General Practice Family Medicine Research Articles

Cross-cultural adaptation of the PHQ-4 to European Portuguese and its validation with the psychological burden by the multimorbidity management in GP/FM practice in Central Portugal

Background: Mental health is an important issue in general practice/family medicine. The Patient Health Questionnaire for Depression and Anxiety (PHQ-4) allows depression and anxiety screening and psychologic distress evaluation. PHQ-4 cross-cultural adaptation and concurrent validation was the objective of this paper in a population of general practice/family medicine (GP/FM) doctors. Methods: Translation, linguistic verification and back-translation, internal consistency, and reliability of the final translated tool were performed for the cultural adaptation of the PHQ-4 scale. The European Quality of Life 5 Dimensions 3L (EQ-5D-3L) scale and the “Sentimentos Negativos – Negative Feelings”, subscale of the “Questionário da Avaliação da Sobrecarga da Gestão da Multimorbilidade em Medicina Geral e Familiar – Questionnaire of Evaluation of Burden of Management of Multimorbidity in General Practice and Family Medicine” [SoGeMM-MGF]) were used for concurrent validation. Descriptive, inferential, and correlational statistics were used, according to the distribution of data, with a p-value of <0.01 for statistical significance being defined. Conclusion: PHQ-4 scale cultural adaptation and concurrent validity were made, PHQ4 being a valid and reliable screening tool, to assess anxiety, depression, and psychological distress.

Systemic inflammation and quality of life in patients with coronavirus disease: interrelation features.

Aim: To characterize the features of the interrelation of systemic inflammation with the quality of life of patients with coronary virus disease. Materials and Methods: 30 patients were examined 1 month after inpatient treatment for COVID-19. Quality of life (QoL) of patients was determined according to the questionnaire Medical Outcomes Study - 36-item Short Form (SF-36). The glucose level, circulating immune complexes (CICs), concentration of immunoglobulin (Ig) A, interleukin (IL)-8 and IL-33 levels were determined in the blood serum of patients. Results: QoL of patients after coronavirus disease is significantly deteriorated: patients note a significant limitation in physical functioning, pain perception, vitality, role-physical and social functioning and mental health. The increase in glycemia and glycated hemoglobin levels in post-COVID-19 patients was significantly associated with the deterioration of patients` general health (GH) (r = -0,228; (p=0,040) and (r = -0,280; (p=0,014), respectively). The IL-33 concentration in such patients correlated directly with role-physical functioning (RP) (r = 0,385; p=0,029). The CICs level decline was associated with deterioration of RP (r = 0,227; p=0,042) and GH (r = 0,227; p=0,041). Conclusions: The study of clinical-functional, biochemical, immunological and psychological indicators, quality of life, and their mutual influences should be included in the development of the program for the diagnosis, treatment, and rehabilitation of patients after the transfer of COVID-19 at the outpatient stage of treatment by doctors of general practice-family medicine.

Experiences of hospital rotation from family medicine residents’ points of view an empirical holistic study

Objective Trainees or medical residents’ experiences of hospital rotations and training have not been sufficiently studied. More empirical holistic studies of experiences of General Practice/Family Medicine (GP/FM) residents in Sweden are needed. The purpose of this study was to describe experiences of hospital rotation during residency. Design Empirical-holistic study. Setting GP/FM residents were invited by email to participate in the study. They could describe their experiences anonymously by answering two questions via an esMaker internet survey. Analyses of the responses were carried out with content analysis as the analytical methodology. Both manifest and latent responses were analyzed. Subjects Fifty-nine GP/FM residents participated in the study. Main Outcome Measure The results identified four main topics: structure, resources, effects, and constructive supervision. Results GP/FM residents experienced hospital rotations as effective when there was a structured schedule and adequate time allotted for introduction and meeting patients. Hospital rotations that lacked, or had unstructured, supervision caused uncertainty and insecurity, which led to rotations being experienced as less beneficial, which was, from a GP/FM perspective, not constructive. Conclusion The study suggests that family medicine residents required a structured and planned schedule during hospital rotations. This study may contribute to increased quality of hospital rotations during residency as a family physician.

Профілактика поведінкових факторів ризику серед дітей та підлітків у практиці сімейного лікаря і педіатра

The medical model of prevention among adolescents in the practice of a family physicians is focused on the medical and social consequences of behavioral risk factors and involves a multidisciplinary approach, interaction with the non-governmental sector, and the development of youth volunteerism. The introduction of new teaching methods, including the «project method», contributes to the formation of professional competence of future family physicians at the undergraduate level. The goal is to analyze the main problems of prevention of behavioral risk factors among adolescent children, the role of the family physician and pediatrician, the effectiveness of implementing the project method in teaching the discipline «general practice-family medicine» at the undergraduate level. Materials and methods. We have analyzed the main components of the family doctor’s preventive work among teenagers. The method of project activity of sixth-year students was implemented in the practical training of students. The basis of the application of project technology was the presence of a problem of medical and social factors affecting the health of a teenager, which requires integrated knowledge and a research search for its solution. Students created and implemented medical and social prevention projects among teenagers. The results. As a result of working on the project, the students found a specific solution to the problem and a specific result suitable for implementation. This approach creates conditions for creative development and self-realization of students, formation of all necessary professional and general life competencies. Conclusion: 1.A comprehensive approach to preventive measures among adolescents is an important component of maintaining the health of adolescents. 2. The problems of medical and social factors affecting adolescent health include not only the work of a family doctor and pediatrician or government regulation, but also interaction with the non-governmental sector and the development of youth volunteerism. 3. Participation in preventive measures among teenagers of sixth-year students through the implementation of the project method helps them master basic knowledge, ensures the formation of professional competences, communicative and social skills, skills, and creative abilities.

Optimization of the Teaching of Surgical Disciplines in the Training of Family Medicine Specialists at the Undergraduate Level of Education

The quality of medical care for the population depends on the level of training of future doctors. The formation of professional competence of a general practitioner-family doctor requires a wide range of multidisciplinary knowledge. The innovative technologies, especially interactive teaching methods, are used to make the conditions of a successful educational process. A large amount of material that a general practitioner-family doctor should master encourages the introduction of innovative and integral pedagogical methods that optimize the possibilities of acquiring knowledge and the formation of special practical skills, including surgical skills. The article deals with new views of a comprehensive treatment approach of patients with acute surgical diseases, analyzed modern methods and perspective rehabilitation methodic of surgical patients during the preparing of a general practitioner–family physician at the level of underground education. On the basis of the analysis of existing educational plans and education programs of doctors in the specialty “General Practice-Family Medicine”, the evaluation of acquired theoretical knowledge, special practical skills and the recommendations on the introduction of innovative and integral methods of teaching the basics were presented. The article reveals aspects of providing specialized gastroenterological medical care to the population of Ukraine, which today has a significant medical and social importance. Over the last 5 years, the incidence of digestive system and mortality due to diseases has increased. The study of manifestation, variants of clinical course, diagnostic tactics, diagnosis are extremely relevant at the level of underground education. Knowledge of major diagnostic and tactical errors in acute surgical diseases of the stomach and duodenum is mandatory. Future general practitioners-family doctors need to know the basic clinical signs of acute surgical diseases of the hepatobiliary system and pancreas, improve the skills of taking the patient’s anamnesis (complaints, anamnesis of the disease, history of life, determination of risk factors), need to be able to make an optimal examination plan to confirm the diagnosis, establish a diagnosis, as well as to learn the algorithm of medical history records and be able to determine the period of disability of patients after surgery. During the stages of the educational process for better study effectiveness interactive, innovative methods, various approaches to diagnosis and treatment. Emergency care and rehabilitation of patients are ought to be used; solving problem situations tasks implement more effective training in surgery for the practical activity of a physician in the specialty “General Practice-Family medicine”.

ANALYSIS OF MAIN TRENDS OF DEVELOPMENT OF HEALTH CARE IN UKRAINE.

The aim: To substantiate the conceptual approaches of building a cluster model of primary medical care at the level of the hospital district in terms of the development of family medicine, in particular, the consolidation of health care institutions as the main providers of medical services in the provision of primary medical care in the hospital district and improving its efficiency. Materials and methods: Methods of structural and logical analysis, bibliosemantic, abstraction and generalization were used in this work. Results: The analysis of the legal framework in the field of health care of Ukraine demonstrated multiple attempts to reform it in order to increase the availability and efficiency of medical and pharmaceutical services. The practical implementation of any innovative project becomes much more difficult or even impossible without a carefully developed plan. Today in Ukraine there are 1,469 united territorial communities, 136 districts, so more than one thousand primary health care centers (further written as PHCCs) have been created against, a possible 136. A comparative analysis indicates the economic validity and possibility of such changes - the creation of a single health care facility at the level of a hospital cluster to provide primary medical care. For example, the Bucha district of the Kyiv region consists of twelve territorial communities, and 11 primary health care centers (PHCCs), the latter have separate subdivisions under their control in the form of: general practice-family medicine dispensary (GPFMD), group practice dispensary (GPD), paramedic and midwifery points (PMP), paramedic points (PP). Conclusions: The implementation of a cluster model of providing primary medical care in the form of the creation of a single health care facility at the level of a hospital cluster has a number of advantages in the short term. For the patient, it is the availability and timeliness of medical care, at least at the level of the district, not the community; cancellation of paid medical services during the provision of primary medical care regardless of the place of its provision. For the subject of governance (the state) - cost reduction during the provision of medical services.

Formation of Specialist’s Competency Model Is an Important Condition for Quality in Family Doctors Undergraduate Education

Competency-oriented training is becoming the main direction of higher education development in Ukraine, which requires implementation of new teaching methods. The main value of project based learning technology lies in directing students to the creation of an intellectual or material product as a result of learning, and not to the simple study of a certain topic. This is a form of organizing classes aimed at developing of communication skills and the ability to work in diverse groups. The objective: to reveal the essence and methodology of the implementation into the educational process of the project method in teaching the discipline “General practice-family medicine” at undergraduate level at the department of therapy and family medicine of the medical faculty. Materials and methods. The method of project activity of students was tested as a part of students practice in the “Youth Friendly Clinic”. The basis for the project technology implementation was the presence of the complex medical and social factors that influence teenagers health, which requires integrated knowledge and a research for its solution. Students created and implemented medical and social prevention projects among teenagers. Results. As a result of working on the project, the students found a specific problem solution and specific result suitable for implementation. This approach creates conditions for creative development and self-realization of students, formation of all necessary professional and general life competencies. Conclusions. Project technology is the main technology for the formation of key professional and general cultural competences of students, helps students master basic knowledge, acquire communicative and social skills, develops analytical thinking, research skills, and creative abilities.

Medical Personnel and Their Professional Level is the Main Component of Family Medicine

The paper focuses on new approaches to the development of family medicine in Ukraine. There has been made a brief historical overview of stages of family medicine development. The main component of the successful development of general practice–family medicine is stated to be human resources: personnel availability, personnel staffing, professional level. The medical education, including continuing professional development, plays an important role in the professional development of family physicians. The modern educational technologies are widely used in Shupyk NMAPE. The paper describes one-day scientific workshops in the format of the off-site training and videoconferences that are conducted under the methodical direction of the Academy.

Prevalence and Management of Anemia in Adolescents in Primary Care Settings

Anemia is defined as a drop in haemoglobin (Hb), hematocrit (HCT), or red blood cell (RBC) count. Anemia is a widespread issue in primary care, and primary care physicians are generally the first to notice its symptoms. Anaemia is a prevalent clinical concern among the adolescents. It is widely known that haemoglobin levels drop with age increase. Anemia has been linked to a variety of negative effects, including higher mortality, hospitalisation, and a worse quality of life. epidemiological reporting of anaemia is fragmented. Anemia is diagnosed in part by symptoms reported in general practice/family medicine (GP/FM). Management of anemia relies on the type of anemia and underlying cause, in this review we will be looking at Prevalence, etiology, classification and management of Anemia.

Holistic Approach in Formation of Communicative Competence of Future Doctors

. It is well known that effective communication of family doctor with patient leads to the development of the trusting long term relations, which is the necessary part of the primary care specialist work. That’s why the development of the communicative skills is important during medical education. The objective: to improve the communication skills acquisition by medical students through the use of the holistic approach in teaching. Materials and methods. Еhe staff of the Department of Primary Healthсare and General Practice-Family Medicine developed and introduced into the educational process an optional discipline «Communication skills in medical practice» Results. Based on the analysis of the survey results of students at the end of the studying the selective subject of “Communicative Skills in Medical Practice” we identified the main andragogical methods and forms of teaching that would correspond to the holistic direction in education. According to our research, the work in small groups, Storytellling, role play is the most valid form of teaching for communication skills, which would be based on the individual needs, feelings and values of every student. A holistic approach of teaching motivates students to continue studying communication skills based on modern learning technologies. Thus, using a holistic educational concept, it is possible to improve the communicative competence of future doctors, to lay the foundations for understanding the need for continuous self-improvement and self-education throughout the professional medical activity. Conclusion. The holistic direction in teaching promotes partnership between a student and a teacher, the achievement of mutual understanding and trust, better commitment and motivation to learn. The use of feedback forms helps to recognize and understand the needs and feelings of each student, work effectively with diversity, motivates the teacher to continuous self-development and self-improvement. Modern teaching methods such as working in small groups, Storytellling and role-play according to students are more valid in mastering the communicative competence of the future doctor.

Teaching and Learning Core Values in General Practice/Family Medicine: A Narrative Review.

General Practice/Family Medicine (GP/FM) is a key discipline within primary health care and so by extension for the whole health care system. An essential condition for effective GP/FM care is a work force that is highly qualified. As society is changing rapidly, a revision of the GP/FM definition is ongoing, in addition to a recent movement of identifying related core values. In this paper, we want to give an overview on how these new paths and perspectives are currently reflected in GP/FM teaching and training. We selected four core values that fit in with possible future visions: person-centered care, continuity of care, cooperation in care, and community-oriented care. By a narrative review, we observed that GP/FM education toward core values is often built around overarching topics. Teaching and learning take place in specific contexts, most of all through placements within communities, primary care settings, or hospital wards. Mixed teaching- and training methods are used combining knowledge, skills, and attitude. Furthermore, collaboration with other health professionals and peers is stressed, in addition to the importance of role models, a holistic focus and the involvement of patients. Since these core values are important within GP/FM and rather few studies on the educational aspects and learning tools were found we advocate encouraging each other more to share good practices, certainly the innovative ones specifically related to GP/FM.

Проблеми дистанційного викладання загальної практики-сімейної медицини на додипломному рівні і шляхи їхнього вирішення

Topicality. Online-learning, which has become a requirement of the circumstances of the epidemiological situation in Ukraine, leads to a number of problems that have to be solved in this way, as far as possible, taking into account the real possibilities of logistics and staffing of the educational process. The aim is to analyze the main problems of distance learning of the discipline «general practice-family medicine» at the undergraduate level of higher medical education, as well as to suggest possible ways to solve them. Main part. The main problem of distance learning of the discipline «general practice-family medicine» is the lack of a real practical part of the lesson. An important stage in the work of a primary care physician at the present stage is the development of skills in working with the E-Health-system, which has become impossible online. An important disadvantage of distance learning is the lack of need for students and teachers to maintain the image of a professional form. A significant problem is the lack of practice by students of the skill of advising the patient with certain real problems and diseases, because each situation is personalized. There is also the problem of technical inconveniences when working online, which prevents the full development of the content of the lesson. The limited ability to work in groups with peers prevents you from feeling feedback from other participants in the learning process. In the context of distance learning, teachers should try to solve the above problems. At the departments that teach general practice-family medicine, it is necessary to ask students to work independently to consider interesting clinical situations of comorbid patients. Considering clinical situations, it is necessary to develop algorithms for comprehensive examination of patients in the outpatient phase, rational schemes of diagnosis and treatment, both protocol and adjuvant, as the medicine of the future must become more personalized, integrative and preventive, especially in the oup-patient. Conclusions: Today there is an urgent need to develop and implement in the educational process of distance learning programs that meet the best world standards and provide training for medical professionals at a high professional level. The use of the Internet provides the ability to quickly access the information resources of the institution and the ability to effectively interact «teacher-student», both online and off-line modes. It is necessary to work in such a way as to minimize the shortcomings of distance learning in the teaching of clinical disciplines. In addition, the deepening of knowledge about coronavirus infection, the basics of its epidemiology, clinic, treatment and prevention, in our opinion, will expand the possibilities of conducting classes in clinical disciplines in an off-line mode, but optimal effective distance learning will always be in demand.

Consulta do registo de saúde eletrônico

Introdução: A bioética surgiu da necessidade de regulamentar um código de conduta ética que evitasse as práticas médicas abusivas realizadas durante vários séculos. O Procedimento Deliberativo (PD) aplicado à medicina, ajuda na tomada de decisões éticas de forma ponderada e justa. Com a apresentação deste caso clínico pretende-se exemplificar a importância da aplicação do PD na prática clínica em Medicina Geral e Familiar (MGF). Apresentação do caso: Homem de 58 anos que no seguimento de um antígeno específico da próstata (PSA) alterado foi referenciado à consulta de urologia. Um mês após biópsia prostática recorre à consulta de MGF confiante de que o resultado seria negativo. Sem a sua autorização, o Médico de Família (MF) acedeu ao Registo de Saúde Eletrónico e verificou que o doente apresentava um adenocarcinoma da próstata, embora não tivesse ainda consulta de reavaliação de urologia. Foi eleito o problema ético mais importante e definido o curso de ação ótimo que cumpria os critérios de legalidade, publicidade e temporalidade. Conclusões: Qualquer que seja a decisão do médico, deve ser sempre em benefício da pessoa. O PD permite uma tomada de decisão estruturada pelo que deve ser aplicado no contexto de MGF perante a ocorrência de problemas éticos.

Patients\u2019 and tutors\u2019 evaluations of medicine students\u2019 consultations in general practice/family medicine in Coimbra

BackgroundUndergraduate teaching of General Practice/Family Medicine (GP/FM) must ensure students acquire the necessary competencies and skills to perform an adequate GP/FM consultation with adequate annotations (the SOAP model) and classifications. So aimed to study and to correlate students’ evaluation by tutors and patients in specific consultations in the formal practical evaluation of GP/FM Curricular Unit of the Integrated Masters on Medicine at the Faculty of Medicine of the University of Coimbra (IMM-FMUC) in the academic years of 2017–2018 and 2018–2019.MethodsObservational study of the 2017–2018 and 2018–2019 academic years of the assessment grids for tutor’s evaluation of SOAP performance and fluency in consultation and for patient’s evaluation of the student ‘performance, in the convenience sample of those who chose to be so evaluated.ResultsWe studied a population of 435 (67,7%) out of a universe of 646 students, 125 (28,7%) males, ns by sex and academic year who performed this evaluation. In a mark up to 20 from tutors, difference was found for Plan (P) mark, higher in 2018–2019 (18,38 ± 2,18vs18,54 ± 2,11, p = 0,005) of the SOAP methodology evaluation. Patients’ evaluation was not different 19,34 ± 1,70vs19,35 ± 1,40, p = 0,091. A positive significant correlation was found between tutors and patients marks (ρ = 0,278; p < 0,001), as well as between tutor mark and final mark (ρ = 0,958; p < 0,001) and patient and final marks (ρ = 0,465; p < 0,001). Final marks were not different in both years, 18,61 ± 1,38vs18,78 ± 1,15, p = 0,158.ConclusionsThis innovative model of evaluation of student’s performance in medical appointment, showed a significant positive moderate correlation between patients’ and tutors’ marks in the setting of GP/FM at the IMM-FMUC, and was not different between years. Yearly evaluation must be continued.

Actual Accents of Optimization of Industrial Practice of Students of the V Year of Higher Medical Institutions of Ukraine

The objective: to raise efficiency of practical skills development of the students in the V course during the outpatient practice based on improvement of teaching methods.The article is devoted to the problem of improving the quality of training specialists in General Practice-Family Medicine at the Postgraduate level. New approaches for supervising medical practice of the students in the V course are offered. The problematic issues of their practical work are discussed using the results of voluntary anonymous questionnaire. The experience of pedagogical techniques optimization is presented.Conclusion. For providing effective outpatient medical practice of the fifth year students it is necessary to update existing clinical facilities and develop new ones based on the primary health care centers, especially in rural areas. The outpatient practice program comprises economic issues of primary health care institutions, medical law, management, marketing and the internship with private family doctors. These issues will allow graduates to be adapted to new social and economic conditions in the process of health care reforms based on primary health care priority.

Selected Aspects of Urgent Noncomplicated Infection of Urinary Tract Curation in Ambulatory Practice and Teaching

The high prevalence of urinary tract infections (STIs), frequent recurrent nature, decreased quality of life of patients and significant medical and social significance determines the importance of knowledge of primary care physicians (PMD) of a rational algorithm for managing patients with this pathology, as well as effective discipline «General Practice-Family Medicine».The purpose is to analyze the basic, relevant in clinical practice and teaching, the provisions of the European Clinical Protocol (Croatia) for the management of uncomplicated infection of the urinary system, created on the basis of evidence. Symptomatic STI is treated with antimicrobials. Asymptomatic infection is similarly treated only in cases such as pregnancy, in patients who have immunocompromised or undergone kidney transplantation. However, these are cases of complicated STI. The antibiotic is selected on the basis of experience with national recommendations, data on bacterial resistance, characteristics of the drug (its spectrum of activity, efficacy, side effects, interaction with other medicines that the patient receives, method and frequency of administration, possible allergies, etc.) and health insurance provisions, which places restrictions on the administration of antibiotics.Simple urinary tract infections are one of the most common bacterial infections through which patients visit their family doctor. Women especially suffer. Important symptoms and signs are polakuria and dysuria, the feeling of incomplete emptying of the bladder and the appearance of blood in the urine. The most common pathogen is E. coli. The probability of making a correct diagnosis based on the clinical picture alone and the anamnesis is high if the clinic is typical. Therefore, it is advisable to empirically treat patients with these characteristic symptoms without any laboratory urinalysis following the guidelines of ISKRA.

Contemprorary features of preparation and teaching cycle «neurology» to doctors-residents in specialty «General Practice – Family Medicine»

The aim of the study is to analyze contemporary features of teaching the course of neurology to doctors-residents in specialty "General Practice-Family Medicine" at the Department of Neurology and Neurosurgery, Faculty of Postgraduate Education (FPE) of the Vinnytsia National Pyrogov Memorial Medical University, to identify problematic issues and prospects for further development.Results. The educational process at the department is carried out according to the program of studying at the internship in the specialty "General Practice-Family Medicine", where 72 academic hours are allotted for the course of neurology. To improve the assimilation of the material and the quality of teaching, the department uses a variety of innovative interactive methods, namely: debriefing of patient’s cases in a small group of interns (2-3 people), case-methodology (active problem-situational analysis), brainstorming and others. The best way in teaching is to combine simultaneously more than one technique depending on the situation. The department widely uses modern multimedia technologies and presentations, where the lecture material is presented briefly, clearly and as much as possible simplified with an emphasis on the most necessary information in practice. The use of the newest technologies of teaching and presenting materials at the department contributes to mastering all the necessary knowledge of neurology in the practical activities of the future family doctor and using this knowledge for the benefit of society.Conclusions. For a qualitative pedagogical process in the system of postgraduate education and increasing its efficiency in modern conditions, constant development and implementation of innovative teaching methods with the use of world experience is necessary. In order to improve the assimilation of material in the conditions of a large information load, modern multimedia technologies and various pedagogical techniques that improve the quality of the learning process and the assimilation of the information provided should be used.

Характеристика підтримки інтеграції акушерсько-гінекологічної допомоги на первинний рівень медичної допомоги та оцінка матеріально-технічної бази закладів загальної практики–сімейної медицини

The objective: to assess the level of support by health organizers, obstetrician-gynecologists and general practitioners–family doctors to integrate obstetric-gynecological care at the primary level of medical care and to study the results of their assessment of the material and technical base of general practice – family medicine institutions in ensuring their functions integration of obstetric and gynecological care to the level of primary care. Materials and methods. The method of sociological research surveyed 197 health care organizers, 601 obstetrician-gynecologists, 434 general practitioners–family doctors. Results. Health care organizers, obstetrician-gynecologists and general practitioners–family doctors supported the integration of obstetric-gynecological care to the level of primary care. At the same time, they low rated the material and technical base of the general practice–family medicine institutions for providing obstetric and gynecological care. Conclusion. Recommended the development of measures for the integration of obstetric and gynecological care to the primary level of medical care. Key words: primary health care, material and technical base, obstetric and gynecological care, integration, support.

Atypical Gout Manifestations in General Practice–Family Medicine: Own Clinical Observations and Literature Data

The objective: to study and systematize own clinical observations and management of gout cases and atypical gout manifestations and literature data on this item. Clarification of main characteristics of atypical manifestations of this pathological condition.Scientific and practical base of the investigation was Kiev City Clinical Hospital № 8, which admits patients by the reference of primary care physicians in general practice – family medicine.Clinically gout is preferably a male disease. The condition is more often seen in men, than in women, but in women it is more obvious in postmenopausal period. Women with gout are more proun to have atypical manifestation (for example, disease on fingers and ankle joint), which becomes at atypical age, making efficiency of treatment problematic because of coexisting comorbidities.Gout is a common and exclusively painful form of inflammatory arthritis, which typically involves first metatarsophalangeal joint (and terminologically this is gout). Atypical signs of the gout are described now with increasing rate in definite populational groups, such as elder people, people with genetic predispositions, enzyme deficiencies, prosthetic implants and those receiving immunosuppressive therapy. Gout can mimic other conditions, such as septic arthritis, osrteoarthritis, rheumatoid arthritis, pseudogout (accumulation of calcium pyrophosphates) and even periarticular tumors. Gout can coexist with other arthropaties, making diagnosis more difficult. Article contains the description of authors own observations of patient with multiple gout atypical manifestations during 35 years. Lower extremities were not involved in the process for a long period of time, and only near 2,5-3 last years patient noted, that tophuses start to appear ass well on both legs.Atypical features differ from “classical” gout, which is found in men of middle age with different aspects: there is no prevalence of men, but there is more uniform gender distribution, polyarthicular involvement with upper extremity, less of acute gout episodes, not intensive clinical picture and increase rate of tophuses formation.

General Practice in Netherlands: Professional Training and Organization of Medical Care

The collaboration of Ukrainian movement of young general practitioners (UMYGP) with the Dutch organization LOVAH (Netherlands) provides the opportunity for many young Ukrainian general practitioners/family doctors (GPs) to take part in experience exchange programs that include 1 day visiting practice of Dutch GP, 1 day participation at GP professional training at university and 2 days participation at the conference in family medicine. The article represent the received experience from dutch exchange program about features of professional training of family doctors, organization of primary care, working day of family doctor, using computer registration system. The experience and active work of the UMYGP representatives allows young family doctors to gain international practice, promote the status and prestige of the general practice/family medicine in the country, especially among young people, helps to improve the development of family medicine in Ukraine, medical and scientific specialty «General practice-family medicine».