residents ' health-related quality of life ( HRQoL ) , health service utilization , and mortality . DESIGN A r and omized controlled trial . SETTING AND PARTICIPANTS In total , 227 residents in 20 wards of assisted living facilities in Helsinki were recruited . The 20 w 
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Meta- analysis found no statistically significant benefit from any interventions on hospitalisation , ED visits , mortality , QoL or mental health and physical function .
Conclusions No significant benefit was gained from any of the interventions in terms of the outcomes considered .