Control of hypertension in Italy: results of the "Study on Antihypertensive Treatment in General Practice (STAP)". Physicians Taking Part in STAP.

Background: Various epidemiological surveys from different countries have documented the unsatisfactory control of arterial hypertension. The aim of this study was to assess the current status of treatment and control of hypertension in Italy.

Methods: A random sample of general practitioners (GP) working in several Aziende Sanitarie Locali (Local health offices-ASL) throughout Italy were invited to take part in the study.

Administration of thrombolytic therapy to 17,944 patients with acute myocardial infarction: the GISSI-3 database.

Background: There is growing interest in assessing therapy for acute myocardial infarction. Because thrombolysis was not a study therapy in the GISSI-3 trial, the decision about thrombolysis was left to the responsible physicians. We evaluated the data on thrombolytic therapy among patients with acute myocardial infarction enrolled in the GISSI-3 trial to study the relation between rate of prescription and the characteristics of patients and participating coronary care units.

Use of beta-blocking agents in secondary prevention after myocardial infarction: a case for evidence-based medicine? GISSI experience, 1984-1993. The Gruppo Italiano di Studio sulla Sopravvivenza nell'Infarto Miocardico (GISSI) Investigators.

Aims: Many clinical trials conducted in the 1970s and early 1980s have shown that the long-term use of beta-blockers after an acute myocardial infarction significantly reduces mortality and reinfarction rates. This study assessed the impact of these findings in clinical practice.

Methods: We retrospectively analysed the beta-blocker prescriptions for 36,817 patients with acute myocardial infarction included in three large randomized clinical trials (Gruppo Italiano di Studio sulla Sopravvivenza nell'Infarto Miocardico--GISSI, 1, 2, and 3), conducted by a highly representative sample (about 75%) of Italian coronary care units in 1984-85, 1988-89 and 1991-93.

Cost-effectiveness analysis of early lisinopril use in patients with acute myocardial infarction. Results from GISSI-3 trial.

The cost effectiveness of early treatment with lisinopril in acute myocardial infarction (MI) was estimated using survival and cost data gathered prospectively during the hospitalisation of the overall population of patients enrolled in the third study of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto (GISSI-3), which assessed the efficacy of early (within 24 hours) treatment with an angiotensin-converting enzyme (ACE) inhibitor (lisinopril) for 6 weeks in a group of 19,394 relatively unselected patients with acute MI. A statistically significant reduction in 6-week mortality was achieved among patients treated with lisinopril when compared with patients allocated to the control group (absolute reduction in mortality: 7.5 +/- 3.

Risk factors for lower limb complications in diabetic patients. The Italian Study Group for the Implementation of the St. Vincent Declaration.

Diabetic lower extremity complications may be influenced by a number of factors, including those related to the interaction between patients and the health-care system. Our objective is to identify risk factors for the development of lower limb complications, by looking for classical clinical variables and those related to quality of care. A case-control study was carried out between December 1993 and June 1994 by interviewing 348 patients with lower-limb diabetic complications and 1050 controls enrolled from 35 diabetes outpatient clinics and 49 general practitioner's offices in Italy.

Possible risk factors for primary adult onset dystonia: a case-control investigation by the Italian Movement Disorders Study Group.

Objectives: Little is known about the aetiology of idiopathic adult onset dystonia. The Italian Movement Disorders Study Group promoted a case-control study on some hypothetical risk factors including past medical events, life events, life habits, occupational hazards, and family history of dystonia, parkinsonism, and tremor.

Methods: Cases affected by idiopathic adult onset dystonia (age at symptom onset >20 years, duration of disease >one year and View Article and Find Full Text PDF

Effect of the ACE inhibitor lisinopril on mortality in diabetic patients with acute myocardial infarction: data from the GISSI-3 study.

Background: Mortality of diabetic patients with acute myocardial infarction (MI) remains high despite recent improvement in their management. There is a need to evaluate efficacy and safety of novel treatments of MI in this high-risk population. We evaluated whether treatment with an ACE inhibitor begun within 24 hours from the onset of symptoms is able to decrease mortality and morbidity of diabetic patients with acute MI.

Approaches to informed consent.

Informed consent (IC) is an indicator, or a pivotal point, in broader and more fundamental questions dealing with the way clinical experimentation and, more specifically, randomized controlled trials (RCTs) relate to routine clinical practice; the rules that characterize the doctor-patient relationship; the self-perception of medicine with respect to its capacity, duty, and autonomy in the production of new knowledge; and the role of medicine in society. The asymmetry of knowledge and power that characterizes the usual relationship between care providers and patients does not resolve when something experimental enters the relationship. The real world of clinical investigation is not uniformly distinct from clinical practice.

The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto.

Background: Prophylactic platelet transfusions are usually administered to patients receiving myelotoxic chemotherapy when their platelet count falls below 20,000 per cubic millimeter. Some observations suggest that lower platelet counts can be appropriate in patients in stable condition, but the safety of lower thresholds is uncertain.

Methods: We evaluated 255 adolescents and adults (age, 16 to 70 years) with newly diagnosed acute myeloid leukemia (but not acute promyelocytic leukemia), who were treated in 21 centers.

Treatment of acute myocardial infarction today.

The management of acute myocardial infarction (AMI) has undergone major changes in the last decade. Today clinical practice can be based on sound evidence derived from a large number of well-conducted, randomized, large-scale clinical trials. Because of this, Scientific Societies, such as the European Society of Cardiology, have recently produced evidence-based guidelines for the treatment of AMI.

Epidemiology of psychiatric care of patients with severe mental disorders in Italy. Rationale and design of a prospective study, and characteristics of the cohort. Italian Collaborative Study Group.

The rationale and design of a large, multicentre, prospective follow-up study on the outcome of severe mental disorders is presented. The study is currently under way in Italy, where psychiatric care has been uniquely characterised since 1978 by the statutory prohibition of admitting patients to psychiatric hospitals. The main purpose of the study is to describe the 5-year outcome of patients with a diagnosis of schizophrenia, paranoid disorder, affective psychosis, reactive psychosis or personality disorder with respect to five areas (clinical condition, personal autonomy, work, and family and social relationships); a secondary objective is to describe the heterogeneity of practices and resources of psychiatric services.

Role of interactions between psychological and clinical factors in determining 6-month mortality among patients with acute myocardial infarction. Application of recursive partitioning techniques to the GISSI-2 database. Gruppo Italiano per lo Studio della Sopravvivenza nell' Infarto Miocardico.

Background: Clinical and epidemiological studies support the hypothesis that ischaemic cardiovascular diseases are consistently associated with psychological, social and behavioural factors. Nevertheless, the joint effect of clinical characteristics and psychological variables in determining the prognosis of acute myocardial infarction survivors has been seldom investigated.

Methods And Results: In the framework of the GISSI-2 trial, the impact of psychological factors on 6-month mortality and their interaction with clinical features was included as an ad hoc research project.

Access to rehabilitation facilities in an unselected hospital population affected by acute stroke.

The aim of this study was to evaluate the selection criteria and characteristics of the patients who have access to rehabilitation facilities after having experienced an acute stroke. Between January 1993 and February 1994, 383 patients were recruited in 13 hospitals in Lombardy, and telephonically followed up four months after study entry. The data were collected by members of the Associazione Volontari Ospedalieri (Hospital Volunteers' Association).

Patterns of care an Italian diabetic population. The Italian Study Group for the Implementation of the St Vincent Declaration, Società Italiana di Diabetologia, Associazione Medici Diabetologi.

We set out to describe patterns of care of an Italian diabetic population, with reference to the recommendations of the St Vincent Declaration. We investigated different aspects of care received by 2707 patients, of whom 2196 in the charge of 35 Diabetes Outpatient Clinics (DOCs) and 511 cared for by 49 General Practitioners (GPs). Data were collected by interviewing the patients, their physicians and by reviewing medical records.