Health services: an Italian market.

One of the glories of Italy is its capacity to surprise. In out-of-the-way places extraordinary things are suddenly encountered; and this is hardly less true of science than of architecture or music or painting. Italian medicine can boast excellence in many quiet spots. Yet Italy's record in medical science and practice is perceived to be below par, and one reason may be a lack of central coordination--forgivable in a country that had fifty governments in half a century. The latest administration offers a rare chance of political stability and the prospect of reforms. In this profile of Italian medicine The Lancet's guide was Dr Giuseppe Remuzzi, whose central coordination was exemplary.

Possible applications of drug prescription monitoring systems in Italy.

Numerous experiences have already been implemented as regards the use of data concerning drug prescriptions and relative expenditure. This article focuses firstly on how such data are used from an administrative point of view in the Veneto Region, and secondly on the cultural and scientific aspects involved. The supply of feedback to general practitioners (GPs) with drug prescription indicators has made possible to cut down farmaceutical expenditure. Moreover, the analysis of the substances used by the GPs highlights the areas which require special attention in order to improve the quality of prescription.

[Photography in orthodontics]. / La fotografia in ortodonzia.

We have analyzed the bases of information about the feasibility of orthodontic photography. After giving details about the photographic equipment and the field lighting we gave a thorough description of the operative modalities of intra and extraoral photos.

Psychotropic drug monitoring in general practice in Italy: a two-year study.

A psychotropic drug monitoring study in general practice was carried out in 1983 and 1984 using a computerized drug information system. The prescription data analysed in the study came from 68 general practitioners operating in south Verona and have been collected by 14 community pharmacies located in the same area. Benzodiazepine hypnotics were the most commonly prescribed drugs, followed by antidepressants and neuroleptics both in 1983 and in 1984. The distribution of the general practitioners in terms of low, medium and high prescribers was examined by analysing the rates of prescriptions per registered patient. The rates were obtained for the total number of prescriptions and also for each of the three different classes of psychotropic drug. The proportion of low and high prescribers decreased from 1983 to 1984 (18.3 versus 11.7 and 26.7 versus 16.7 for low and high prescribers respectively); this change was mainly due to the reduction in benzodiazepine prescriptions. No significant correlation was found between the rates of psychotropic drug prescriptions and list size. The monthly variation in prescription of the three drug classes followed a similar pattern during the two years; the fluctuations were clearly cyclical, more definitely in 1984 than in 1983 where the most relevant feature was the summer trough.

[From Italy to Québec : impact of the Italian psychiatric reform.]. / De l'Italie au Québec : implications de la réforme psychiatrique italienne.

This article has two aims: 1) to help in the understanding of the much discussed Italian reform in psychiatry. 2) to offer for review, discussion or action, a certain number of implications uncovered by this reform with regard to the ongoing discussions on the reorganization of Mental Health Services in Quebec. On the first aim, the key message is as follows: it is possible to create another psychiatry if society in general and those actually participating really want such a project. On the second aim, the main conditions of success for a global and deinstitutionalized psychiatry seem to be as follows: Sufficient resources, freedom to develop policies (a deep decentralisation of the decision making process and the organization) that are central to the integration of the services in a given territory; a dedicated study of the culture and the local social live; a continuous presence (intime and space) of the service in the territory; a total response (and deinstitu-tionalization) to the patient's needs; a democratic team work. However, there are no miracles in Italy; in the cooled down society of the 80's there is room for experimentation.

Serum and sputum concentrations of azlocillin, cefoperazone and ceftazidime in patients with cystic fibrosis.

Single-dose pharmacokinetics of azlocillin, cefoperazone and ceftazidime were studied in 17 patients with cystic fibrosis (CF). All patients had broncho-pulmonary infections caused by Pseudomonas aeruginosa. Three groups of five, six, and six patients were treated with azlocillin, cefoperazone, or ceftazidime, respectively. The size of the single dose was 133 mg/kg for azlocillin, 66.7 mg/kg for ceftazidime and 66.7 mg/kg for cefoperazone. The clearance values for the three antibiotics calculated from the single-dose data were, on the average, higher than the values previously reported for normal subjects. After the first dose, the patients received a repeated-dose treatment with the same antibiotic. During the first 5 days of therapy, a complement postural drainage of sputum was obtained four times a day for each patient. Cefoperazone could be measured in 47 (39.2%) of the 120 sputum samples assayed while ceftazidime was shown to be present in all 120 sputum samples examined. Azlocillin was not detected in any of the 100 sputum samples assayed.

[Surveillance of cephalosporins therapy in therapeutic practice of 15 Italian hospitals (author's transl)]. / Indagine policentrica sul consumo e sui criteri d'uso delle cefalosporine in ambito ospedaliero.

A retrospective review and evaluation of systemic cephalosporin therapy in 15 hospitals of various italian Regions was conducted. In any hospital the Pharmacy Service has examined a random sample of medical records of hospitalized patients exposed to cephalosporin therapy over a twelve month period (January-December 1976). In the years 1974-1976 were also examined the consumption and cost for Penicillin G, Ampicillin and Cephalosporins. A standard protocol and methodology for homogeneous collection of data was developed. On the base of collected data, the patterns of choice, the rational and irrational use, the role of cephalosporins in hospital practice are discussed.

[Descriptive analysis of psychiatric emergencies in the greater Montréal area.]. / Analyse descriptive des urgences psychiatriques dans la région du Montréal métropolitain.

In. September 197S1, a research team from the Department of Health Administration of the University of Montreal, completed a research study on psychiatric emergencies financed by the Planning section of Quebec's Ministry of Social Affairs. The purpose of this research was on the one hand, to measure the importance of psychiatric problems in the emergency services of hospital centers in Montreal's metropolitan region (22 institutions) and, on the other hand, to describe the characteristics of patients who have access to these emergency services for the purpose of psychiatric treatment. This article summarizes the first section of this research study. Firstly, the authors explain the problem underlying the study, as well as the objectives pursued. Subsequently, a brief description of the research is made, according to its major methodological features. Finally, in the third section, data relative to the number of psychiatric emergencies and to the distribution of this care demand in Montreal's hospital centers, are presented. A second article will deal with the main characteristics of the psychiatric clientele requiring emergency resources i.e. age, sex, marital status, socio-professional categories, types of emotional distress, profiles of past-utilization of services (etc.).

[Psychiatric emergencies in the greater Montréal region : some difference between men and women.]. / Les urgences psychiatriques dans la région du Montréal métropolitain : quelques différences entre les hommes et les femmes.

This article presents a general description of the clientele requiring emergency psychiatric services in the Greater Montreal area, with a particular emphasis on the differences between the characteristics of the female and of the male clientele of these emergency services (demographic variables, diagnosis, treatment and disposition variables).