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Breast cancer is the most common cancer in women worldwide. Most current guidelines recommend using multigene profiling assays to aid the decision on the addition of chemotherapy to adjuvant hormone therapy for women who present with early‐stage, hormone receptor‐positive, HER2‐negative disease. One of these assays is the Oncotype DX, which predicts the disease recurrence risk and adjuvant chemotherapy benefits. Given its high cost, there is an economic incentive to evaluate its surrogates, such as the Magee equations. We assessed health system costs associated with the use of the Magee scores. A probabilistic decision tree was used to calculate the difference in mean health system costs based on data obtained from a randomized trial and the published literature. Costs were calculated from a perspective of Canada's publicly funded health care system. A series of sensitivity analysis was conducted to assess the robustness of the study findings. The Magee equations were associated with a total cost savings of C$100 per patient (95% CI, −C$3068 to C$5022) compared with standard of care. The difference in costs was highly sensitive to the extent that the Magee scores could reduce the frequency of adjuvant chemotherapy and Oncotype DX requests. [ABSTRACT FROM AUTHOR]

Objective: Pre-eclampsia (PE) remains a leading cause of maternal and fetal morbidity and mortality. A first-trimester screening algorithm predicting the risk of early-onset PE has been developed and validated. Early prediction coupled with initiation of aspirin at 11-13 weeks in women identified as high risk is effective at reducing the prevalence of early-onset PE. The aim of this study was to evaluate the cost-effectiveness of this first-trimester screening program coupled with early use of low-dose aspirin in women at high risk of developing early-onset PE, in comparison to current practice in Canada.Methods: A decision analysis was performed based on a theoretical population of 387 516 live births in Canada in 1 year. The clinical and financial impact of early preventative screening using the Fetal Medicine Foundation algorithm for prediction of early-onset PE coupled with early (< 16 weeks) use of low-dose aspirin in those at high risk was simulated and compared with current practice using decision-tree analysis. The probabilities at each decision point and associated costs of utilized resources were calculated based on published literature and public databases.Results: Of the theoretical 387 516 births per year, the estimated prevalence of early PE based on first-trimester screening and aspirin use was 705 vs 1801 cases based on the current practice. This was associated with an estimated total cost of C$9.52 million with the first-trimester screening program compared with C$23.91 million with current practice for the diagnosis and management of women with early-onset PE. This equals an annual cost saving to the Canadian healthcare system of approximately C$14.39 million.Conclusions: The implementation of a first-trimester screening program for PE and early intervention with aspirin in women identified as high risk for early PE has the potential to prevent a significant number of early-onset PE cases with a substantial associated cost saving to the healthcare system in Canada. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Background With growing interest in resilience among mental health care providers globally, there is a need for a simple way to consider the complex interactions that predict adaptive coping when there is exposure to high levels of adversity such as family violence, mental illness of a child or caregiver, natural disasters, social marginalization, or political conflict. Methods This article presents diagnostic criteria for assessing childhood resilience in a way that is sensitive to the systemic factors that influence a child's wellbeing. The most important characteristics of children who cope well under adversity and avoid problems like depression, PTSD, and delinquency are highlighted. Results A multidimensional assessment of resilience is presented that examines, first, the severity, chronicity, ecological level, children's attributions of causality, and cultural and contextual relevance of experiences of adversity. Second, promotive and protective factors related to resilience are assessed with sensitivity to the differential impact these have on outcomes depending on a child's level of exposure to adversity. These factors include individual qualities like temperament, personality, and cognitions, as well as contextual dimensions of positive functioning related to the available and accessibility of resources, their strategic use, positive reinforcement by a child's significant others, and the adaptive capacity of the environment itself. Third, an assessment of resilience includes temporal and cultural factors that increase or decrease the influence of protective factors. A decision tree for the diagnosis of resilience is presented, followed by a case study and diagnosis of a 15-year-old boy who required treatment for a number of mental health challenges. Conclusions The diagnostic criteria for assessing resilience and its application to clinical practice demonstrate the potential usefulness of a systemic approach to understanding resilience among child populations. [ABSTRACT FROM AUTHOR]

The article presents a study on the formulation and testing of a new method to gauge daily snowfall from precipitation and related temperature records. It consists of two variables such as the threshold mean daily air temperature and the temperature range. It notes the need for separation of precipitation into snow and rain in calculating water balance. It presents details about daily precipitation observations taken from the National Data Archive, Meteorological Service of Canada, Environment Canada. It discusses the use of sensitivity analysis and objective functions such as mean annual snowfall. It also cites a series of model intercomparison analysis. Moreover, a decision tree that helps determine applicable methods and approach on certain data availabilities is given.

Why are guidelines in medicine so important today? What role do they have? Why and how did the World Gastroenterology Organization (WGO) choose a global focus? What does this mean for guidelines? These are the underlying questions addressed by our article. We argue that the addition of 'Cascades' to guidelines will increase their impact in large parts of the world. By so doing, we hope to add a new dimension to the 'knowledge into action' debate. A number of illustrations shows how raised expectations and resource restrictions pose - or should pose - an enormous challenge for guideline makers. Furthermore, the emphasis on evidence also creates problems for guideline making. If resources are limited it is unlikely gold-standard technologies are available. We believe Cascades can help. A Cascade is a selection of two or more hierarchical diagnostic or therapeutic options, based on proven medical procedures, methods, tools or products for the same disease, condition or diagnosis, aiming to achieve the same outcome and ranked by available resources. The construction of such a cascade is a hazardous intellectual journey that goes, to some extent, against established practice. But lives can be saved by matching options for diagnosis and treatment to available resources. While the optimal strategy, defined through an evidence-based approach, should always be the goal, one must be aware of the resource limitations that confront our colleagues in certain parts of the world and we should endeavour to work with them in the guideline development process to develop strategies that are clinically sound yet economically feasible and dacceptable to their populace.

Background: The efficacy of high-dose intravenous proton pump inhibition has recently been shown, yet its cost-effectiveness remains poorly studied., Aim: To assess the cost-effectiveness of this approach separately for American and Canadian health care settings., Methods: A validated decision model included patients with bleeding ulcers after successful endoscopic haemostasis. Probabilities were determined from the literature, and charges and lengths of stay from national databases. A third-party payer perspective was adopted over a 30-day time horizon., Results: Re-bleeding rates were 5.9% for patients who received high-dose intravenous proton pump inhibition and 22.9% for those who did not. Hospitalization costs for patients with and without re-bleeding were 11,802 US dollars and 7993 US dollars, and 5220 Canadian dollars and 2696 Canadian dollars, respectively. High-dose intravenous proton pump inhibition was more effective and less costly than the alternative of not administering it. The cost-effectiveness ratios for high-dose and no high-dose intravenous proton pump inhibition were 9112 US dollars and 11,819 US dollars (3293 dollars and 4284 dollars for the Canadian case), respectively. Sensitivity and threshold analyses showed that the results were robust across a wide range of clinically relevant assumptions., Conclusion: In the USA and Canada, administering high-dose intravenous proton pump inhibition for 3 days is both more effective and less costly than not doing so for patients with bleeding ulcers after successful endoscopic haemostasis.

Glycerol dialkyl glycerol tetraethers (GDGTs), both archaeal isoprenoid GDGTs (isoGDGTs) and bacterial branched GDGTs (brGDGTs), have been used in paleoclimate studies to reconstruct environmental conditions. Since GDGTs are produced in many types of environments, their relative abundances also depend on the depositional setting. This suggests that the distribution of GDGTs also preserves useful information that can be used more broadly to infer these depositional environments in the geological past. Here, we combined existing iso‐ and brGDGT relative abundance data with newly analyzed samples to generate a database of 1,153 samples from several modern sedimentary settings. We observed a robust relationship between the depositional environment and the relative abundances of GDGTs in our samples. This data set was used to train and test the Branched and isoGDGT Machine learning Classification (BIGMaC) algorithm, which identifies the environment a sample comes from based on the distribution of GDGTs with high precision and recall (F1 = 0.95). We tested the model on the sedimentary record from the Giraffe kimberlite pipe, an Eocene maar in subantarctic Canada, and found that the BIGMaC reconstruction agrees with independent stratigraphic and palynological information, provides new information about the paleoenvironment of this site, and helps improve its paleotemperature reconstruction. In contrast, we also include an example from the PETM‐aged Cobham lignite as a cautionary example that illustrates the limitations of the algorithm. We propose that in cases where paleoenvironments are unknown or are changing, BIGMaC can be applied in concert with other proxies to generate more refined paleoclimate records. Key Points: The distribution of glycerol dialkyl glycerol tetraethers (GDGTs) is particular to each depositional environment and has unique responses to environmental factorsThe BIGMaC algorithm captures the relationship between both branched and isoprenoid GDGTs (isoGDGTs) with depositional environmentsOur approach can provide paleoclimatological and paleoenvironmental information based only on GDGTs [ABSTRACT FROM AUTHOR]

Aim: Many tree species distribution models use black‐box machine learning techniques that often neglect interpretative aspects and instead focus mainly on maximizing predictive accuracy. In this study, we outline an interpretative modelling framework to gain better ecological insights while mapping abundance patterns of six North American species. Location: Continental United States and Canada. Methods: We develop an innovative procedure using regression trees by stabilizing variance, and mapping dominant rules which we term 'optimized regression tree bagging for interpretation and mapping' (ORTBIM). We apply this technique to understand ecological features influencing the abundance patterns of three eastern (Pinus strobus, Acer saccharum and Quercus montana), and three western (Picea engelmannii, Pinus ponderosa and Pseudotsuga menziesii) tree species in North America. For these species, we assess and map the dominant climate–terrain interactions that partly determine abundance patterns in the eastern and western regions. In the process, we examine the role of varying responses and scales and explore finer‐scale species climate–terrain niches and non‐linear relationships. Results: Our study emphasizes the prominent role of elevation and heat–moisture variables in the west and the greater importance of seasonal precipitation and seasonal temperature in the east. The abundance patterns under future climate (SSP5‐8.5) show climate–terrain habitats shifting northward and westward into Canada and Alaska for the eastern species, and predominantly north‐westward for the western species. Conclusion: Our interpretative modelling framework can be used to gain a more comprehensive understanding of the abundance patterns across the full species range, formulate better predictive models and facilitate improved management practices under climate change. [ABSTRACT FROM AUTHOR]

Background: Fetal alcohol spectrum disorder (FASD) resulting from prenatal alcohol exposure (PAE) is a common neurodevelopmental disorder, but substantial interindividual heterogeneity complicates timely and accurate assessment, diagnosis, and intervention. The current study aimed to identify classes of children and adolescents with PAE assessed for FASD according to their pattern of significant neurodevelopmental functioning across 10 domains using latent class analysis (LCA), and to characterize these subgroups across clinical features. Methods: Data from the Canadian National FASD Database, a large ongoing repository of anonymized clinical data received from diagnostic clinics across Canada, was analyzed using a retrospective cross‐sectional cohort design. The sample included 1440 children and adolescents ages 6 to 17 years (M = 11.0, SD = 3.5, 41.7% female) with confirmed PAE assessed for FASD between 2016 and 2020. Results: Results revealed an optimal four‐class solution. The Global needs group was characterized by high overall neurodevelopmental impairment considered severe in nature. The Regulation and Cognitive needs groups presented with moderate but substantively distinguishable patterns of significant neurodevelopmental impairment. The Attention needs group was characterized by relatively low probabilities of significant neurodevelopmental impairment. Both the Global and Regulation needs groups also presented with the highest probabilities of clinical needs, further signifying potential substantive differences in assessment and intervention needs across classes. Conclusions: Four relatively distinct subgroups were present in a large heterogeneous sample of children and adolescents with PAE assessed for FASD in Canada. These findings may inform clinical services by guiding clinicians to identify distinct service pathways for these subgroups, potentially increasing access to a more personalized treatment approach and improving outcomes. [ABSTRACT FROM AUTHOR]

Why are some cities more compact than others? We argue that riskier housing markets have a costlier real option; developers would require greater compensation to build now—thus, developers are being incentivized to delay, giving rise to more compact cities. We test this hypothesis cross‐sectionally for Canada's 11 largest census metropolitan areas. We interpret satellite imageries and estimate a hierarchical spatial autoregressive model to account for both the hierarchical and the spatial structure of our data. Our results show that, on average, a one‐percentage‐point increase in price risk reduces urban land coverage in the fringe by about 0.7 percentage point. [ABSTRACT FROM AUTHOR]

Canada is home to more lakes than any other nation, but there is a fragmented and limited understanding of the ecological status of these water bodies. Zooplankton are excellent bioindicators of lake health, given their central food web position. To date, many studies have investigated the effect of individual stressors on zooplankton communities, mediated through changes in water quality (e.g., macronutrients, temperature, or chemicals). Increasingly, stressors act simultaneously in lakes, often over extended periods of time. As part of the NSERC Canadian Lake Pulse Network project, pelagic zooplankton were sampled in 624 lakes across Canada, spanning six continental drainage basins. We evaluated the effect of 40+ environmental variables on zooplankton diversity and community composition, considering both taxonomic and functional approaches. We also tested specific hypotheses on the relationships between zooplankton communities and environmental conditions, including eutrophication, calcium, chloride, and fish predation. We found that lake morphometry variables were among the most important predictors of zooplankton diversity, while water quality metrics were more critical in explaining variation in community composition. Our results also reveal significant heterogeneity across Canada, with contrasting effects of environmental drivers among continental watersheds, highlighting that response models cannot be assumed to apply universally. [ABSTRACT FROM AUTHOR]

Purpose: Organizational context influences the effect of facilitation efforts on research use in care settings. The interactions of these factors are complex. Therefore, the use of traditional statistical methods to examine their interrelationships is often impractical. Big Data analytics can automatically detect patterns within the data. We applied the chi‐squared automatic interaction detection (CHAID) algorithm and classification tree technique to explore the dynamic and interdependent relationships between the implementation science concepts—context, facilitation, and research use. Design: Observational, cross‐sectional study based on survey data collected from a representative sample of nursing homes in western Canada. Methods: We assessed three major constructs: (a) Conceptual research utilization (CRU) using the CRU scale; (b) facilitation of research use measured by the frequency of contacts between the frontline staff and a clinical educator, or person who brings new ideas to the care unit; and (c) organizational context at the unit level using the Alberta Context Tool (ACT). CHAID analysis was performed to detect the interactions between facilitation and context variables. Results were illustrated in a classification tree to provide a straightforward visualization. Findings: Data from 312 care units in three provinces were included in the final analysis. Results indicate significant multiway interactions between facilitation and various aspects of the organizational context, including leadership, culture, evaluation, structural resources, and organizational slack (staffing). Findings suggested the preconditions of the care settings where research use can be maximized. Conclusions: CHAID analysis helped transform data into usable knowledge. Our findings provide insight into the dynamic relationships of facilitators' efforts and organizational context, and how these factors' interplay and their interdependence together may influence research use. Clinical relevance: Knowledge of the combined effects of facilitators' efforts and various aspects of organizational context on research use can contribute to effective strategies to narrow the evidence‐practice gap in care settings. [ABSTRACT FROM AUTHOR]

In January 2019, the Safe Food for Canadians Act/Safe Food for Canadians regulations (heretofore identified as SFCR) came into force across Canada and brought a more streamlined process to food safety practice in Canada. Food trade and production processes have evolved rapidly in recent decades, as Canada imports and exports food products; therefore it is critically important to remain aware of the latest advances responding to a range of challenges and opportunities in the food safety value chain. Looking through the optics of the recent SFCR framework, this paper places the spotlight on leading domestic and international research and practices to help strengthen food safety policies of the future. By shedding some light on new research, we also draw attention to international developments that are noteworthy, and place those in context as to how new Canadian food safety policy and regulation can be further advanced. The paper will benchmark Canada through a review study of food safety best practices by juxtaposing (i) stated aspirations with, (ii) actual performance in leading Organization for Economic Cooperation and Development (OECD) jurisdictions. [ABSTRACT FROM AUTHOR]

Aim: To evaluate current and future dynamics of 25 tree species spanning United States and Canada. Location: United States and Canada. Methods: We combine, for the first time, the species compositions from relative importance derived from the USA's Forest Inventory Analysis (FIA) with gridded estimates based on Canada's National Forest Inventory (NFI‐kNN))‐based photo plot data to evaluate future habitats and colonization potentials for 25 tree species. Using 21 climatic variables under RCP 4.5 and RCP 8.5, we model climatic habitat suitability (HQ) within a consensus‐based multimodel ensemble regression approach. A migration model is used to assess colonization likelihoods (CL) for ~100 years and combined with HQ to evaluate the various combinations of HQ + CL outcomes for the 25 species. Results: At a continental scale, many species in the conterminous United States lose suitable climatic habitat (especially under RCP 8.5) while Canada and USA's Alaska gain climate habitat. For most species, even under optimistic migration rates, only a small portion of overall future suitable habitat is projected to be naturally colonized in ~100 years, although considerable variation exists among species. Main conclusions: For the species examined here, habitat losses were primarily experienced along southern range limits, while habitat gains were associated with northern range limits (especially under RCP 8.5). However, for many species, southern range limits are projected to remain relatively intact, albeit with reduced habitat quality. Our models predict that only a small portion of the climatic habitat generated by climate change will be colonized naturally by the end of the current century—even with optimistic tree migration rates. However, considerable variation among species points to the need for significant management efforts, including assisted migration, for economic or ecological reasons. Our work highlights the need to employ range‐wide data, evaluate colonization potentials and enhance cross‐border collaborations. [ABSTRACT FROM AUTHOR]

Decline in size‐at‐age of Chinook Salmon (Oncorhynchus tshawytscha) has been observed for many populations across the entire Northeast Pacific Ocean, and identifying external drivers of this decline is important for sustainable management of these ecologically, economically, and culturally valuable resources. We assessed size‐at‐age of 96,939 Chinook Salmon sampled in the Fraser River watershed (Canada) from 1969 to 2017. A broad decline in size‐at‐age was confirmed across all population aggregates of Fraser River Chinook Salmon, in particular since year 2000. By developing a novel probability‐based approach to calculate age‐ and year‐specific growth rates for Fraser River Chinook Salmon and relating growth rates to environmental conditions in specific years through a machine learning method (boosted regression trees), we were able to disentangle multi‐year effects on size‐at‐age and thus identify environmental factors that were most related to the observed size‐at‐age of Chinook Salmon. Among 10 selected environmental variables, ocean salinity at Entrance Island in spring, the Aleutian Low Pressure Index and the North Pacific Current Bifurcation Index were consistently identified as important contributors for four of the seven age and population aggregate combinations. These top environmental contributors could be incorporated into future stock assessment and forecast models to improve Chinook Salmon fisheries management under climate change. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Statistics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Most regulatory and certification agencies in Canada now require forest management plans to include some level of historical fire pattern approximation. As a result, sustainable forest management and enhancements to existing fire management policies and practices require a thorough understanding of the spatial fire patterns created and maintained by fire as well as the environmental conditions when they occur. To date, however, no boreal fire pattern study has examined relationships between the spatial arrangement of fire patterns, including vegetation remnants, and its main environmental top‐down and bottom‐up controls, based on a large number of fire events across large areas of the Canadian boreal forest. In this study, we leverage a recent, comprehensive, Landsat‐derived fire pattern dataset that includes information on fire vegetation remnants for the Canadian boreal plains ecozone, covering 507 fires and 2.5 Mha, to characterize the predictability of six fire pattern metrics. We then compare these metrics to multiple top‐down (monthly climate) and bottom‐up (topography, fuels, natural barriers, and disturbance history) controls on fire behavior. To do so, we first reduced the fire pattern metrics to three principal components and used a random forest modeling approach to better understand the main environmental explanatory controls. Across this large number of fires, we identified three dimensions of fire patterns: compactness, or the complexity of the perimeter; patchiness, or the spatial heterogeneity in the burned patches; and residualness, or the amount of fire vegetation remnants within the burned patches. We found that patchiness was mostly conditioned by the land cover through variables characterizing the type and connectedness of the fuels; however, summer and spring drought were locally important. Compactness responded to a combination of the disturbance history, land cover, and summer drought. The presence of water resulted in less compact fires. Residualness was a function of the disturbance history, topography, and land cover. Fires in lower elevations presented the most variable patterns, in response to changes in the amount and types of fuel. This research offers an enhanced understanding of the hierarchical interactions between resulting fire patterns and environmental conditions that are critical to supporting management decisions. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Administrative Sciences (John Wiley & Sons, Inc.) is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Examines the use of decision analysis in the operating plans of hydroelectric facilities in British Columbia. Challenges encountered in value tradeoffs and in making judgments; Application of analytical approaches in water-use planning sites; Aspects of environmental policy implementation.

Better selection of personnel can reduce training costs and attrition rates by matching candidates more effectively with jobs. But what can trainers do to improve their selection of personnel? One answer is illustrated in an adventure game designed to help measure problem sensitivity in potential candidates for the Canadian Navy's Maritime Surface and Subsurface officer program. This article examines problem sensitivity as an important criterion for officer candidates and the resulting development and testing of the adventure game to measure this attribute. The authors provide ways to adapt this procedure and the test instrument for use with other groups in other situations. [ABSTRACT FROM AUTHOR]

In this article, we discuss how we used institutional ethnography (Institutional ethnography as practice, Rowman & Littlefield, Lanham, MD and 2006) to map out powerful ruling relations that organize nurses' wound care work. In recent years, the growing number of people living with wounds that heal slowly or not at all has presented substantial challenges for those managing the demands on Canada's publicly insured health‐care system. In efforts to address this burden, Canadian health‐care administrators and policy‐makers rely on scientific evidence about how wounds heal and what treatments are most effective. Advanced wound care exemplifies the growing authorization of particular forms of evidence that change the ways in which nurses come to know about and conduct their work. The focus of this paper's nursing inquiry is a critique of registered nurses' wound work as it arises within the established uptake of scientific evidence. [ABSTRACT FROM AUTHOR]

ACADEMIC EMERGENCY MEDICINE 2012; 19:640-649 © 2012 by the Society for Academic Emergency Medicine Abstract Objectives: Adverse drug events (ADEs) are unintended and harmful consequences of medication use. They are associated with high health resource use and cost. Yet, high levels of inaccuracy exist in their identification in clinical practice, with over one-third remaining unidentified in the emergency department (ED). The study objective was to derive clinical decision rules (CDRs) that are sensitive for the detection of ADEs, allowing their systematic identification early in a patient's hospital course. Methods: This was a prospective observational cohort study carried out in two Canadian tertiary care hospitals. Participants were adults presenting to the ED having ingested at least one prescription or over-the-counter medication within 2 weeks. Nurses and physicians evaluated patients for standardized clinical findings. A second evaluator performed interobserver assessments of predictor variables in a subset of patients. Pharmacists, who were blinded to the predictor variables, evaluated all patients for ADEs. An independent committee reviewed and adjudicated cases where the ADE assessment was uncertain or the pharmacist's diagnosis differed from the physician's working diagnosis. The primary outcome was an ADE that required a change in medical therapy, diagnostic testing, consultation, or hospital admission. CDRs were derived using kappa coefficients, chi-square statistics, and recursive partitioning. Results: Among 1,591 patients, 131 (8.2%, 95% confidence interval [CI] = 7.0% to 9.7%) were diagnosed with the primary outcome. The following variables were associated with ADEs and were used to derive two CDRs: 1) presence of comorbid conditions, 2) antibiotic use within 7 days, 3) medication changes within 28 days, 4) age ≥80 years, 5) arrival by ambulance, 6) triage acuity, 7) recent hospital admission, 8) renal failure, and 9) use of three or more prescription medications. The more sensitive rule had a sensitivity of 96.7% (95% CI = 91.8% to 98.6%) and required 40.8% (95% CI = 37.7% to 42.9%) of patients to have medication review. The more specific rule had a sensitivity 90.8% (95% CI = 81.4% to 95.7%) and required 28.3% of patients to proceed to medication review. Conclusions: The authors derived CDRs that identified patients with ADEs with high sensitivity. These rules may improve the identification of ADEs early in a patient's hospital course while limiting the number of patients requiring a detailed medication review. [ABSTRACT FROM AUTHOR]