Prospective prescription review system correlated with more rational PPI medication use, better clinical outcomes and reduced PPI costs: experience from a retrospective cohort study.

INTRODUCTION: Proton pump inhibitor (PPI) abuse poses an overwhelming threat to the allocation of medical resources and places a heavy burden on global medical expenses. In this study, we put forward our prospective prescription review system and evaluated the effects of this system on clinical outcomes, rational medication use and costs related to PPIs. METHODS: A retrospective cohort study was conducted in which the included patients were divided into a preintervention group (2019.10-2020.09) and a postintervention group (2020.10-2021.09). To reduce the bias of patients' baseline characteristics, the propensity score matching (PSM) method was employed. The primary endpoints were the incidence of stress ulcers (SUs), the improvement and cure rates of gastrointestinal haemorrhage, the defined daily dose (DDD), the drug utilization index (DUI) and the DDD/100 patient-days. The secondary endpoints included the types of unreasonable medication orders for PPIs, the PPI utilization rate and PPI costs. RESULTS: A total of 53,870 patients were included to evaluate the secondary endpoints, and 46,922 patients were paired by PSM and assessed to evaluate the primary endpoints. The number of PPIs used and PPI costs were significantly lower in the postintervention group than in the preintervention group (P < 0.001). The rationality evaluation results showed that the frequency of PPI use and the number of drug interactions were significantly higher in the preintervention group than in the postintervention group (P < 0.01). The proportion of patients taking oral PPIs was significantly increased in the postintervention group (29.30% vs. 34.56%, p < 0.01). For the utilization of PPIs both for prevention and treatment, the DUI and DDD/100 patient-days were substantially decreased in the postintervention group (P < 0.001 and P < 0.05, respectively). The incidence of SUs in the postintervention group was 44.95%, and that in the preintervention group was 51.93% (p < 0.05). CONCLUSION: The implementation of the prospective prescription review system on rational PPI use correlated with reduced PPI costs, more rational PPI medication use and better clinical outcomes, and this system is worthy of long-term implementation for further improvement of rational drug use.

Designing a Coupling Agent with Aliphatic Polyether Chain and Exploring Its Effect on Silica/Natural Rubber Nanocomposites under the Action of Non-Rubber Contents.

In order to prepare engineering tires with lower rolling resistance and better wet slip resistance in a more environmentally friendly way. In this study, a series of low volatile organic compound (VOC) Mx-Si69 coupling agents (x = 1, 2, 3, 4, 5, 6, which means the number of ethoxy group in bis-(γ-triethoxysilylpropyl)-tetrasulfide (Si69) substituted by the aliphatic polyether chain) were applied to silica/NR nanocomposites to prepare tire tread with excellent performance. Firstly, M1-Si69 was substantiated as the best choice of Mx-Si69 and Si69 to achieve comprehensive optima in the mechanical properties of silica/NR nanocomposites characterized by dynamic and static mechanical properties. Afterwards, the modification of silica with M1-Si69 induced by Non-Rubber Contents (NRCs) in silica/NR nanocomposites was revealed by comparing the filler network, micromorphology, and mechanical properties of isoprene rubber (IR) and NR nanocomposites. Furthermore, compared with Si69, the M1-Si69 coupling agent was found to conspicuously reduce the energy loss and improve the safety performance of engineering tires according to evaluations of the rolling resistance and dynamic thermomechanical properties of the silica/NR nanocomposites. Finally, the critical function of M1-Si69 in reducing ethanol (a kind of volatile organic compound (VOC)) emissions from the reaction of coupling agent and silica was disclosed by gas chromatography-mass spectrometry.

Infection and the evaluation of biomarkers in obstetrics and gynecology patients with infectious disease: a retrospective observational study from clinical pharmacists' consultation experience.

BACKGROUND: The use of empirical anti-infective medication calls for the identification of common pathogens and accurate infectious biomarkers. However, clinical pharmacists' anti-infective experience in the field of obstetrics and gynaecology is rare in the literature. This study aimed to retrospectively analyze the correlation between the anti-infective effectiveness after 7 days of antibiotic treatment and infectious biomarkers, according to clinical pharmacists' consultation cases of gynecological and obstetric infections. METHODS: In this retrospective study, clinical pharmacists' anti-infective consultation experiences applied by physicians from January 1, 2018, to December 31, 2020, were included. The exclusion criteria were as follows: (1) the patient died or left the hospital before undergoing an effectiveness evaluation after the consultation; (2) treatment was discontinued due to adverse reactions related to antibiotics; (3) the patient did not undergo an effectiveness evaluation within 3 or 7 days after application of the clinical pharmacist's treatment plan; and (4) the physician did not adopt the clinical pharmacist's suggestions. The registered information included patient characteristics, pathological bacteria, anti-infective medication and changes in infection indices before and after treatment. Statistical analysis of temperature, white blood cells (WBCs), C-reactive protein (CRP), procalcitonin (PCT) and WBCs in urine after 3 days and 7 days of anti-infective treatment, compared with before anti-infective treatment, was performed by the chi-square test. A t test was conducted to further study WBC count and CRP. A receiver operating characteristic curve verified the sensitivity and specificity of WBC count, CRP and PCT. RESULTS: A total of 265 cases were included. The CRP levels of patients 3 d and 7 d after antibiotic treatment were significantly lower than before antibiotic treatment (P < 0.05, P < 0.01), while the WBC count showed a downward trend after 3 days and a significant decrease after 7 days (P < 0.01). The areas under the curve (AUCs) for prognosis on the 7th day for WBC count, CRP and PCT were 0.90, 0.75 and 0.522, respectively. The AUC for WBC count combined with CRP was 0.90, which was higher than that for the biomarkers tested separately, especially compared to PCT. The most common gynecological infections were surgical site infection (SSI), urinary tract infection and fever of unknown origin, and the most common pathogens were E. coli and E. faecalis in Gram-negative and Gram-positive samples, respectively. Pharmacists' recommended treatment plans included carbapenems and ß-lactam antibiotics. CONCLUSIONS: Our dual-center study indicates that the combination of WBC count and CRP can improve diagnostic accuracy and treatment efficiency, and PCT alone is insensitive to gynecological infections, according to clinical pharmacists' experience.

Integrating Multidisciplinary Individualized Medication Recommendations Into the Traditional Pharmacists' Consultation Method: A Retrospective Study Using Propensity Score Matching Analysis.

Chinese clinical pharmacists consider improving the quantity and quality of consultations to be an important task in providing better pharmaceutical care. To achieve this goal, we developed a clinical pharmacist consultation method using multidisciplinary individualized medication recommendations (MIMRs) and studied the effects of its implementation. A retrospective study of 812 clinical pharmacist-led consultations was conducted. In the pre-intervention group, medication advice was given based on the purpose of the consultation. In the post-intervention group, a consultation method using MIMRs was implemented, in which clinical pharmacists with specialties in anticoagulation, gastroenterology, and nutrition were asked to give individualized medication recommendations. Outcomes, including the effectiveness rate of consultations (ERC) and acceptance rate of consultations (ARC), were compared between the two groups using propensity score matching method. Patterns and numbers of consultations and individualized medication recommendations were also compared. The results showed that the ERC in the post-intervention group compared with the ERC in the pre-intervention group was 83.3% vs 74.0%, respectively (P < .05). Significant difference was also shown between the two groups in ARC (98.4% vs 92.2%, P < .05). The total number of consultations increased, as did the number of general consultations, multidisciplinary/difficult consultations, anti-infection consultations, and non-anti-infection consultations specifically. As a result, we proposed that the implementation of MIMRs can improve the effects of treatment and increase the number of consultations by pharmacists, which is worthy of further promotion to better serve physicians and patients.

Emergency hospitalizations for adverse drug events in China: Clinical pharmacists' approach to assessment and categorization.

PURPOSE: Little is known about emergency hospitalizations owing to adverse drug events (ADEs) in Chinese populations. The aim of this study was to identify the types and characteristics of ADEs as well as estimate the length of hospital stay and ADE-related costs in a hospital emergency setting in China. METHODS: This prospective study was conducted in the emergency department of our hospital from April 1, 2017 to December 31, 2019. ADEs of patients admitted to the emergency department were collected by a clinical pharmacist during daily pharmacy rounds. RESULTS: Of 4020 cases admitted to the emergency department, 198 emergency ADE-related hospitalizations (4.93%) were noted, which were classified into certain (n = 0, 0%), probable (n = 122, 61.6%), and possible (n = 76, 38.4%). The ADE was serious in 93.9% of the 198 cases. Ten cases were fatal, and two cases were life-threatening. More than 80% of the emergency ADE-related hospitalization cases were of patients over 60 years. The pharmacological agents implicated in the hospitalizations were oral antiplatelet agents (20.7%), oral hypoglycemic agents (16.7%), insulin (11.1%), and antihypertensive agents (9.1%). The average length of ADE-related hospital stay was 10 (7.0-14.0) days. ADE-related costs ranged from $1684.68 to $4531.35 for each hospitalization. The length of ADE-related hospital stay and associated costs were statistically significant. Most ADEs (n = 146, 73.7%) were preventable. CONCLUSIONS: Most emergency ADE-related hospitalizations in older adults resulted from lack of medication monitoring or inappropriate medication. Improved management of medicines by clinical pharmacists has the potential to reduce ADE-related hospitalizations in older adults in China.

Extended harmonic mapping connects the equations in classical, statistical, fluid, quantum physics and general relativity.

One potential pathway to find an ultimate rule governing our universe is to hunt for a connection among the fundamental equations in physics. Recently, Ren et al. reported that the harmonic maps with potential introduced by Duan, named extended harmonic mapping (EHM), connect the equations of general relativity, chaos and quantum mechanics via a universal geodesic equation. The equation, expressed as Euler-Lagrange equations on the Riemannian manifold, was obtained from the principle of least action. Here, we further demonstrate that more than ten fundamental equations, including that  of classical mechanics, fluid physics, statistical physics, astrophysics, quantum physics and general relativity, can be connected by the same universal geodesic equation. The connection sketches a family tree of the physics equations, and their intrinsic connections reflect an alternative ultimate rule of our universe, i.e., the principle of least action on a Finsler manifold.

Using Epoxidized Solution Polymerized Styrene-Butadiene Rubbers (ESSBRs) as Coupling Agents to Modify Silica without Volatile Organic Compounds.

Rubber used in tire is usually strengthened by nanofiller, and the most popular nanofiller for tire tread rubber is nano silica, which can not only strengthen rubber but also lower the tire rolling resistance to reduce fuel consumption. However, silica particles are difficult to disperse in the rubber matrix because of the abundant silicon hydroxyl on their surface. Silane coupling agents are always used to modify silica and improve their dispersion, but a large number of volatile organic compounds (VOCs) are emitted during the manufacturing of the nanosilica/rubber composites because of the condensation reaction between silane coupling agents and silicon hydroxyl on the surface of silica. Those VOCs will do great harm to the environment and the workers' health. In this work, epoxidized solution polymerized styrene-butadiene rubbers (ESSBR) with different epoxy degrees were prepared and used as macromolecular coupling agents aimed at fully eliminating VOCs. Fourier transform infrared (FTIR) spectroscopy and nuclear magnetic resonance (NMR) analyses verified that the different ESSBRs were successfully synthesized from solution polymerized styrene-butadiene rubbers (SSBR). With the help of the reaction between epoxy groups and silicon hydroxyl without any VOC emission, nanosilica can be well dispersed in the rubber matrix when SSBR partially replaced by ESSBR which was proved by Payne effect and TEM analysis. Dynamic and static mechanical testing demonstrated that silica/ESSBR/SSBR/BR nanocomposites have better performance and no VOC emission compared with Bis-(γ-triethoxysilylpropyl)-disulfide (TESPD) modified silica/rubber nanocomposites. ESSBR is very hopeful to replace traditional coupling agent TESPD to get high properties silica/rubber nanocomposites with no VOCs emission.

LoTToR: An Algorithm for Missing-Wedge Correction of the Low-Tilt Tomographic 3D Reconstruction of a Single-Molecule Structure.

A single-molecule three-dimensional (3D) structure is essential for understanding the thermal vibrations and dynamics as well as the conformational changes during the chemical reaction of macromolecules. Individual-particle electron tomography (IPET) is an approach for obtaining a snap-shot 3D structure of an individual macromolecule particle by aligning the tilt series of electron tomographic (ET) images of a targeted particle through a focused iterative 3D reconstruction method. The method can reduce the influence on the 3D reconstruction from large-scale image distortion and deformation. Due to the mechanical tilt limitation, 3D reconstruction often contains missing-wedge artifacts, presented as elongation and an anisotropic resolution. Here, we report a post-processing method to correct the missing-wedge artifact. This low-tilt tomographic reconstruction (LoTToR) method contains a model-free iteration process under a set of constraints in real and reciprocal spaces. A proof of concept is conducted by using the LoTToR on a phantom, i.e., a simulated 3D reconstruction from a low-tilt series of images, including that within a tilt range of ±15°. The method is validated by using both negative-staining (NS) and cryo-electron tomography (cryo-ET) experimental data. A significantly reduced missing-wedge artifact verifies the capability of LoTToR, suggesting a new tool to support the future study of macromolecular dynamics, fluctuation and chemical activity from the viewpoint of single-molecule 3D structure determination.

Clinical pharmacist intervention reduces mortality in patients with acute myocardial infarction: a propensity score matched analysis.

BACKGROUND: Is it possible that the mortality rate from acute myocardial infarction (AMI) may decline after interventions by pharmacists? OBJECTIVE: To evaluate the impact of clinical pharmacist on the mortality of AMI. METHODS: Clinical pharmacists did not perform any interventions during phase 1 (pre-intervention), and consulted with physicians to address drug related problems (DRPs) during phase 2 (post-intervention). The main outcome was a decrease in mortality from AMI. The two phases were compared using propensity score matching (PSM). RESULTS: 1388 interventions were suggested by clinical pharmacists during phase 2, of which 1239 (89.2%) were accepted. Logistic regression analysis demonstrated that interventions of clinical pharmacists were significantly associated with a reduced mortality in patients with both ST segment elevation myocardial infarction (STEMI) (OR 0.449; 95% CI 0.296 to 0.680) and non-ST segment elevation myocardial infarction (NSTEMI) (OR 0.268; 95% CI 0.125 to 0.572). Using PSM analysis, mortality reduced from 6.8% to 4.3% in STEMI patients (P=0.0034) and from 3.2% to 0.7% in NSTEMI patients (P=0.0202) after the interventions. CONCLUSIONS: DRPs that caused or contributed to possible mortality were detected by clinical pharmacists in patients with AMI. Correcting these DRPs after pharmacists' interventions could result in a significant decrease in mortality.

Large plasticity in magnesium mediated by pyramidal dislocations.

Lightweight magnesium alloys are attractive as structural materials for improving energy efficiency in applications such as weight reduction of transportation vehicles. One major obstacle for widespread applications is the limited ductility of magnesium, which has been attributed to [Formula: see text] dislocations failing to accommodate plastic strain. We demonstrate, using in situ transmission electron microscope mechanical testing, that [Formula: see text] dislocations of various characters can accommodate considerable plasticity through gliding on pyramidal planes. We found that submicrometer-size magnesium samples exhibit high plasticity that is far greater than for their bulk counterparts. Small crystal size usually brings high stress, which in turn activates more [Formula: see text] dislocations in magnesium to accommodate plasticity, leading to both high strength and good plasticity.

Transport of a graphene nanosheet sandwiched inside cell membranes.

The transport of nanoparticles at bio-nano interfaces is essential for many cellular responses and biomedical applications. How two-dimensional nanomaterials, such as graphene and transition-metal dichalcogenides, diffuse along the cell membrane is, however, unknown, posing an urgent and important issue to promote their applications in the biomedical area. Here, we show that the transport of graphene oxides (GOs) sandwiched inside cell membranes varies from Brownian to Lévy and even directional dynamics. Specifically, experiments evidence sandwiched graphene-cell membrane superstructures in different cells. Combined simulations and analysis identify a sandwiched GO-induced pore in cell membrane leaflets, spanning unstable, metastable, and stable states. An analytical model that rationalizes the regimes of these membrane-pore states fits simulations quantitatively, resulting in a mechanistic interpretation of the emergence of Lévy and directional dynamics. We finally demonstrate the applicability of sandwiched GOs in enhanced efficiency of membrane-specific drug delivery. Our findings inform approaches to programming intramembrane transport of two-dimensional nanomaterials toward advantageous biomedical applications.

An Algorithm for Enhancing the Image Contrast of Electron Tomography.

Three-dimensional (3D) reconstruction of a single protein molecule is essential for understanding the relationship between the structural dynamics and functions of the protein. Electron tomography (ET) provides a tool for imaging an individual particle of protein from a series of tilted angles. Individual-particle electron tomography (IPET) provides an approach for reconstructing a 3D density map from a single targeted protein particle (without averaging from different particles of this type of protein), in which the target particle was imaged from a series of tilting angles. However, owing to radiation damage limitations, low-dose images (high noise, and low image contrast) are often challenging to be aligned for 3D reconstruction at intermediate resolution (1-3 nm). Here, we propose a computational method to enhance the image contrast, without increasing any experimental dose, for IPET 3D reconstruction. Using an edge-preserving smoothing-based multi-scale image decomposition algorithm, this method can detect the object against a high-noise background and enhance the object image contrast without increasing the noise level or significantly decreasing the image resolution. The method was validated by using both negative staining (NS) ET and cryo-ET images. The successful 3D reconstruction of a small molecule (<100 kDa) indicated that this method can be used as a supporting tool to current ET 3D reconstruction methods for studying protein dynamics via structure determination from each individual particle of the same type of protein.

A mobile, modular and rapidly-acting treatment system for optimizing and improving the removal of non-aqueous phase liquids (NAPLs) in groundwater.

Non-aqueous phase liquids (NAPLs) in pumped groundwater are highly variable, challenging the selection of above-ground treatment strategies in pump-and-treat system. Adjustable systems with multiple treatment units are urgently required. In the present study, a mobile, modular and rapidly-acting treatment system was developed to treat groundwater contaminated by NAPLs at a chemical industrial site. The system integrated four units of coagulation sedimentation, air flotation, air stripping and chemical oxidation. During a 3-month onsite operation, the composition of groundwater NAPLs had huge fluctuations and different treatment units had unique advantages in eliminating some components. For instance, air stripping exhibited satisfactory removal efficiencies (>80%) for short-chain petroleum hydrocarbons and chloroalkanes, but poor performance for others comparing to other units. A decision-making tool and a central control system were further developed to combine and adjust the four units in proper orders, achieving satisfied removal efficiency (70-90%) for multi-component NAPLs, regardless of composition fluctuation. These findings raise the state-of-the-art modular and rapidly-acting groundwater treatment system to clean up NAPLs contaminated groundwater through pump-and-treat strategy, help in better understanding on the decision and management to improve the treatment performance, and provide guidelines for its implication at other sites contaminated with multi-component NAPLs or undergoing accidental contamination.

Structural basis of the lipid transfer mechanism of phospholipid transfer protein (PLTP).

Human phospholipid transfer protein (PLTP) mediates the transfer of phospholipids among atheroprotective high-density lipoproteins (HDL) and atherogenic low-density lipoproteins (LDL) by an unknown mechanism. Delineating this mechanism would represent the first step towards understanding PLTP-mediated lipid transfers, which may be important for treating lipoprotein abnormalities and cardiovascular disease. Here, using various electron microscopy techniques, PLTP is revealed to have a banana-shaped structure similar to cholesteryl ester transfer protein (CETP). We provide evidence that PLTP penetrates into the HDL and LDL surfaces, respectively, and then forms a ternary complex with HDL and LDL. Insights into the interaction of PLTP with lipoproteins at the molecular level provide a basis to understand the PLTP-dependent lipid transfer mechanisms for dyslipidemia treatment.

Polyhedral 3D structure of human plasma very low density lipoproteins by individual particle cryo-electron tomography1.

Human VLDLs assembled in the liver and secreted into the circulation supply energy to peripheral tissues. VLDL lipolysis yields atherogenic LDLs and VLDL remnants that strongly correlate with CVD. Although the composition of VLDL particles has been well-characterized, their 3D structure is elusive because of their variations in size, heterogeneity in composition, structural flexibility, and mobility in solution. Here, we employed cryo-electron microscopy and individual-particle electron tomography to study the 3D structure of individual VLDL particles (without averaging) at both below and above their lipid phase transition temperatures. The 3D reconstructions of VLDL and VLDL bound to antibodies revealed an unexpected polyhedral shape, in contrast to the generally accepted model of a spherical emulsion-like particle. The smaller curvature of surface lipids compared with HDL may also reduce surface hydrophobicity, resulting in lower binding affinity to the hydrophobic distal end of the N-terminal ß-barrel domain of cholesteryl ester transfer protein (CETP) compared with HDL. The directional binding of CETP to HDL and VLDL may explain the function of CETP in transferring TGs and cholesteryl esters between these particles. This first visualization of the 3D structure of VLDL could improve our understanding of the role of VLDL in atherogenesis.

Phase diagram of a tubular vesicle adhering between two parallel rigid planes.

In this study, we propose a two-dimensional (2D) theoretical model to explore the adhesion behavior of a tubular vesicle adhering between two rigid planes, which are constrained by a couple of forces. Based upon the free-energy functional of the system, the equations for the equilibrium shape are derived. The general solution for the system with zero pressure is obtained analytically and the stability of the corresponding equilibrium shapes is tested by numerical simulation. With the volume constraint, three kinds of typical stable shapes are obtained through scanning the parameter space numerically. The phase diagram is obtained and it is occupied mostly by nonsymmetrical shapes. The force-displacement curves obtained for our model are in agreement with experimental results. The catastrophe of force is found at a critical state, which reveals a huge expanding force will act on the two planes by the vesicle. It also implies that vesicles can spontaneously squeeze into a slit only due to adhesion.

Effectiveness of the clinical pharmacist in reducing mortality in hospitalized cardiac patients: a propensity score-matched analysis.

BACKGROUND: Pharmacist-led medication review services have been assessed in the meta-analyses in hospital. Of the 135 relevant articles located, 21 studies met the inclusion criteria; however, there was no statistically significant difference found between pharmacists' interventions and usual care for mortality (odds ratio 1.50, 95% confidence interval 0.65, 3.46, P=0.34). These analyses may not have found a statistically significant effect because they did not adequately control the wide variation in the delivery of care and patient selection parameters. Additionally, the investigators did not conduct research on the cases of death specifically and did not identify all possible drug-related problems (DRPs) that could cause or contribute to mortality and then convince physicians to correct. So there will be a condition to use a more precise approach to evaluate the effect of clinical pharmacist interventions on the mortality rates of hospitalized cardiac patients. OBJECTIVE: To evaluate the impact of the clinical pharmacist as a direct patient-care team member on the mortality of all patients admitted to the cardiology unit. METHODS: A comparative study was conducted in a cardiology unit of a university-affiliated hospital. The clinical pharmacists did not perform any intervention associated with improper use of medications during Phase I (preintervention) and consulted with the physicians to address the DRPs during Phase II (postintervention). The two phases were compared to evaluate the outcome, and propensity score (PS) matching was applied to enhance the comparability. The primary endpoint of the study was the composite of all-cause mortality during Phase I and Phase II. RESULTS: Pharmacists were consulted by the physicians to correct any drug-related issues that they suspected may cause or contribute to a fatal outcome in the cardiology ward. A total of 1,541 interventions were suggested by the clinical pharmacist in the study group; 1,416 (92.0%) of them were accepted by the cardiology team, and violation of incompatibilities had the highest percentage of acceptance by the cardiology team. All-cause mortality was 1.5% during Phase I (preintervention) and was reduced to 0.9% during Phase II (postintervention), and the difference was statistically significant (P=0.0005). After PS matching, all-cause mortality changed from 1.7% during Phase I down to 1.0% during Phase II, and the difference was also statistically significant (P=0.0074). CONCLUSION: DRPs that were suspected to cause or contribute to a possibly fatal outcome were determined by clinical pharmacist service in patients hospitalized in a cardiology ward. Correction of these DRPs by physicians after pharmacist's advice caused a significant decrease in mortality as analyzed by PS matching. The significant reduction in the mortality rate in this patient population observed in this study is "hypothesis generating" for future randomized studies.

The role of the clinical pharmacist in reducing mortality in hospitalized cardiac patients: A prospective, nonrandomized controlled trial using propensity score methods.

BACKGROUND: Meta-analyses have suggested that pharmacist-led medication reviews have no discernable effect on patient mortality. These analyses may not have found a statistically significant effect because they did not adequately control for the patient selection parameters. Therefore, a more precise approach to evaluating the effect of clinical pharmacist interventions on the mortality rates of hospitalized cardiac patients is required. OBJECTIVE: To evaluate the impact of the clinical pharmacist as a direct patient-care team member on the mortality of all patients admitted to cardiology units. METHODS: A prospective, nonrandomized observational study compared patients who received standard care with patients admitted to a service that included clinical pharmacists. Propensity score matching was applied to enhance the comparability. The primary endpoint of the study was the composite of all-cause mortality in the study group and the control group. RESULTS: Pharmacists were consulted by physicians to correct any drug-related issues that they suspected may cause or contribute to a fatal outcome in the cardiology ward. A total of 428 interventions were suggested by the clinical pharmacist in the study group; 375 (87.6%) of them were accepted by the cardiology team. All-cause mortality was 1.8% during phase 1 treatment (preintervention) and was reduced to 1.1% during phase 2 treatment (postintervention); the difference was statistically significant. There was no statistical difference in all-cause mortality in the control unit between phase 1 and phase 2. Results were similar in the propensity score-matched subcohort. CONCLUSIONS: Drug-related problems that were suspected to cause or contribute to a possibly fatal outcome were determined by the clinical pharmacist service in patients hospitalized in a cardiology ward. Correction of these drug-related problems by physicians after the pharmacist's advice caused a significant decrease in mortality as analyzed by propensity score matching. The significant reduction in the mortality rate in this patient population observed in this study is "hypothesis generating" for future randomized studies.