The use of proton pump inhibitors in an Italian hospital: focus on oncologic and critical non-ICU patients.

BACKGROUND: Proton pump inhibitors (PPIs) are among the most misused drugs both at the community and hospital level. Recently, possible risks have been underscored, suggesting the importance of limiting PPI use to proven indications. OBJECTIVE: To survey the appropriateness of PPI use in a University hospital in Italy. Setting Azienda Ospedaliera Universitaria Policlinico 'P. Giaccone', in Palermo, Italy. METHOD: A one day-observational study, reviewing patients' medical records to identify treatments with PPIs and the indications for their use. After discharge, a subgroup of the cohort was followed up to assess the continuation of therapy at home. Appropriateness was evaluated according to the indications stated in the official product information sheet and supported by the AIFA notes. MAIN OUTCOME MEASURE: Prevalence and appropriateness of PPI use in the hospital and after discharge. RESULTS: In the index day 62.9 % of 343 evaluable patients received a PPI. In only 29.1 % of these, the treatment could be considered appropriate. The most frequent reasons for inappropriate treatment were stress ulcer prophylaxis in low risk patients and unwarranted gastro-protection in drug treated patients. 30.9 % of patients received PPIs for uncertain indications: of these, 25.7 % were "critical" patients admitted in non-ICU wards. Furthermore, as much as 88.2 % of anticancer drug treated patients received PPIs as gastroprotective agents. At discharge 48.6 % of patients received a prescription to continue PPI therapy at home and 75.9 % of the 83 followed up patients were found to be still taking these drugs after on average 3 months from discharge. CONCLUSION: This study confirms a high proportion of inappropriate PPI therapy into the hospital that translates in a prolonged unnecessary administration in the community setting. Further studies are needed to assess the cost-effectiveness of PPI therapy in subgroups of patients at moderate risk for gastric complications to optimize current guidelines.

[PLAGUE IN PALERMO IN 1575 AND SOCIAL CONTROL]. / LA PESTE A PALERMO NEL 1575 E IL CONTROLLO SOCIALE.

The work moves from the low mortality of the plague of Palermo in 1575 - 1576 in comparison to similar outbreaks and contemporary analysis of the activity of Ingrassia, a man that the city government had wanted at his side. The extraordinary health interventions, including those to favor of the predisposition of health building to isolation, gears for a more wide-ranging than the traditional one. The isolation adopted by Ingrassia wasn't a novelty because it was already in use half a century earlier, as the Previdelli wrote. We assume that the population in crisis, hungry and out of work for the huge military expenditure of king Philip II, would have prompted the City government to use the outbreak for the purposes of <>. At the same goal always answered in the sixteenth century the establishment of the parish, created to divide the territory in order to guide and control the practice of the faith of the people. Ingrassia, a man next to political power, which in turn welded with the spiritual power in order to implement the Catholic Counter-Reformation, justified the coercive initiatives towards the population. The practice of medicine, as still happens today, is affected by the conditions of the policy, raising one of the fundamental principles of bioethics, the question ofthe independence ofthe doctor: a physician divided by the duty to represent the legitimate interests of the patient and those of political power, perhaps not always shared. It is a new interpretation of the activity of Ingrassia and his <> results than the plague.

[Zolfare in Sicily: a research survey]. / Zolfare di Sicilia: le tematiche della ricerca.

Sicilian zolfare (sulphur mines) have long been one of the economic resourches of the island. Miners have worked in difficult and dangerous conditions; many of them were young children (carusi). The paper deals with medical and health provisions for zolfara workers.

[Steri's graffiti of Palermo and medical knowledges]. / Graffiti dello Steri di Palermo e conoscenze mediche.

The graffiti left by prisoners in the Inquisition gaols of Palermo's represent a testimony of the historical period between 1600 to 1793. In that period, by order of the viceroy Caracciolo, all the testimonies were removed at the same time in which the Inquisition court was suppressed. In this work the historical subdivision between sacred and profane themes is analyzed with the purpose to study human body in an anthropological key as a language in condition of limited freedom and under torture. Many of the profane graffiti are devoted to medical knowledge suggesting that doctors were involved in the activities of this religious court likewise happened in civil courts. Giovanni Filippo Ingrassia, the well-known proto-medical physician of the kingdom, in his treatise, wrote in 1578 and entitled Methodus dandi relationes ... reports many examples of the role of medical doctors in attesting fitness to torture of inquired people or the necessity of graduating torture when they were hill or in a morbid conditions.