General Medical Practice Research Articles

Multidisciplinary Approaches in General Medical Practice: Enhancing Collaboration for Better Patient Care

Multidisciplinary approaches in general medical practice have become integral to providing comprehensive, patient-centered care, as the complexity of modern health issues often requires a diverse range of expertise. This review explores the role and benefits of multidisciplinary teams in enhancing patient outcomes, improving resource efficiency, and increasing patient satisfaction in general medical settings. By examining the contributions of various healthcare professionals—including primary care physicians, specialists, allied health professionals, and behavioral health specialists—this review emphasizes how collaborative efforts address complex health needs more effectively than traditional, siloed approaches. Key case studies illustrate successful multidisciplinary practices in managing chronic diseases and complex conditions, highlighting the advantages of coordinated care models. The review also addresses challenges, such as communication barriers, hierarchical dynamics, and logistical constraints, that can hinder effective collaboration. Furthermore, it discusses technological supports, such as electronic health records (EHR) and telemedicine, which facilitate real-time communication and care coordination. The article concludes with recommendations for expanding multidisciplinary teams in primary care, promoting educational initiatives for team-based care skills, and advocating for policy support to institutionalize multidisciplinary approaches in general medicine. These findings suggest that well-coordinated multidisciplinary teams can transform patient care, making it more holistic, efficient, and responsive to individual needs.

Prostate Specific Antigen (PSA) testing in a general practice 2009-2019.

Prostate-specific antigen (PSA) testing is not recommended as a population screening measure for prostate cancer. PSA testing is nevertheless widespread and is associated with harm due to false-positive test results, overdiagnosis and economic costs. This study sought to document the exposure of patients to PSA testing over a decade in a general medical practice setting. Laboratory results for each year were extracted from the clinical record. A chart review was undertaken for cases of prostate cancer. We report 13,743 PSA results in 3313 men. In any year, 18% of all men and 33% of men aged over 50years had at least one PSA test. Between 4.8 and 21% of first tests exceeded age normal values depending on age. There were 113 incident cancers in the study interval of which 84 (74%) were screen detected. Mortality was lower in screen-detected than symptomatic cancers. Men at our practice are significantly exposed to PSA testing. We found evidence of possible overdiagnosis.

Perspectives for using serratiopeptidase in systemic enzyme therapy for low-intensity chronic inflammation and pain syndromes: from mechanisms of action to practical implementation (literature review)

Background. Recent experimental and clinical stu­dies have confirmed the effectiveness and safety of serratiopeptidase (SRP) as a powerful anti-inflammatory agent, highlighting its potential benefits across various fields of medicine. The ­purpose was to analyze current literature on the mechanisms of action of SRP as a means of systemic enzyme therapy for low-intensity chronic inflammation and pain syndromes, its clinical applications, and prospects for implementation in general medical practice. ­Materials and methods. To identify relevant literature sources, a comprehensive search was conducted in electronic databases, inclu­ding PubMed, Scopus, Web of Science, and the Cochrane Library. ­Results. According to modern literature data, SRP demonstrates quite powerful anti-inflammatory, analgesic, reparative, fibrinoly­tic, and mucolytic properties, and exhibits a certain antimicrobial activity, especially against biofilm-forming bacteria. The combination of this enzyme with traditional antibiotics provides a more effective treatment of infectious processes. SRP has significant potential in the treatment of conditions and diseases associated with the development of low-intensity chronic inflammation and pain syndromes (especially in comorbid ones) due to its anti-inflammatory, anti-edematous, antithrombotic, and analgesic properties associated with the inhibition of cyclooxygenase 1 and 2, 5-lipoxygenase activity, myeloperoxidase and elastase, suppression of the formation and/or release of bradykinin, biogenic amines, pro-inflammatory cytokines, cell adhesion molecules, cleavage of bradykinin-related peptides, limitation of oxidative-nitrosative stress. The effectiveness of the enzyme notably increases when it is combined with some prebiotics and/or probiotics. Conclusions. The development of new dosage forms of SRP, along with further preclinical and clinical trials, could lead to new strategies for the prevention and treatment of inflamatory diseases.

Serum 25 Hydroxy – D in Patients without Vitamin D Supplementation: Perspectives from Cohorts with Rheumatoid Arthritis and Systemic Lupus Erythematosus

Hypovitaminosis D is common in the sunny UAE. This study focusses on the perspectives of 25 hydroxy-D in patients with RA and others with SLE ((Autoimmune disease, ADs)) and to compare them to others of patients without ADs) .The latter were used as control group. All included individuals were without history of vitamin D intake. Hypovitaminosis D was common in the 3 groups (RA, SLE and controls). However, the prevalence of hypovitaminosis D in patients with each of ADs was significantly lower to that of the control group yet with higher means of 25 (OH) D levels. These findings were in contrast to those of number of regional and international studies conducted earlier. Data on the high prevalence of hypovitaminosis D and the low mean values of 25 (OH) D were comparable between the two groups of ADs. Overall, the results of this study may lead to some controversy or perhaps a challenge to the widespread understanding of the contrary as per previous international and regional studies. They also argue further the concept of specific association of hypovitaminosis D and autoimmune disease and certainly encourage wider estimation of 25(OH) D among larger numbers of patients in general medical practice. Finally, the outcomes of this work deserve further study/ies in larger groups in the future.

Humoral serotonin and neuropsychological status of patients with dizziness

Dizziness is often accompanied by affective disorders such as anxiety and depression, in the occurrence of which the role of the serotonergic system is discussed.Objective: to investigate the serotonin content in blood serum and neuropsychological status in patients with vestibular and non-vestibular dizziness.Material and methods. The study included 97 patients. Two observation groups were formed according to the type of dizziness complaints. The first group (n=47) comprised patients with vestibular (systemic) dizziness against a background of peripheral vestibulopathy, the second group (n=35) comprised patients with non-vestibular (non-systemic) dizziness with a diagnosis of probable persistent postural-perceptual dizziness (PPPD). The control group (n=15) consisted of patients without complaints of dizziness. Neurological and otoneurological status, psychoemotional parameters (level of anxiety and depression) and cognitive functions were analyzed, and the quantitative level of serotonin in blood serum was determined by enzyme immunoassay.Results. The study revealed a significant decrease in the serum serotonin levels in vestibular and non-vestibular dizziness; a lower serotonin level was found in non-vestibular dizziness (p<0.05). The presence of affective disorders did not correlate with a decrease in serotonin levels in vestibular dizziness against a background of peripheral vestibulopathy. It is assumed that a decrease in serotonin content plays a role in pathogenesis of vestibular dizziness on the background of peripheral part of vestibular system involvement.Conclusion. We demonstrated possibility of using the level of serotonin in peripheral blood as an objective laboratory marker of vestibular and non-vestibular dizziness in general clinical medical practice.

A study of medical students’ experiences at Shiraz University of medical sciences from the implementation of integration in medical education: a qualitative study

BackgroundThe basic science course is the foundation of medical knowledge, and how and in what form the teaching of this course is a vital issue. A successful curriculum should include everything medical students need in their future careers. Basic science education should be such that students clearly understand the relationship between the content and its application in clinical practice. Therefore, the need to change the curriculum of the general medicine course, especially course of the Basic science, in content and layout in an integrated way is felt more than before. This study was designed to explain the experiences of medical students from the Shiraz University of Medical Sciences since the implementation of integration in 2020.MethodsThe present study was qualitative research with a conventional content analysis method. Participants were selected for the interview purposefully. They included 12 Medical students from basic and clinical sciences and 5 faculty members. Data were collected through semi-structured interviews and the content analysis method. Four methods of Goba and Lincoln were used to evaluate the accuracy of the data.ResultsAfter summarizing and analyzing the data, 221 codes were extracted. They were divided into seven subcategories and finally, three main themes including Enjoyable experiences (advantages of the integration system), Upsetting experiences (Disadvantages of the integration system), Resolutions to solving integration problems were extracted. Generally, the findings indicated a positive evaluation of medical students of Shiraz University of Medical Sciences from the integration system, and they stated that the integration causes an interaction between basic and clinical sciences and also increases students’ motivation.ConclusionThe findings indicated a positive evaluation of Shiraz’s medical students of the integrated system. According to the results of this research, it can be said; that the use of integration horizontally and vertically in medical education improves the quality of education compared to traditional methods. The integration of basic and clinical science is important in the sense that can be a powerful tool for learning and acquiring skills, also, it can also help in the promotion of professional development of students and motivate them to study more in interactive manner and be loyal to lifelong learning. study generally showed that combining theoretical and practical courses has advantages and disadvantages, but its advantages are more. Paying attention to the shortcomings, especially in the supply of human resources and professors, and reforming the program with continuous revision are issues that education managers and medical educators of the general medical practice should address.

Priority of competencies in the professional activities of general practitioners (family doctors)

The functional responsibilities of general practitioners (family doctors) (GPs) have changed significantly over the past decade. The number of GP functions has expanded. Despite the increasingly complex professional activities of GPs, there is no scientific evidence for the qualification characteristics of GPs expressed in knowledge, skills, abilities, and competencies in the theory and practice in training. In this regard, a study was conducted to determine the priority of GP competencies that make up the qualification characteristics of a specialist. Aim. To analyze, generalize and rationale the research results, as well as to develop preliminary guidelines for GP training. Material and methods. The information base for the study was the results of ranking competencies according to their importance in the professional activities of GPs in Russia. It was obtained during the ascertaining experiment, implemented using the Delphi method as a method of expert assessment and strategic planning of training specialists. Conclusion. The analysis of competencies developed and agreed upon by experts showed its compliance with the job functions of GPs, the requirements of the Federal State Educational Standard for the General Medical Practice (Family Medicine) and the WONCA guidelines. A summary of the study results to determine the priority of competence in GP activities showed the following: — all competencies (25) were defined as necessary and constitutive of GP qualification; — 21 competencies were considered significant and highly significant for GPs; — 4 competencies were considered as of moderate significance and below moderate significance. The analysis of the priority of competences revealed insufficient methodological support for GP training in accordance with the social order. The results obtained showed the need to continue the study within the project "Quality Management of Training of General Practitioners (Family Doctors)".

Mental Health Disorders of Bulgarian Healthcare Professionals during a Recurring Wave of the COVID-19 Pandemic

Introduction: During the COVID-19 pandemic, health hazards for medical professionals are associated not only with the high risk of infection, but also with poor working conditions, a stressful psychosocial environment and several socio-demographic factors. Objectives: The study aims to gain insight into possible mental health disorders among healthcare professionals working in the Bulgarian healthcare system and to determine which professional and socio-demographic categories are most significantly affected. Methods: This cross-sectional study was conducted in October 2022 in healthcare facilities from seven regions in Southern Bulgaria. A total of 665 workers from hospitals, emergency centers, general and specialized medical practices, and medical laboratories filled out the self-assessment mental health questionnaire DASS-21 (Depression, Anxiety and Stress Scale), as well as a survey about their occupational and socio-demographic characteristics. Suitable statistical methods were used to assess the scientific hypothesis. Results: 40% of all surveyed healthcare workers had some type of self-reported mental health disorder, with 27% having more than one. 13% had simultaneous signs of depression, anxiety and stress. The rates of depression, anxiety and stress were highest among those working in COVID wards and emergency care centers, among young workers under 26 years of age, and among workers with disabilities and frequently ill workers. Conclusions: Protecting healthcare workers’ physical and mental health and work ability is a matter of primary importance, particularly under challenging working conditions such as the COVID-19 epidemic.

Effect of Fermented Soybean (FSB) Supplementation on Gastroesophageal Reflux Disease (GERD).

Gastroesophageal reflux disease (GERD) is a prevalent chronic condition affecting the well-being of both adults and children in general medical practice. Research on the effects of fermented soybean (SB) supplementation in managing GERD is relatively new, with limited studies available. The existing research often lacks sufficient dosing regimens and study durations to differentiate between transient placebo effects and sustained benefits. In this study, the beneficial effects of FSB supplementation were investigated in 110 voluntary participants (NCT06524271). The participants were required to take 1 g of FSB supplement once daily for 12 weeks. GERD symptoms were evaluated using the Reflux Disease Questionnaire (RDQ), while inflammatory markers, including interleukin-4 (IL-4), interleukin-6 (IL-6), and interleukin-8 (IL-8), were measured to assess inflammation. The Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire was used to evaluate participants' quality of life. The results indicated that FSB supplementation significantly (p < 0.05) alleviated heartburn and regurgitation symptoms and reduced levels of IL-4, IL-6, and IL-8, indicating a notable anti-inflammatory effect. Additionally, significant (p < 0.05) improvements were observed in QOLRAD scores, particularly in vitality, emotional distress, and physical/social functioning. Collectively, our findings support the use of FSB as an adjuvant approach in managing GERD, with notable improvements in patients' quality of life.

Serum Transaminases and Older Adults: Distribution and Associations With All-Cause Mortality.

Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are commonly ordered tests in general medical practice. However, their distribution and significance in older adults are understudied. As such, we aimed to evaluate sex-stratified distribution of both ALT and AST in older adults (≥70 years) and assess for associations with mortality. Post-hoc analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) randomized, placebo-controlled trial of daily low-dose aspirin for initially relatively healthy older persons. Univariate analysis and multiple logistic regression were used to explore baseline characteristics. Cox regression and restricted cubic splines were used to examine links between transaminase levels and mortality. Of the 11 853 participants with ALT and AST levels, 1 054 (8.9%) deaths were recorded over a median of 6.4 (interquartile range [IQR] 5.4-7.6) years. For ALT, the lowest quintiles for males and females were 6-15 and 5-13 U/L, respectively; for AST, the lowest quintiles were 8-18 and 7-17 U/L, respectively. On both univariate and models adjusted for covariates including age, body mass index, frailty, diabetes, and kidney disease, males and females in the lowest quintile of ALT had an increased hazard of mortality (aHR 1.51 [95% confidence interval {CI} 1.14-1.99] and aHR 1.39 [95% CI 1.03-1.88], respectively). For the lowest quintile of AST, only males were at increased risk (aHR 1.33 [95% CI 1.04-1.70]). Associations remained significant when removing outliers. Low ALT levels independently confer an increased hazard of mortality for older males and females; low AST only affected older male survival. Further evaluation of mechanisms would be worthwhile, and re-evaluating the lower limit of normal for ALT in older adults should be considered.

Review and Therapeutic Approach to Malalignment of the Great Toenails: A Common Condition That Is Uncommonly Diagnosed.

Malalignment of the great toenails is a common nail disorder that is uncommonly recognized in general practice. Review available literature on lateral malalignment of the great toenails to increase awareness of this underdiagnosed condition and provide management recommendations. A PubMed search was conducted using the terms "congenital malalignment toenail" and "malalignment great toenail". All articles were reviewed, and all relevant articles were included in this analysis. Thirty-four distinct articles encompassing 117 patients with similar clinical findings: lateral deviation of the great toenails with yellow brown dyschromia, thickening, and scalloping. Description of malalignment and terminology can vary, which may have led to exclusion of some relevant articles. Lateral malalignment is a common nail condition that is underappreciated and often misdiagnosed in general dermatologic and medical practice. This review aims to increase awareness to facilitate better care of these patients.

Prevalence of Osteosarcopenic Adiposity in Apparently Healthy Adults and Appraisal of Age, Sex, and Ethnic Differences.

Osteosarcopenic adiposity (OSA) syndrome, the coexistence of osteoporosis, sarcopenia, and adiposity (either excess or redistributed/infiltrated), has been studied globally in different populations and regions (mostly in East Asia, less in Europe and North America), resulting in varied prevalence. We aimed to determine the prevalence of OSA in a large population of apparently healthy Caucasian adults (18-90 years) and to compare it with the prevalence reported in other studies and other ethnicities. This study included 9719 participants (6412 women and 3307 men), stratified into four age-group categories, and recruited from the general medical practices in Italy. OSA was defined based on body composition measurements using bioelectrical impedance BIA-ACC®, which enables assessment of total bone mass, muscle/lean, and adipose tissues. The overall prevalence of OSA was 21.9% in women and 14.0% in men, and it significantly increased in every subsequent age group for both women and men (p < 0.001). The OSA prevalence was not significantly different between men and women below 40 years; however, it was considerably higher in women over 40 years. Participants with OSA had a significantly lower BMI compared to those without OSA, indicating OSA is a separate disorder not necessarily related to physiological fluctuations of BMI. The prevalence in Asian populations was lower than in our sample, indicating ethnic specificity. The relatively high prevalence of OSA detected in this study's population across the age groups suggests the necessity for its appropriate and timely identification to prevent possible clinical outcomes, including fracture, dismobility, frailty, or chronic diseases.

Компоненты личностной зрелости студентов первого курса.

Research of personal maturity allows to determine the resources of professional responsibility in the development of the doctor’s competencies, which is especially important during the period of adaptation to the new conditions of learning in the first year. Mature person due to developed qualities achieves better results in a short time and effectively interacts with other people. Purpose of the study is to determine the indicators of personal maturity of students enrolled in the first year in 2023. Materials and methods. The Department of General Medical Practice conducted a survey of students enrolled in the first year in 2023. Total 396 persons: 313 women and 83 men. The average age of the respondents was 18,18±1,71 years. The study used the Hilbuch method to assess the level of personal maturity in general and its components. Results. The high level of unsatisfactory indicators of both personal maturity in general and its components was revealed, among which the worst results were noted when assessing the relationship of freshmen to their «I» (74.8% to 63.9% for females and males respectively). The medians of most indicators were not satisfactory. There are no statistically significant differences by sex, but the median sense of relationship to his «I» was significant among female respondents. Findings. The low level of personal maturity of students was revealed with no motivation and undetermined life attitudes in the absence of the ability to psychological intimacy with other people, which can become a psychological barrier to the development of professional competencies and communication in medical professions. Components of personal maturity, sense of civic responsibility and «I»-concept must be formed at the initial stage of learning, using all the possibilities of educational work and psychological support for freshmen.

Features of the use of art therapy in working with members of military families

The article is devoted to the analysis of the peculiarities of the use of art therapy in working with members of military families. The concepts of art therapy, social adaptation, and coping resources are characterized. The concept of grief and its course during war, in particular when a loved one is lost in war, is defined. The results of an empirical study on the severity of anxiety, depression and post-traumatic growth of women who lost relatives in the war are presented. The art therapy technique "Painting grief" is characterized. The purpose of this article is to determine the possibilities of using art therapy in working with military family members. The tasks of the article are to define the concept of grief and its course during war, in particular when a loved one is lost in war; analysis of the results of an empirical study on the severity of anxiety, depression and post-traumatic growth of women who lost relatives in the war, an outline of the possibilities of implementing the art therapy technique "Painting grief". To achieve the goals of the study, we used the following methods: Hospital anxiety and depression scale (HADS) Post-traumatic growth questionnaire (PGI). The hospital scale of anxiety and depression is designed to assess the severity of depression and anxiety in the conditions of general medical practice, contains 14 items, each of which corresponds to 4 options of answers that reflect the degree of increase in the corresponding symptomatology: normal, borderline state, moderately expressed anxiety/depression, severe form of anxiety /depression. Questionnaire of post-traumatic growth (R. Tadeshi and L. Calhoun) contains 21 statements with six possible answer options that form five scales: attitude to others, new opportunities, personal strength, spiritual changes, increased value life, as well as the general index of post-traumatic growth. According to the HADS method, subclinically expressed depression, the so-called borderline state, was detected, however, in the case of the death of a loved one in the war, relatives feel moderately expressed anxiety, while after death from diseases or simply death in civilian life, relatives note the absence of reliably expressed symptoms. Personal growth means the feeling that after a loss a person has become more merciful, tolerant towards himself and others, learned to forgive himself and the people around him, and look optimistically at the future. Although the loss of a loved one is a natural life event experienced by all people, it is also one of the most difficult experiences in a person's life. For many people, the loss of a loved one is accompanied by an intense emotional and devastating period. Experiencing the death of a loved one causes great stress both because of the loss and because of the encounter with mortality. Numerous stressors also occur when a bereaved person attends various events and services that are not normally included in the routine of daily life, including memorial services in a church. Many bereaved people find a path that leads to the restoration of a relatively normal life. However, some people do not cope effectively with loss. They experience grief very emotionally, often denying the fact of loss, trying to avoid reminders of death and helplessly focusing on the nagging waves of painful emotions. One of the effective methods of dealing with grief is art therapy.

Sicherstellung der hausärztlichen Versorgung in Deutschland – Befunde einer quantitativen Befragung von Allgemeinmediziner*innen

ZusammenfassungHintergrundAngesichts der Gefahr einer Verknappung niedergelassener Allgemeinmediziner*innen stellt sich die Frage, welche Konzepte wirksame Beiträge leisten können, um eine drohende Mangelversorgung abzuwenden. Bis dato fehlt es an Studien, die beleuchten, wie Hausärzt*innen aus ihrer beruflichen Erfahrung zu verschiedenen Ansätzen zur langfristigen Sicherstellung der Primärversorgung stehen.Ziel der ArbeitZiel der Studie war es, Positionen, Haltungen und Erfahrungswerte von Hausärzt*innen mit Blick auf eine Sicherstellung der allgemeinmedizinischen Breitenversorgung zu ermitteln.MethodenIm Zuge einer Online-Befragung wurden zwischen Februar und Juni 2023 insgesamt 4176 Hausärzt*innen befragt. Über die deskriptive Analyse hinaus erfolgte zur Ermittlung von signifikanten Unterschieden zwischen 2 Gruppen ein t‑Test bei unabhängigen Stichproben.Ergebnisse42 % beobachten im Umfeld einen merklichen Schwund allgemeinärztlicher Praxen. 53 % bescheinigen der Hausarztmedizin eine sinkende Attraktivität für den ärztlichen Nachwuchs, was 3 Problembereichen zugeordnet wird: 1) Stellung der hausärztlichen Versorgung im Gesundheitswesen, 2) Voraussetzungen in Aus- und Weiterbildung, 3) Arbeitsbedingungen. Zur Sicherung der Hausarztmedizin sprechen sich die Befragten v. a. für folgende Ansatzpunkte aus: Einrichtung eines Primärarztsystems (85 %), vermehrte Förderung von Interesse und Berührungspunkten in Aus- und Weiterbildung (80 %), Stärkung multiprofessioneller ambulanter Versorgungszentren (64 %), Restrukturierung von Curricula (56 %) und Zulassungskriterien zum Medizinstudium (50 %), Reform der allgemeinmedizinischen Weiterbildung (53 %).DiskussionHausärzt*innen haben eigene Vorschläge und Präferenzen, die Expertisen und Sachverständige ergänzen. Bei der Planung, Implementierung und Evaluation von Maßnahmen zur Stabilisierung der hausärztlichen Versorgung sollten Allgemeinmediziner*innen konsequenter als bislang involviert werden.

Impact of the COVID-19 pandemic on the patients&amp;rsquo; emotional state in general practice in Bulgaria

The study aimed to evaluate and analyze the impact of the COVID-19 pandemic on the emotional state of patients in General Medical Practice in Bulgaria. In July-December 2022, a survey was organized among 306 GPs working in primary health care (PHC) in Bulgaria. They represent about 8% of the country&amp;rsquo;s general practitioners and work in eight regions. An individual self-completion questionnaire was offered. After obtaining permission from the Ethics Committee, respondents were randomly selected. The data was processed with a specialized statistical software package, SPSS 22. The COVID-19 pandemic has increased the number of patients with anxiety and depressive symptoms in the period 2020&amp;ndash;2022, according to 95.3% (286) of the GPs surveyed. According to the GPs, the reasons for this were social isolation &amp;ndash; 79.4%, negative information from the media &amp;ndash; 73.1%, uncertainty &amp;ndash; 65%, financial worries &amp;ndash; 51.7%, uncertainty about the future &amp;ndash; 38.8%, and other &amp;ndash; 2.1%. The population of Bulgaria has been greatly affected by the COVID-19 pandemic. The pandemic has increased the number of patients with anxiety and depression in the General Medical Practice for the period 2020&amp;ndash;2022. Bulgarians often resort to self-medication despite the easy access to general practitioners and the possibility of consultation with a psychiatrist.

Features of Constipation Syndrome Management in Elderly and Senile Patients in General Medical Practice (Literature Review)

Constipation in old age ppatients is most often caused by disorders of the digestive tract (DT) and, less often, by the use of medications that affect it. One of the reasons that cause problems with bowel movements is a nutritional disorder. It is known that people in old age eat less. The amount of dietary fiber and the amount of water consumed in the diet are reduced. This leads to a decrease in liquid in the stool masses, which become harder. A significant decrease in motor activity of a person, in particular due to both somatic diseases and mental disorders, causes the development of pathology. Usually, such patients are prescribed cardiac glycosides, sleeping pills, analgesics, and antidepressants. It is necessary to take into account the peculiarities of the psyche of the elderly and senile persons. Loneliness and social isolation combined with depression or egocentrism, as well as poor memory, have a negative impact on a person at this age. It should be taken into account that often elderly and senile patients have their own system of views on treatment and this can make it difficult for them to understand each other with the doctor. Due to biological, medical and social challenges, elderly patients are one of the most vulnerable population groups. At the same time, they are the main consumers of medicines. Therefore, it is very important that the prescribed treatment for constipation is the most rational and safe, taking into account the side effects of drug therapy of the main and concomitant diseases. Compliance with the specified requirements guarantees the safe use of medicinal products, prevents the development of their side effects, and contributes to the continuation of an active and healthy lifestyle of gerontological and geriatric patients.

#2247 Influence of the diagnosis of atopic dermatitis in childhood on the course of kidney function in young adulthood: a single-center study

Abstract Background and Aims Several studies demonstrated non-osmotic sodium-storage, especially in the skin. Patients with chronic kidney disease often suffer from skin symptoms and furthermore an association of advanced CKD-stages with inflammatory skin diseases has been shown. Additionally, in inflammatory skin disease atopic dermatitis an increased salt content was found in the affected skin areas. Thus we hypothesized that atopic dermatitis might have a detrimental effect on kidney function later in life. Method The retrospective case-control study using the patient files of a general medical practice included a randomly selected sample with a 2:1 matching technique. Initially, data of 114 patients who underwent J1-screening exam for adolescents (age 12-14) and also a follow-up examination in adulthood (over the age of 18) between January 1980 and April 2022 have been examined. By the time of inclusion they had to be over 18 years old and did not suffer knowingly from a kidney disease. Over the course of the study, patients for whom no creatinine value was recorded during the following examinations were excluded. Serum creatinine levels and eGFR were compared between the two groups at two assessment times (J1 in adolescence and Follow-Up in young adulthood) and within each group using a one-tailed t-test. A point-biserial correlation analysis was then performed. Results Biometric characteristics, gender distribution and kidney function for J1 as the first measurement point and for follow-up in young adulthood as the second one for both atopic dermatitis and control group are shown in Table 1. The statistical analysis showed that the two groups did not differ significantly in terms of gender distribution at both the first (X²(89) = 0.4918, p = 0.483103) and the second measuring point (X²(73) = 0.45, p = 0.50), therefore a gender bias in the results is unlikely. Furthermore, it was shown by a one-tailed, unpaired t-test for serum creatinine levels ​​at time J1 did not differ from those in the control group (t = 0.60, p = 0.28). This applies too for the corresponding eGFR according to Schwartz-Bedside (t = -0.47, p = 0.32). At the time of follow-up, 16 patients, 8 per group, were excluded due to a lack of creatinine values ​​- in this study using a hypothesis test, no significant difference in the creatinine values ​​was found between the two groups (t = 0.91, p = 0.18), consequently also not in the comparison of eGFR after CKD-Epi (t = -1.28, p = 0.10). Only when comparing creatinine values ​​and eGFR over time within the individual groups, a significant difference for each group was found. In the atopic dermatitis group, the creatinine levels and the eGFR differed significantly in between J1 and the follow-up examination (creatinin: t = 4.29, p = 0.00015, eGFR: t = 1.83, p = 0.042). Likewise did the creatinine levels and the eGFR differ significantly over time in the control group (creatinine: t = 4.77, p &amp;lt; 0.00001 and eGFR: t = 5.72, p &amp;lt; 0.0001). In the point-biserial correlation analysis, no connection between the presence of atopic dermatitis and the level of the serum creatinine value could be confirmed (t = 0.6, df = 89, p = 0.55, 95% CI [-0.14, 0.27], r = 0.063). Conclusion In our study, the diagnosis of atopic dermatitis in childhood does not seem to be a determinant risk factor for a decline in kidney function in young adulthood.

Prevalence and risk factors for long COVID among adults in Scotland using electronic health records: a national, retrospective, observational cohort study

Long COVID is a debilitating multisystem condition. The objective of this study was to estimate the prevalence of long COVID in the adult population of Scotland, and to identify risk factors associated with its development. In this national, retrospective, observational cohort study, we analysed electronic health records (EHRs) for all adults (≥18 years) registered with a general medical practice and resident in Scotland between March 1, 2020, and October 26, 2022 (98-99% of the population). We linked data from primary care, secondary care, laboratory testing and prescribing. Four outcome measures were used to identify long COVID: clinical codes, free text in primary care records, free text on sick notes, and a novel operational definition. The operational definition was developed using Poisson regression to identify clinical encounters indicative of long COVID from a sample of negative and positive COVID-19 cases matched on time-varying propensity to test positive for SARS-CoV-2. Possible risk factors for long COVID were identified by stratifying descriptive statistics by long COVID status. Of 4,676,390 participants, 81,219 (1.7%) were identified as having long COVID. Clinical codes identified the fewest cases (n=1,092, 0.02%), followed by free text (n=8,368, 0.2%), sick notes (n=14,469, 0.3%), and the operational definition (n=64,193, 1.4%). There was limited overlap in cases identified by the measures; however, temporal trends and patient characteristics were consistent across measures. Compared with the general population, a higher proportion of people with long COVID were female (65.1% versus 50.4%), aged 38-67 (63.7% versus 48.9%), overweight or obese (45.7% versus 29.4%), had one or more comorbidities (52.7% versus 36.0%), were immunosuppressed (6.9% versus 3.2%), shielding (7.9% versus 3.4%), or hospitalised within 28 days of testing positive (8.8% versus 3.3%%), and had tested positive before Omicron became the dominant variant (44.9% versus 35.9%). The operational definition identified long COVID cases with combinations of clinical encounters (from four symptoms, six investigation types, and seven management strategies) recorded in EHRs within 4-26 weeks of a positive SARS-CoV-2 test. These combinations were significantly (p<0.0001) more prevalent in positive COVID-19 patients than in matched negative controls. In a case-crossover analysis, 16.4% of those identified by the operational definition had similar healthcare patterns recorded before testing positive. The prevalence of long COVID presenting in general practice was estimated to be 0.02-1.7%, depending on the measure used. Due to challenges in diagnosing long COVID and inconsistent recording of information in EHRs, the true prevalence of long COVID is likely to be higher. The operational definition provided a novel approach but relied on a restricted set of symptoms and may misclassify individuals with pre-existing health conditions. Further research is needed to refine and validate this approach. Chief Scientist Office (Scotland), Medical Research Council, and BREATHE.

Chiropractors in Multidisciplinary Teams: Enablers of Colocation Integration in GP-Led Primary Healthcare.

The aim of this study was to explore and document the enablers and barriers of chiropractic care colocation in general practice at a large-scale private primary care centre in Australia. This study focused on the perceptions of healthcare professionals regarding this integration. The research setting was a large integrated primary care centre located in an outer metro, low-socioeconomic area in the City of Moreton Bay, Queensland, Australia. Participant inclusion criteria included general medical practitioners, practice nurses, and medical managers who self-reported interactions with the physically collocated and integrated chiropractic practice. Data was collected from 22 participants using face-to-face, qualitative, semi-structured interviews with an average duration of 32 min. The data collected included perceptions of chiropractic treatment, enablers to patient referral pathways, and views of the integrated chiropractic care model. A reflexive thematic analysis was conducted on the data set. All participants reported that this was their first exposure to the colocation of a chiropractor within a general medical practice. Four key enablers of chiropractic care integration were identified: (1) the practitioner [chiropractor], (2) the organisation [general practice], (3) consumer flow, and (4) the environment [shared spaces and tenant ecosystem]. The chiropractic integration enhanced knowledge sharing and interprofessional trust among healthcare providers. The formal reporting of patient outcomes and understanding of the chiropractor's scope of practice further enabled referrals to the service. Shared administrative and business processes, including patient records, booking systems, and clinical meetings, facilitated relationship development between the chiropractor and referring health providers. Colocation as part of a larger primary care centre created proximity and convenience for health providers in terms of interprofessional communication, and for patients, in terms of access to chiropractic services. Existing governance structures supported communication, professional education, and shared values related to the delivery of patient-centred care. Identified barriers included limited public funding for chiropractic services resulting in reduced access for patients of low-socioeconomic status. Additionally, scepticism or negativity towards the discipline of chiropractic care was identified as an initial barrier to refer patients. In most cases, this view towards the chiropractor was overcome by regular patient reporting of positive treatment outcomes to their GP, the delivery of education sessions by the chiropractor for the health providers, and the development of interprofessional trust between the chiropractor and referring health providers. This study provides preliminary evidence and a conceptual framework of factors influencing the successful integration of chiropractic care within an Australian large primary care centre. The data collected indicated that integration of chiropractic care into a primary care centre serving a low-socioeconomic region can be achieved with a high degree of health provider satisfaction.