You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Costs of medical injuries in Utah and Colorado.
Abstract 1:
Patient injuries are thought to have a substantial financial impact on the health care system , but recent studies have been limited to estimating the costs of adverse drug events in teaching hospitals . This analysis estimated the costs of all types of patient injuries from a representative sample of hospitals in Utah and Colorado . We detected 459 adverse events ( of which 265 were preventable ) by review ing the medical records of 14,732 r and omly selected 1992 discharges from 28 hospitals . The total costs ( all results are discounted 1996 dollars ) were $ 661,889,000 for adverse events , and $ 308,382,000 for preventable adverse events . Health care costs totaled $ 348,081,000 for all adverse events and $ 159,245,000 for the preventable adverse events . Fifty-seven percent of the adverse event health care costs , and 46 % of the preventable adverse event costs were attributed to outpatient medical care . Surgical complications , adverse drug events , and delayed or incorrect diagnoses and therapies were the most expensive types of adverse events . The costs of adverse events were similar to the national costs of caring for people with HIV/AIDS , and totaled 4.8 % of per capita health care expenditures in these states


Title 2:
The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada
Abstract 2:
Background : Research into adverse events ( AEs ) has highlighted the need to improve patient safety . AEs are unintended injuries or complications result ing in death , disability or prolonged hospital stay that arise from health care management . We estimated the incidence of AEs among patients in Canadian acute care hospitals . Methods : We r and omly selected 1 teaching , 1 large community and 2 small community hospitals in each of 5 provinces ( British Columbia , Alberta , Ontario , Quebec and Nova Scotia ) and review ed a r and om sample of charts for nonpsychiatric , nonobstetric adult patients in each hospital for the fiscal year 2000 .  Trained review ers screened all eligible charts , and physicians review ed the positively screened charts to identify AEs and determine their preventability . Results : At least 1 screening criterion was identified in 1527 ( 40.8 % ) of 3745 charts . The physician review ers identified AEs in 255 of the charts . After adjustment for the sampling strategy , the AE rate was 7.5 per 100 hospital admissions ( 95 % confidence interval [ CI ] 5.7– 9.3 ) . Among the patients with AEs , events judged to be preventable occurred in 36.9 % ( 95 % CI 32.0%–41.8 % ) and death in 20.8 % ( 95 % CI 7.8%–33.8 % ) . Physician review ers estimated that 1521 additional hospital days were associated with AEs . Although men and women experienced equal rates of AEs , patients who had AEs were significantly older than those who did not ( mean age [ and st and ard deviation ] 64.9 [ 16.7 ] v. 62.0 [ 18.4 ] years ; p = 0.016 ) . Interpretation : The overall incidence rate of AEs of 7.5 % in our study suggests that , of the almost 2.5 million annual hospital admissions in Canada similar to the type studied , about 185 000 are associated with an AE and close to 70 000 of these are potentially preventable


Title 3:
Improving ambulatory prescribing safety with a handheld decision support system: a randomized controlled trial.
Abstract 3:
OBJECTIVE To evaluate the effectiveness of a personal digital assistant (PDA)-based clinical decision support system ( CDSS ) on nonsteroidal anti-inflammatory drug ( NSAID ) prescribing safety in the outpatient setting . DESIGN The design was a r and omized , controlled trial conducted in a university-based resident clinic . Internal medicine residents received a PDA-based CDSS suite . For intervention residents , the CDSS included a prediction rule for NSAID-related gastrointestinal risk assessment and treatment recommendations . Unannounced st and ardized patients ( SPs ) trained to portray musculoskeletal symptoms presented to study physicians . Safety outcomes were assessed from the prescriptions given to the SPs . Each prescription was review ed by a committee of clinicians blinded to participant , intervention group assignment , and baseline or follow-up status . MEASUREMENTS Prescriptions were judged as safe or unsafe . The main outcome measure was the differential change in unsafe prescribing of NSAIDs for the intervention versus the control group . RESULTS At baseline , the mean proportion of cases per physician with unsafe prescriptions for the two groups was similar ( 0.27 vs. 0.29 , p > 0.05 ) . Controlling for baseline performance , intervention participants prescribed more safely than controls after receiving the CDSS ( 0.23 vs. 0.45 [ F = 4.24 , p < 0.05 ] ) . With the CDSS , intervention participants documented more complete assessment of patient gastrointestinal risk from NSAIDs . CONCLUSION PARTICIPANTS provided with a PDA-based CDSS for NSAID prescribing made fewer unsafe treatment decisions than participants without the CDSS


Title 4:
[Development and effectiveness of a drug dosage calculation training program using cognitive loading theory based on smartphone application].
Abstract 4:
PURPOSE This study was done to develop and evaluate a drug dosage calculation training program using cognitive loading theory based on a smartphone application .  Calculation ability , dosage calculation related self-efficacy and anxiety were measured . METHODS A nonequivalent control group design was used . Smartphone application and a h and out for self- study were developed and administered to the experimental group and only a h and out was provided for control group . Intervention period was 4 weeks . Data were analyzed using descriptive analysis , χ²-test , t-test , and ANCOVA with the SPSS 18.0 . RESULTS The experimental group showed more ' self-efficacy for drug dosage calculation ' than the control group ( t=3.82 , p<.001 ) . Experimental group students had higher ability to perform drug dosage calculations than control group students ( t=3.98 , p<.001 ) , with regard to ' metric conversion ' ( t=2.25 , p=.027 ) , ' table dosage calculation ' ( t=2.20 , p=.031 ) and ' drop rate calculation ' ( t=4.60 , p<.001 ) . There was no difference in improvement in ' anxiety for drug dosage calculation ' . Mean satisfaction score for the program was 86.1 . CONCLUSION These results indicate that this drug dosage calculation training program using smartphone application is effective in improving dosage calculation related self-efficacy and calculation ability . Further study should be done to develop additional interventions for reducing anxiety


Title 5:
Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group.
Abstract 5:
OBJECTIVES To assess incidence and preventability of adverse drug events ( ADEs ) and potential ADEs . To analyze preventable events to develop prevention strategies . DESIGN Prospect i ve cohort study . PARTICIPANTS All 4031 adult admissions to a stratified r and om sample of 11 medical and surgical units in two tertiary care hospitals over a 6-month period . Units included two medical and three surgical intensive care units and four medical and two surgical general care units . MAIN OUTCOME MEASURES Adverse drug events and potential ADEs . METHODS Incidents were detected by stimulated self-report by nurses and pharmacists and by daily review of all charts by nurse investigators . Incidents were subsequently classified by two independent review ers as to whether they represented ADEs or potential ADEs and as to severity and preventability . RESULTS Over 6 months , 247 ADEs and 194 potential ADEs were identified . Extrapolated event rates were 6.5 ADEs and 5.5 potential ADEs per 100 nonobstetrical admissions , for mean numbers per hospital per year of approximately 1900 ADEs and 1600 potential ADEs . Of all ADEs , 1 % were fatal ( none preventable ) , 12 % life-threatening , 30 % serious , and 57 % significant . Twenty-eight percent were judged preventable . Of the life-threatening and serious ADEs , 42 % were preventable , compared with 18 % of significant ADEs . Errors result ing in preventable ADEs occurred most often at the stages of ordering ( 56 % ) and administration ( 34 % ) ; transcription ( 6 % ) and dispensing errors ( 4 % ) were less common . Errors were much more likely to be intercepted if the error occurred earlier in the process : 48 % at the ordering stage vs 0 % at the administration stage . CONCLUSION Adverse drug events were common and often preventable ; serious ADEs were more likely to be preventable . Most result ed from errors at the ordering stage , but many also occurred at the administration stage . Prevention strategies should target both stages of the drug delivery process
REVIEW QUESTION / OBJECTIVE The objective of this review is to synthesize the best available evidence on the effects of healthcare providers using mobile devices at any stage of medication provision on medication errors in acute care setting s. Provision of medication includes prescribing , dispensing or administrating medicine in the acute care setting