[Appropriateness of hospitalization in the teaching hospital of Chieti using the P.R.U.O. approach]. / Valutazione dell'appropriatezza dei ricoveri con la metodica P.R.U.O. nell'ospedale clinicizzato di Chieti.

This study describes the results of a research carried out to evaluate inappropriate admissions and totally inappropriate hospitalizations (RTI) in the teaching hospital "SS. Annunziata" of Chieti using the 1999 version of the PRUO manual. A random sample of 1218 medical charts, drawn from all the medical charts of patients admitted from June to December 2000 in the units of Medicine, Surgery and Orthopaedics, was selected. The percentage of inappropriate admissions was 38.2%, while totally inappropriate hospitalizations were 18.1%. The highest percentage of inappropriate admissions was in the class of age 55-64 years. Moreover, inappropriate admissions were more frequent in the morning hours (7:00-12:59) and, within the week, on Monday. The first reason of inappropriateness of the admission, was the execution of diagnostic examinations (62.2%), followed by the execution of medical therapy (19.3%) and waiting of surgical intervention (13.4%). Short hospitalizations (2-3 days) are more frequently totally inappropriate as compared to longer hospitalizations. These findings suggest that a system for the assessment of appropriateness of hospitalizations should be established in the Abruzzo region including all accredited public and private hospitals.

Omeprazole, bismuth and clarithromycin in the sequential treatment of Helicobacter pylori infection.

AIMS: To assess the therapeutic potential of clarithromycin, a new macrolide with high anti-Helicobacter pylori activity, given with bismuth salts and omeprazole in different regimens aimed at simplifying the treatment of H. pylori-related gastritis. METHODS: Eighty-eight patients with proven H. pylori infection and gastritis were treated with one of the following four regimens: omeprazole 40 mg/day for one week (group A, n = 14); omeprazole 40 mg/day for one week followed by clarithromycin 1 g/day for 2 weeks (group B, n = 26); omeprazole 40 mg/day for one week followed by tripotassium dicitrato bismuthate 480 mg/day and clarithromycin 1 g/day, both for two weeks (group C, n = 26); and tripotassium dicitrato bismuthate 480 mg/day and clarithromycin 1 g/day for two weeks (group D, n = 22). Presence of H. pylori, histology and electron microscopy were assessed at entry and four weeks after the end of each treatment. RESULTS: Omeprazole alone had no effect on H. pylori status. The highest eradication rate was obtained in group C patients (81%), a proportion significantly greater than that observed in group B (50%, P < 0.03) or group D patients (55%, P < 0.05). CONCLUSION: Sequential treatment may be a useful option in the treatment of H. pylori-related gastritis.

Effect of azelastine on the seasonal increase in non-specific bronchial responsiveness to methacholine in pollen allergic patients. A randomized, double-blind placebo-controlled, crossover study.

Azelastine, a phthalazinone derivative, is a new potent, long acting, orally active anti-allergic compound with particularly strong H1-histamine receptor antagonistic effects which has been proven to possess in vitro and in vivo a number of anti-inflammatory properties. The aim of the present study was to investigate whether azelastine would be able to prevent and/or reverse the seasonal increase in non-specific bronchial responsiveness to methacholine in pollen allergic patients. Twelve atopic patients (5 males, mean age 31 years), skin positive exclusively to grass and/or Parietaria pollen extract, with rhinitis and mild asthma occurring in the spring for at least two years previously, were studied. After a 2 week run-in period, oral azelastine, 4 mg twice daily, or placebo, was given for 2 weeks from the start of the pollen season, according to a randomized, double-blind design. After 2 weeks, the treatments were crossed over. During both the run-in and study periods, patients recorded rhinitis and asthma symptoms, additional antihistamine and bronchodilator drugs taken and peak expiratory flow measurements. A methacholine inhalation test was carried out on four occasions in each patient: before the run-in period, before the start of the treatment, and at the end of the two 2 week treatment periods. Azelastine significantly reduced rhinitis symptoms and the need for antihistamine drugs, whereas asthmatic symptoms, use of bronchodilator drugs, peak flow recordings and bronchial responsiveness to methacholine were unaffected by the treatment. Compliance level and adverse side-effects were not significantly different between active treatment and placebo. In the final subjective evaluation of the two treatments, eight out of 12 patients preferred azelastine.(ABSTRACT TRUNCATED AT 250 WORDS)