Effectiveness of different local actions to control vitamin D prescription in Italy.

Introduction: In the last decade, the significant expenditure and consumption increase of vitamin D in Italy led some regions to adopt strategies to improve prescribing appropriateness and contain expenditure.

Materials And Methods: Using the statistical analysis method of interrupted time series for consumption and expenditure of cholecalciferol, different types of interventions adopted in four Italian regions and their efficacy were evaluated.

Results: Molise achieved the best results by adopting a health professionals' education program in addition to a prescriber-sanction system.

[Vitamin D and COVID-19: a communication far from reality].

The intake of Vitamin D against COVID-19 has theoretical bases. In the 3-year period of the pandemic, hundreds of favorable observational studies and some small randomized controlled trials (RCTs) have been produced.However, to date, RCTs of larger size and quality have unfavorable results and do not support its use, neither in oral form at various doses nor as injection boluses nor in prophylaxis nor in treatment of COVID-19, not even in severe or critical cases, nor to prevent deaths.

[Vitamin D and coronavirus: a new field of use?].

Given the succession of communications in scientific and popular circuits, tending to take for granted a role for vitamin D in the control of the coronavirus pandemic, the authors conducted an analysis of the literature currently available in order to recognize what is supported by opinions personal and what evidence of effectiveness. At the end of the bibliographic survey there is the current absence of evidence of efficacy in favor of vitamin D in the treatment of coronavirus infection in its various expressions. The diffusion of personal opinions as if they were evidence can be a disturbing factor for adequate assistance and for correct research.

Short-term and long-term effects of tibolone in postmenopausal women.

Background: Tibolone is a synthetic steroid used for the treatment of menopausal symptoms, on the basis of short-term data suggesting its efficacy. We considered the balance between the benefits and risks of tibolone.

Objectives: To evaluate the effectiveness and safety of tibolone for treatment of postmenopausal and perimenopausal women.

[Guided clinical practice guidelines: how to blunt the weapon of evidence].

The public should trust practice guidelines only if the recommendations accurately reflect the underlying evidence about benefits and harms to individual patients. However, the process of development of clinical practice guidelines is fraught with problem, conflicts and controversies. A few examples, starting from the guidelines on osteoporosis are presented and commented on.

Long term effectiveness on prescribing of two multifaceted educational interventions: results of two large scale randomized cluster trials.

Introduction: Information on benefits and risks of drugs is a key element affecting doctors' prescribing decisions. Outreach visits promoting independent information have proved moderately effective in changing prescribing behaviours.

Objectives: Testing the short and long-term effectiveness on general practitioners' prescribing of small groups meetings led by pharmacists.

[Novel oral anticoagulants: more opportunities or more risks? And for which patients?].

Novel direct oral anticoagulants (NAO) represent an innovative and potentially relevant option for the prevention of cardiac embolism in patients with atrial fibrillation. Their recent introduction has been followed by a wide debate on their appropriate use, considering that they do not require regular monitoring of INR values as Vitamin K Antagonists (VKA) do, but that are much less tested in everyday clinical practice and much more expensive than VKA. Starting from the quite favourable results of the available RCTs - showing that NAO are at least non-inferior to VKA and that may be even better for some outcomes - this article discusses the clinical relevance of these results, their transferability into clinical practice looking at the methods of those RCTs and potential risks related to their widespread introduction.

Short and long term effects of tibolone in postmenopausal women.

Background: Tibolone is an option available for the treatment of menopausal symptoms, based on short-term data on its efficacy. However, there is a need to consider the balance between the benefits and risks of tibolone as there are concerns about breast and endometrial cancer as well as stroke.

Objectives: To evaluate the effectiveness and safety of tibolone in treating postmenopausal women.

Randomised controlled trials for evaluating the prescribing impact of information meetings led by pharmacists and of new information formats, in General Practice in Italy.

Background: Suboptimal translation of valid and relevant information in clinical practice is a problem for all health systems. Lack of information independent from commercial influences, limited efforts to actively implement evidence-based information and its limited comprehensibility are important determinants of this gap and may influence an excessive variability in physicians' prescriptions. This is quite noticeable in Italy, where the philosophy and methods of Evidence-Based Medicine still enjoy limited diffusion among practitioners.

[Practice guidelines, CME and epidemiologic research in general practice: a consistent triad?].

A multidisciplinary effort involving epidemiologists, general practitioners and specialists is critical for finding valid and feasible answers, by asking the right questions through observational and experimental studies. Clinical practice guidelines may represent a good starting point of this research process, highlighting which information needs exist in everyday practice; logically, guidelines also represent an ideal end, as a means of transferring any useful knowledge produced into practice. In between, this research process may have an added educational value and represent an active and valuable means of achieving continuing medical education credits.