[Implementing clinical pathways: some practical notes]. / L'implementazione dei percorsi: note pratiche.

The traditional biomedical paradigm is no longer a guarantee of quality for health care, facing increasingly difficult challenges caused by chronic diseases and increasingly fragmented resources that current healthcare systems are dealing with. Health care organizations, considered to be the most complex enterprises of the modern era, must be able to focus on the flow of patients, integrating primary and secondary care through tools such as the Integrated Care Pathways (ICP). This brief discussion attempts to define the ICP its purposes, the elements that characterize it, its limitations and the mechanisms to push for a successful implementation. In order to highlight the elements and basic steps for the creation of an ICP, the authors have compared five different clinical pathways, whose implementation they have contributed to. The comparison was made using two grids: the first showing the essential elements for the definition of lCP and the second one with features that can facilitate their effectiveness. The conclusions of the work show what, pursuing the construction of a pathway, we must never forget: to analyze the gap between the clinical-care activities performed and the theoretical framework provided by the evidence; to see the barriers to change that may impede the implementation; to involve all actors in the system, with particular attention to patients and their associations, and finally to provide a plan for information and education, addressed to health professionals and patients as well.

[Celiac disease in Emilia Romagna]. / La malattia celiaca in Emilia Romagna.

The prevalence of celiac disease is still significantly under-estimated world-wide. We compared the Emilia Romagna's with international data. We studied symptomatic patients recorded in reimbursement regional health service program. In year 2008, the patients were 7811. Our investigation did not show age related prevalence, except in the age group 0 to 1 probably due to breastfeeding. The overall prevalence is 1,8 patient/1000 of Emilia Romagna citizens. The prevalence is extremely variable in the different districts from 1:384 Parma's area to 1:909 Piacenza's. Our data confirm the underestimation previously found in other countries. Diagnosis (tests and small bowel histology) are performed, but probably a multidisciplinary effort must be made to promote knowledge and to understand pathogenesis of CD.

Observations made on strains of Campylobacter spp. isolated in 1989 in northern Italy.

Over a 12-month period (1989), 192 thermophilic campylobacters (190 from stool and two from blood specimens) were isolated. All the strains were identified as far as species and biotype was concerned and 89 were also serotyped according to the Lior method. C. jejuni (90.10%) was the species most frequently isolated (mainly biotype I) while the most frequent serogroup was LIO 4. Erythromycin-resistance was found in only 15 strains, but while it was very low for the species C. jejuni (1.16%), it was frequent for C. Coli (68.42%), mainly for biotype I (73.33%). Moreover, eight strains of thermophilic campylobacters resistant to nalidixic acid (three strains of C. jejuni and five strains of C. coli) were found.