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Objective: To find just how suitable thromboembolism prophylaxis (TEP) is in a group of patients with chronic auricular fibrillation belonging to the primary care environment., Design: Cross-sectional and descriptive multi-centre study., Setting: The study was performed at 3 urban primary care centres in Madrid., Participants: All the patients recorded up to April 2001 with the diagnosis of chronic auricular fibrillation (n=274) were included. Patients with no clinical history or who had a valve prosthesis were excluded., Main Measurements: Demographic variables, existence of factors of risk of embolism, presence of counter-indications for oral anti-coagulants, and the kind of thromboembolic prophylaxis taken were collected., Results: A total of 274 patients were evaluated. Average age was 75 (SD, 9) and 52% were women. 82% of patients had at least one factor of risk of thromboembolism. The most commonly used kind of TEP was oral anti-coagulants. 45% of patients did not receive suitable TEP. 13.5% of patients at risk of embolism and who had no kind of TEP were found., Conclusions: There is a high percentage of patients with chronic auricular fibrillation and a high risk of embolism, who do not receive adequate TEP, in the absence of counter-indications to taking oral anticoagulants. There is great scope for improvement, which is within professionals' possibilities.

Objectives: To find the number of patients seen in casualty who received gastropathy prophylaxis with NSAIDs that complied with the pharmaco-therapeutic guidelines of the health district., Design: Descriptive study of technical-scientific quality., Setting: The Casualty Department of the Ramón y Cajal hospital., Participants: Randomised sample of 400 emergencies attended in January 1999 and 2000, excluding paediatric cases, people previously treated with gastro-protectors, patients admitted and the deceased. Main measurements. On the basis of casualty records: suitability of indication and criteria used; if unsuitable, how; adequacy of selection of the principle, patient' age and sex, digestive pathology history, area and year of care., Results: NSAIDs were prescribed in 37.9% of cases (33.27-42.79), with prescription unsuitable in 21.19% (15.2-28.3). 15% (9.5-22) were unsuitable by default; and 54.2% (35.1-72.1), by excess. Unsuitability was greater among women, if there was history of digestive pathology, and among older people, with no differences found for area or year of care. The choice of gastric protector was not suitable in any case., Conclusions: Given the amount of primary care prescription originating in hospital casualty departments, and its effect on the training of family medicine interns, strategies coordinated between health care levels must be introduced in order to improve gastric protection prescription in NSAID gastropathy prophylaxis. The effectiveness of these strategies must be evaluated.

Objective: To find scientific evidence to support the indication for treating outbreaks in COPD patients on an out-patient basis with levofloxacine, as against conventional treatments., Design: Standardised review, following the criteria of medicine based on the evidence. A bibliographic search of the MEDLINE data base from 1966 to June 2000 was the basis for an analysis of the evidence found., Setting: Non-hospital treatment., Patients and Other Participants: COPD patients suffering a light outbreak of probable bacterial origin, according to the Anthonisen criteria., Interventions: The intervention analysed was treatment with 500 mg/day of levofloxacine taken orally. An attempt was made to compare this with conventional treatments such as amoxycillin-clavulanic acid and acetyl cefuroxime. The indicators of results analysed were reduction in mortality or in the number of hospital admissions., Measurements and Main Results: No clinical trial was found that compared levofloxacine and amoxycillin-clavulanic acid. Two clinical trials were found that compared levofloxacine and acetyl cefuroxime. These found no significant differences between the group treated with levofloxacine and the group treated with cefuroxime., Conclusions: No scientific evidence demonstrating advantages of levofloxacine treatment over amoxycillin-clavulanic acid was found, or over acetyl cefuroxime as empirical PC first-choice treatment for patients with outbreaks of COPD.