***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: OBJECTIVE : To describe the incidence of adverse drug events ( ADEs ) , preventable ADEs , and ameliorable ADEs occurring after hospital discharge and their associated risk factors . DESIGN : Prospect i ve cohort study . SETTING : Urban academic health sciences center . PATIENTS : Consecutive patients discharged home from the general medical service . INTERVENTIONS : We determined posthospital outcomes approximately 24 days following discharge by performing a chart review and telephone interview . Using the telephone interview , we identified new or worsening symptoms , the patient ’s health system use , and re collection of processes of care . Posthospital outcomes were judged by 2 internists independently . RESULTS : Four hundred of 581 potentially eligible patients were evaluated . Of the 400 patients , 45 developed an ADE ( incidence , 11 % ; 95 % confidence interval [ CI ] , 8 % to 14 % ) . Of these , 27 % were preventable and 33 % were ameliorable . Injuries were significant in 32 patients , serious in 6 , and life threatening in 7 . Patients were less likely to experience an ADE if they recalled having side effects of prescribed medications explained ( OR , 0.4 ; 95 % CI , 0.2 to 0.8 ) . The risk of ADE per prescription was highest for corticosteroids , anticoagulants , antibiotics , analgesics , and cardiovascular medications . Risk increased with prescription number . Failure to monitor was an especially common cause of preventable and ameliorable ADEs . CONCLUSION : Following discharge , ADEs were common and many were preventable or ameliorable . Medication side effects should be discussed , and interventions should include better monitoring and target patients receiving specific drug classes or multiple medications Background : Hospital discharge is an interlace of care when patients are at a high risk of medication discrepancies as they transition from hospital to home . These discrepancies are important , as they may contribute to drug-related problems , medication errors , and adverse drug events . Objective : To Identify , characterize , and assess the clinical impact of unintentional medication discrepancies at hospital discharge . Methods : All consecutive general internal medicine patients admitted for at least 72 hours to a tertiary care teaching hospital were prospect ively assessed . Patients were excluded if they were discharged with verbal prescriptions ; died during hospitalization ; or transferred from or to a nursing home , another institution , or another unit within the same hospital . The primary endpoint was to determine the number of patients with at least one unintended medication discrepancy on hospital discharge . Medication discrepancies were assessed through comparison of a best possible medication discharge list with the actual discharge prescriptions . Secondary objectives were to characterize and assess the potential clinical impact of the unintentional discrepancies . Results : From March 14,2006 , to June 2,2006,430 patients were screened for eligibility ; 150 patients were included in the study . Overall , 106 ( 70.7 % ) patients had at least one actual or potential unintentional discrepancy . Sixty-two patients ( 41.3 % ) had at least one actual unintentional medication discrepancy al hospital discharge and 83 patients ( 55.3 % ) had at least one potential unintentional discrepancy . The most common unintentional discrepancies were an incomplete prescription requiring clarification , which could result in a patient delay in obtaining medications ( 49.5 % ) , and the omission of medications ( 22.9 % ) . Of the 105 unintentional discrepancies , 31 ( 29.5 % ) had the potential to cause possible or probable patient discomfort and /or clinical deterioration . Conclusions : Medication discrepancies occur commonly on hospital discharge . Underst and ing the type and frequency of discrepancies can help clinicians better underst and ways to prevent them . Structured medication reconciliation may help to prevent discharge medication discrepancies 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 BACKGROUND Prior studies suggest that unintended medication discrepancies that represent errors are common at the time of hospital admission . These errors are particularly worthy of attention because they are not likely to be detected by computerized physician order entry systems . METHODS We prospect ively studied patients reporting the use of at least 4 regular prescription medications who were admitted to general internal medicine clinical teaching units . The primary outcome was unintended discrepancies ( errors ) between the physicians ' admission medication orders and a comprehensive medication history obtained through interview . We also evaluated the potential seriousness of these discrepancies . All discrepancies were review ed with the medical team to determine if they were intentional or unintentional . All unintended discrepancies were rated for their potential to cause patient harm . RESULTS After screening 523 admissions , 151 patients were enrolled based on the inclusion criteria . Eighty-one patients ( 53.6 % ; 95 % confidence interval , 45.7%-61.6 % ) had at least 1 unintended discrepancy . The most common error ( 46.4 % ) was omission of a regularly used medication . Most ( 61.4 % ) of the discrepancies were judged to have no potential to cause serious harm . However , 38.6 % of the discrepancies had the potential to cause moderate to severe discomfort or clinical deterioration . CONCLUSIONS Medication errors at the time of hospital admission are common , and some have the potential to cause harm . Better methods of ensuring an accurate medication history at the time of hospital admission 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 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 Objective The objective of this study was to investigate whether a Medication Report also can reduce the number of patients with clinical outcomes due to medication errors . Method A prospect i ve intervention study with retrospective controls on patients at three departments at Lund University Hospital , Sweden that where transferred to primary care . The intervention group , where  patients received a Medication Report at discharge , was compared with a  control group with patients of the same age , who were not given a Medication Report when discharged from the same ward one year earlier . For patients with at least one medication error all contacts with hospital or primary care within 3 months after discharge were identified . For each contact it was evaluated whether this was caused by the medication error . We also compared medication errors that have been evaluated as high or moderate clinical risk with medication errors without clinical risk . Main outcome measures Need for medical care in hospital or primary care within three months after discharge from hospital . Medical care is readmission to hospital as well as visits of study population to primary and out-patient secondary health care . Results The use of Medication Report reduced the need for medical care due to medication errors . Of the patients with Medication Report 11 out of 248 ( 4.4 % ) needed medical care because of medication errors compared with 16 out of 179 ( 8.9 % ) of patients without Medication Report ( p = 0.049 ) . The use of a Medication Report significantly reduced the risk of any consequences due to medication errors , p = 0.0052 . These consequences included probable and possible care due to medication error as well as administrative procedures ( corrections ) made by physicians in hospital or primary care . Conclusions The Medication Report seems to be an effective tool to decrease adverse clinical consequences when elderly patients are discharged from hospital care BACKGROUND Medication reconciliation at transitions in care is a national patient safety goal , but its effects on important patient outcomes require further evaluation . We sought to measure the impact of an information technology-based medication reconciliation intervention on medication discrepancies with potential for harm ( potential adverse drug events [ PADEs ] ) . METHODS We performed a controlled trial , r and omized by medical team , on general medical inpatient units at 2 academic hospitals from May to June 2006 . We enrolled 322 patients admitted to 14 medical teams , for whom a medication history could be obtained before discharge . The intervention was a computerized medication reconciliation tool and process re design involving physicians , nurses , and pharmacists . The main outcome was unintentional discrepancies between preadmission medications and admission or discharge medications that had potential for harm ( PADEs ) . RESULTS Among 160 control patients , there were 230 PADEs ( 1.44 per patient ) , while among 162 intervention patients there were 170 PADEs ( 
    Output:
    
Available evidence supports medication reconciliation interventions that heavily use pharmacy staff and focus on patients at high risk for adverse events .