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The purpose of this study was to determine the extent of inappropriate admissions and days of stay in acute beds of patients who were admitted to hospital after attending the emergency department for urgent medical attention in Italy. The medical records of all adult patients (aged 16 years and over) on one randomly preselected day during the period January-December 2001 were reviewed. The retrospective application was made using the Appropriateness Evaluation Protocol list of criteria. Overall, 28.4 and 75.7% of hospital admissions and days of stay, respectively, were judged to be inappropriate. Results of the multiple logistic regression analysis indicated that inappropriate admission was significantly more likely in patients who lived closer to hospital, in younger patients, in patients from lower socio-economic classes, and in patients who did not receive diagnostic procedures in the emergency department. The proportion of patients whose admission was considered inappropriate was significantly lower in medical specialties wards. The number of inappropriate hospitalisation days was significantly higher in younger patients, in those admitted inappropriately, and in patients sampled close to discharge (during the final-third of his/her stay). The number of inappropriate hospitalisation days was significantly lower in patients admitted to surgical and traumatology/orthopaedics and medical specialties wards. Our findings indicate the need for specific interventions to reduce the prevalence of inappropriate hospital use and to modify physicians' attitudes and behaviours.

We investigated the knowledge and behaviors of a random sample of 500 primary care physicians (PCPs) regarding oral cancer in Calabria (Italy). 87.6% and 64% indicated tobacco and alcohol use as risk factors, only 31.5% and 2.8% having a prior oral cancer lesion and older age. 60.9% knew that squamous-cell carcinoma is the most common form; 68.8% and 37.1% that the tongue and floor of the mouth were the two most common sites. Respectively 91.5% and 41.7% knew that leukoplakia and erythroplakia were the two conditions most likely to be associated with oral cancer. 17.6% of PCPs recognized that an early oral lesion usually is small and painless red area and 26.8% knew how to examine the tongue. PCPs who learned about oral cancer from scientific journals were more likely to indicate tobacco use as a risk factor for oral cancer and those who do not need additional information to indicate alcohol use as a risk factor. Oral examination was provided by 63.8% and 37.1% to those 40 years of age and older. Half of respondents asked about the personal patient's experience of oral cancer and about the patient's family, most about patients' tobacco and alcohol use. The odds of asking about patients' tobacco and alcohol use and of performing oral cancer examination were significantly higher for those who practiced medicine for a longer period. Additional training and continuing educational programs on prevention and early detection of oral cancer for PCPs are strongly needed.