[Believe the guidelines?] / Credere alle linee guida?

In recent years the guidelines (GL) have experienced increasing popularity, in parallel with positive economic consequences and the low time commitment for doctors. Time, however, has photographed a more complex reality. On the one hand, it brought out the diversity and difficulty of the GL problems (questionable methodology, conflict of interest, unreliability of scientific societies, risk of overdiagnosis and treatment), on the other hand it raised the need for better quality control of the Education. In any case, only the time will tell to us if and when we will be able to answer the LG question.

[Atrial fibrillation therapy: different opinions]. / Terapia della fibrillazione atriale: diversi pareri.

Atrial fibrillation is the most common cardiac arrhythmia and its spread in the population is growing. The introduction of new drugs has widened the range of therapeutic strategies available to clinicians but there are different positions in the scientific community. The most accredited guidelines published in Chest suggest the use of new anticoagulant drugs in non valvular atrial fibrillation, while some independent drug information bulletins have a more conservative position. The editorial discusses this disagreement, urging government institutions to continue to monitor doctors' choices, while making the best sources of evidence available for health workers to make the most appropriate decisions.

[Antimicrobial resistance forever? Judicious and appropriate use of antibiotics]. / Ora e sempre resistenza? Razionalità e appropriatezza nell'uso degli antibiotici.

This article takes its cue from the original work of sir Alexander Fleming on penicillin, published in the first issue of Recenti Progressi in Medicina in 1946 and reproduced here on the occasion of the approaching 70-year anniversary of the journal. In 1928, at the time when penicillin was discovered, it could not be imagined that bacterial resistance to antibiotics would develop so rapidly: the introduction of every new class of antibiotics has been shortly followed by the emergence of new strains of bacteria resistant to that class. Bacterial resistance to antibiotic treatment is a huge concern. In this respect, an action plan against antimicrobial resistance has been devised in the United States that is targeted for a 50% reduction over the next five years.

[In-hospital management of acute ischemic stroke. A retrospective analysis at the Viterbo hospital (Italy), 2008 to 2012]. / Percorsi intraospedalieri nelle malattie cerebrovascolari acute. Studio retrospettivo presso l'ospedale di Viterbo, 2008-2012.

BACKGROUND: Cerebrovascular diseases account for 10-12% of all deaths in Italy, and are the leading cause of disability and the second major cause of dementia. Cerebrovascular events may affect cerebral vascular function resulting in symptoms of variable duration and severity. METHODS: This retrospective analysis included 1892 patients admitted with a definite or probable diagnosis of cerebrovascular disease who experienced an acute vascular injury. Data were collected from the medical records at the Belcolle Hospital of Viterbo (Italy) from January 2008 to November 2012. RESULTS: A definite diagnosis was not made on admission in 15.4% of patients, and blood pressure measurement was not performed in 6.9% of patients. Almost all patients underwent a brain CT scan and interdisciplinary assessment. CONCLUSIONS: Our findings based on the experience of the Belcolle Hospital show several limitations in the diagnostic and therapeutic management of patients with acute cerebrovascular events. These are mainly related to diagnostic and therapeutic attitudes of the emergency department personnel (physicians and nurses), funding for professional training, and implementation of stroke units.

[Adverse drug reactions in emergency department]. / Le reazioni avverse ai farmaci (ADR) in pronto soccorso.

INTRODUCTION: Adverse drug reactions (ADR) are among the reasons of admission to Emergency departmens (ED), specifically in elderly people. AIM AND METHOD: To analyze the literature to report the main information on ADR in emergency departments and to describe the most common treatments. RESULTS: The number of patients admitted to ED for an ADR ranges from 0.6 to 3.6%. The most commonly agreed on and aspecific treatments performed are forced diuresis, urine acidification, bowel irrigation and haemodialysis. CONCLUSIONS: The number and characteristics of ADR may be a useful guide for health care professionals in EDs.