Welcome to the 26th WONCA Europe Virtual Conference Programme Scheduling

Abstract Body

Background

One of the most stressful situations for family doctors who treat with emergencies is dealing with acute cardiac pathologies, which put the patient in a critical condition and push physicians to the limit, challenging their knowledge, reaction capacity and clinical judgment.

A wide variety of pathologies to attend and, frequently, the uncertainty among professionals in the ability to manage them, is our reality.

This is especially crucial in systems with small clinics and rural consultations, where lack of collegial support, the growing proportion of elderly, fragile and challenging patients are common.

Aim:

We aim to train general practitioners up giving the required skills to help them feel more prepared and confident in the most common cardiac emergencies of their daily practice.

Methods and timetable:

The idea is to develop a 90-minute fun "Know and Win" contest. Behind its casual format and lively appearance, a meticulous analysis of clinical cases will be hidden, accompanied by ECG traces of the heart rhythms most frequently encountered in daily practice and most feared by family doctors.

Results / Conclusions

- Elaborate a working model of the Emergency Skills Module (ESM) to be used in the training of general practitioners working in emergency services and rural areas and keeping them updated

- Offer a new self-assessment format to improve interpretation skills through ECG problems for exam preparation and real daily practice.

- Encourage discussion about what emergency skills and ranges of knowledge are essential for general practitioners in the emergency setting.

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Background: Prinzmetals Angina accounts for a greater number of patients presenting with chest pain to tertiary care health facilities requiring immediate management to reduce the incidence of complications such as heart attacks and strokes .This case explains the endothelial dysfunction as a rare cause of prinzmetal angina. She has a H/O patent foramen ovale,psoriatic arthritis,B/L optic nerve infarction with inferior field defect.Iron deficiency Anemia. Recurrent TIA

Introduction: 46 years old lady presented to A&E with complaint of increasing intensity chest pain and difficulty in breathing.

Case Description:On examination, patient was anxious with pain, blood pressure 148/88mmhg with a pulse rate 76 beats/min, slightly tachypneic with respiratory rate of 20/min. JVP-not raised. Rest of the examination was unremarkable. ECG showed TWI in leads III,V2 to V4.Initial investigations showed normal full blood count and kidney function, raised troponin level, urgent cardiology input was taken and coronary angiography was done which showed widespread and diffuse endothelial dysfunction resulting in coronary artery spasm and microvascular angina. Ultrasound angiology and nailfold capillaroscopy also showed vasospasm. Echo showed good LV function with EF 65-70%,normal structure and dimensions.

Outcome: The patient was started on IV GTN infusion(via porta cath) and her symptoms improved dramatically, remain stable during the hospital stay and discharged on CCB,isosorbide mono & dinitrate and advised for cardiology follow up in a few days time.

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Background and purpose Up to 40% of dementia cases may be attributable to potentially modifiable risk factors, suggesting dementia may be delayed or prevented by adequately acting these risk factors. Mobile Health (mHealth) may improve accessibility to prevention strategies in hard-to-reach populations, where the expected rise of dementia prevalence is largest. We will investigate the effectiveness and implementation of a coach-supported mHealth intervention to reduce the risk of dementia by targeting dementia risk factors.

Methods The PRODEMOS RCT has an effectiveness-implementation hybrid design, taking place in the United Kingdom (UK) and China. Eligibility criteria are: 55-75 years, low SES (UK) or from the general population (China), ≥2 dementia risk factors, own a smartphone. Overall, 2400 participants will be randomised to either a coach-supported, interactive mHealth platform, facilitating self-management of dementia risk factors, or to a static control platform. The intervention and follow-up period are 18 months. The primary effectiveness outcome is change on the CAIDE dementia risk score. Implementation outcomes include acceptability, adoption, feasibility, and sustainability of the intervention.

Results The design of the mHealth platform has been informed by qualitative studies with the target population in the UK and China, existing literature, and the concepts of the Healthy Ageing Through Internet Counseling in the Elderly (HATICE) platform, and has been tested in a pilot study in both countries.

Conclusions The current study, targeting populations with a high dementia risk and poor access to preventive care, will provide insight in the implementation potential and effectiveness of a coach-supported mHealth intervention to reduce the risk of dementia.

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ST- Segment Elevation Acute Myocardial Infarction (STEMI) represents a medical emergency that reflects high mortality rates, reaching 80% in the first 24 hours. Besides, one of the most notable complications associated with this emergency is Cardiogenic Shock (CS), which affects about 10% of patients. METHODS: Considering the incidence of cases, as well as the severity of STEMI related to CS, this study will search for understanding the treatment established in this population, intending to determine the differences between the treatment of multivessel revascularization or just the culprit artery. RESULTS: Furthermore, in this perspective, studies have shown that exclusively clinical treatment is unfavorable compared to revascularization, being the invasive approach with the greatest chance of success, indicating higher survival rates of patients when introduced early treatment. In addition, among the possible approaches, we have revascularization of only the culprit artery and the multivessel; in relation to multivessel treatment, it can be mentioned as benefits of this technique, the reduction of the ischemic load and the reduction of the need for future intervention; however, on the other hand, the patients time in the procedure is enhanced, increasing the risk of complications such as contrast-induced nephropathy. CONCLUSION: Thus, taking into account the guidelines of the European Society of Cardiology and the American Heart Association (AHA), revascularization is recommended through percutaneous intervention of the culprit artery for the ischemic event instead of multivessel unblocking. Consequently, complications and associated mortality decrease, quitting the reperfusion of additional affected arteries for another moment.

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Background and purpose:

Eletrocardiogram(EKG) is a very informative, cheap and widespread tool that can diagnose heart problems. Every phsysician should know how to read an EKG, however, in Portugal, in ambulatory setting they are reported by cardiologists. The aim of this case report is to highlight the importance of carefully analyzing all the exams that are requested in daily practice.

Methods:

Case study. The information was retrieved from the electronic medical record.

Results:

A 62-years-old patient, diagnosed with cholecystitis in an emergency department(ED), was supposed to be submitted to elective cholecystectomy, however, during pre-procedure routines the patient was found to have an abnormal EKG. It revealed excessive supraventricular extrassystoles, and an observation by cardiology was advised in order to decide if the surgery could be performed. The patient’s condition worsened and had to return to the ED. An urgent surgery was advised, however it was not performed given the abnormal EKG. The patient was discharged home on analgesics and antibiotics. The following day, we saw the patient in our health center and after looking at the EKG, we realized that it had been incorrectly interpreted and it was normal. The timing intervals settings were not correct and it was shorter than the usual interval. The patient ended up doing the surgery and recovered well.

Conclusions:

This case highlights the importance of analyzing all the exams that are requested in daily practice, and, despite their report, the physician should be critical and analyze them to the best of his knowledge.

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Background and purpose: Secondary hypertension is less common among patients aged > 50 years, being Cushing Syndrome an unusual cause. However, specific signs and symptoms together with a sudden increase in blood pressure previously stable, should be kept in mind to make the right diagnosis in adults.

Methods: The information about patient’s clinical data was obtained through consultation of clinical records.

Results: A 55-year woman with a history of controlled hypertension, depression and overweight, presented with thin skin and spontaneous bruising, followed by permanent elevated blood pressure, occasional palpitations, fatigue, chest pain, hair and memory loss, since 5 months ago. On examination she had a sustained high blood pressure of 205/112mmHg and pulse of 68 beats per minute. The body mass index was 39,5. Auscultation of the heart and lungs was clear. Both forearms and legs had bruises. Abdomen had multiple striae. She had a generalized edema mainly localized in the face, abdomen and neck. Investigation of secondary forms of hypertension revealed leukocytosis in blood count, a higher level of cortisol in 24h-urine with normal serum ACTH; renal echography showed bilateral supra-renal gland mass, which were confirmed by abdominal TC as suspected adrenal tumours. The patient was referred for an hospital Endocrinology appointment and a surgical intervention was recommended.

Conclusions: This case caveat the importance of being aware of secondary causes for hypertension, especially in adults. It also points to the role of family doctors in the early detection of this pathology and urgent referral to improve its prognosis.

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Background:

Overweight is a common risk factor for several chronic conditions including diabetes, dyslipidemia, high blood pressure and cardiovascular diseases. In Tunisia, although the National Obesity Prevention and Control Strategy was established since 2013, its implementation did not take place until now.

Purpose: To evaluate the management of overweight among adults in the health care centers of the governorate of Sousse.

Method:

A cross-sectional study was conducted in 2014, among 1977 adults living in 16 districts randomly selected from 3 delegations of the governorate of Sousse. A pre-established and pre-tested questionnaire was administered to participants during face to face interviews with pre-trained medical doctors at their homes. Weight, height and waist circumference were measured at the end of each interview.

Results:

The participant’s average age was 39.8 (± 13.8) years. Females represented 61% of participants. Prevalence of overweight was 65.7%. Among those who visited a health care center during the previous year, measurements of weight and waist circumference were reported by 36.5% and 5.6% respectively. Assessment of dietary habits and physical activity were more common among obese consultants. However, assessment proportions of these behavioral risk factors were around 50%.

Conclusion:

Overweight is highly prevalent among the adults of Sousse. The national prevention program of obesity should be no more delayed in Tunisia.

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BACKGROUND
Digoxin is a cardiotonic glycoside that is mainly used in the treatment of heart failure,
atrial fibrillation, flutter, and paroxysmal atrial tachycardia. Intoxication due to digoxin
excess is a common problem in clinical practice because it is therapeutically effective
within a narrow dose range, Acute toxicity is more likely to result in a younger
individual following an overdose. Chronic digoxin toxicity frequently occurs in the
elderly as a result of declining renal function or drug-drug interactions, is harder to
diagnose, and has a more insidious onset of symptoms. Gastrointestinal symptoms can
be less pronounced than in acute toxicity. Neurologic manifestations, such as lethargy,
fatigue, confusion, and weakness, are common. Hyperkalemia or hypokalemia can be
observed.

LEARNING OBJECTIVES
– Managing drug-drug interactions
– Precognition of clinical signs or symptoms
– Signs of poisoning in the electrocardiogram
– Analysing blood tests if suspicion of poisoning

ORGANIZATION
– We will make an introduction with a clinical case and explaning
characteristic features, diagnosis, and management.
– We will make 4 groups and provide to each group a different clinical case
and ask to make an evaluation, management, afterwards each group make a
presentation and discuss the case with the other groups, realizing a group
debate.
– Finally we will use Kahoot and ask everyone to participate and evaluate if
the principal topics have been learned.

CONCLUSIONS
We aim that the participants will be able to monitor Digital, recognice clinical
symptoms, what to request in blood test, and read an electrocardiogram, all key tools in
the diagnosis of poisoning of Digital.

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The aim. To assess the variation of metabolic biomarkers in young people (apoB atherogenic particles and apoA-I antiatherogenic particles).

Materials and methods. A cross-sectional study of 88 young apparently healthy individuals, 23 (26.1%) men and 65 (73.9%) women with the mean age 19.3±0.2 (17 to 25 age range), predominantly from a rural area (78,4%). The data on demographic and social characteristics of participants were collected, and clinical examination performed. The blood samples were collected under standard conditions. The plasma total cholesterol (TC) was measured using an enzymatic method, the LDL-C was calculated according to Friedewald’s formula. The apoA-I and apoB concentrations were measured using the immunoturbidimetric method.

Results. The HDL level was 1,55±0,037 and LDL-C – 2, 29±0,05 mmol/L, and both of them increase with age in male and female (p<0.05). The levels of apoA-I varied within 0,66–3,98 g/l, the mean apoA-I values being 1,12±0,019 g/l, with fluctuations depending on sex: 0,95±0,034 g/l in males versus 0,39±0,049 g/l females (p<0,05). The mean level of apo B was 0,50±0,016 g/l, with variance between 0,01 g/l to 3,25 g/l, with significantly lower level in males 0,46±0,024 g/l versus 0,51±0,049 g/l (p<0,05). The mean of apo B/apoA-I ratio was 0,46±0,024, and it increased with age in females (p<0,05) and decreased in males (p<0,05).

Conclusion. The studied biomarkers have a tendency to increase in concentration with age and have demonstrated more “protective”, profiles in young females. However, longitudinal studies are needed to evaluate the role of their value estimated in young people to predict the cardiovascular events in adulthood.

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Takotsubo cardiomyopathy is a myocardial disease that is structurally and functionally abnormal in the absence of structural cardiac alterations. It is often indistinguishable from acute coronary syndrome (ACS) and usually preceded by stress, hence it´s also called “broken heart syndrome”.

Woman, 49 years, divorced and hairdresser. Background: dyslipidemia, excess weight, reflux esophagitis and anxiety disorder. Presently medicated with proton pump inhibitors.

In September 2014, in consultation with her General Practitioner (GP) due to retrosternal pain with cervical irradiation and dyspnea, she was referred to the emergency department. Being tachypneic and tachycardic, with increased cardiac markers, electrocardiographic changes and chest X-ray with pulmonary congestion, was diagnosed with ACS. Echocardiogram showed acute heart failure (AHF) with severe impairment of left ventricular systolic function (LVSF). Coronary angiography didn´t reveal CAD, assuming AHF of unclear cause. She was discharged after rapid improvement and complete recovery of her cardiac function.

In consultation with her GP: asymptomatic but distressed by the past episode. After reavaluation, the GP concluded that the triggering factor was stress motivated by her work. In a new Cardiology consultation: assumed the final diagnosis of Takotsubo syndrome.

In subsequent consultations, the GP intervened scheduling frequent consultations where therapeutic listening played an influential role in teaching anxiety management to prevent recurrence.

Although an increasingly investigated entity, the number of cases described is small and much is still unknown. This case intends to emphasize the importance of the GP in the differential diagnosis of this syndrome, given its comprehensive knowledge of the patient´s biopsychosocial context.

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Background: Recurrent respiratory tract infections (RRTIs) frequently affects children. It is widely accepted that RRTIs in childhood represents a problem per se in addition to an increased predisposition to future respiratory problems. In this regard, bacterial lysates were introduced in human therapy many decades ago.

Purpose: To identify the efficacy of bacterial lysates in the secondary prevention of recurrent RTIs in children.

Methods: Published randomized controlled trials (RCTs), meta-analysis, systematic reviews, and clinical oriented guidelines were searched using multiple bibliographic databases in the last 20 years. The mesh words used were: recurrent respiratory tract infections, bacterial lysates, OM-85, sublingual vaccine, oral immunotherapy. The level of evidence and strength of recommendation was graded according to SORT of the American Academy of Family Physicians.

Results: 103 studies were found, but only 6 were retained as relevant trials (3 RCTs, 2 meta-analyses, and 1 systematic review). The RCTs and the meta-analysis reported a decrease in the number of RRTIs. The systematic review showed that the evidence in favor of bacterial lysates in the prevention of RRTIs in children was weak. There is a trend for fewer and shorter infections as well as a smaller reduction of antibiotic use.

Conclusion: The strength of recommendation in favor of using bacterial lysates to prevent RRTIs is B. Further confirmatory evidence from high-quality and large-scale RCT trials is required.

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Background and purpose: Little is known about the extent to which Lebanese travelers seek pre-travel advice. This study aims to determine the level of knowledge, attitudes, and practices (KAP) of Lebanese travelers towards travel health.

Methods: A cross-sectional study over a period of 1 week using a self-administered questionnaire at Rafic Hariri International Airport in Beirut in January 2020, before the Covid pandemic reached the country. It included 615 Lebanese travellers.

Results: Travelers were predominantly men (68%), and 80% had a high educational level. The majority were travelling to the Middle East/Gulf countries (36%) and sub-Saharan Africa (35%). The big majority (75%) sought general information about their travel destination, and the sources of information were mainly family and friends (44%), and the internet (36.7%). Around the third (33%) sought medical advice, mostly from physicians (19%). Only 2.4% sought it from travel clinics. No medical concerns was the main reason not to get medical advice (42.9%). Half of travelers were planning to participate in outdoor activities, but most won’t use protection to mosquitoes. Only 15.8% of travelers sought pre-travel medical advice at least one month before; this behavior was found to be associated with high risk destinations, stay length, travelling for religion/mission, participating in outdoor activities, visiting rural areas, and health insurance status.

Conclusions: Lebanese travelers had less than optimal levels of knowledge, attidues and practices towards travel health. This highlights the need to develop specialized travel medicine services and educational materials enhancing the public's travel health perceptions. A similar study evaluating the impact of covid-19 would be of great benefit.

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Background. The health services can be organized in several ways. The most important distinction is between tax-funded collective services like the British NHS developed after World War II and services organized in a free market as in the US. In Norway, which developed a healthcare system that resembled the NHS, general practitioners continue to play a key role.

Material and methods. We completed a scoping review and looked at different ways to organize the health services, with emphasis on the role of GPs.

Results. In open healthcare markets, patients can seek all types of services directly, including specialized and costly services and examinations without prior GP assessment. The disadvantages of this are, among other, increased costs for society, more poorly justified medical tests and sub-optimal prioritization of the total health service resources. In the tax-funded collective services in Norway, all residents are on a list for a specific GP. The GP's task is to be the first contact with the health service for all and to clarify whether more advanced specialized examinations are needed. The benefits of this are many, reducing the overall cost of the society, protects the patients for unnecessary, unpleasant and time-consuming examinations, level out social inequalities in access to health care, and ensure that disease is treated at the lowest effective level of care.

Conclusion. Health care should be public, tax funded with the GP in a central position.

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BACKGROUND

Dignified dying combined with fulfillment of the final wish for organ donation of a patient experiencing hopeless and unbearable suffering who decides voluntarily to end their life has evolved from existing euthanasia practice. This noble and empathetic gesture saves other lives. ODE (Organ Donation after Euthanasia/Physician-assisted death) is decriminalized and regulary performed in three countries (Canada, The Netherlands, Belgium) and was recently decriminalized in several more (Spain, Portugal, New Zealand, Australia).

The family physician plays an integral part in the procedure as a trusted guide, performing part of the procedure and overseeing the entire palliative process. The Netherlands and Canada have developed detailed guidelines stressing the key role and importance of the family physician, working in harmony with the hospital donation physicians. Results are positive.

The major reason why many sick, hospital-weary patients ultimately decide not to proceed with ODE is their desire to end their suffering in the comfort and privacy of their own home. The recent development of ODET (ODE starting at home) removes this obstacle by enabling the patient to be sedated at home.

AIM AND LEARNING OBJECTIVES

-Spreading knowledge about these procedures to family physicians

-Furthering use of the procedures and learning from each others practice.

-Establishing a WONCA special interest group

METHODS AND TIMETABLE

Online international gathering of family physician experts and other interested doctors for introductions and discussion. One hour.

-ODET/ODE practice description

-ODET/ODE evaluation: advantages and disadvantages

-Attitudes towards ODE/ODET in countries where performed

RESULTS

-Increased family doctor knowledge, involvement and furthering introduction

-Improvement of processes

-Initiation of WONCA special interest group

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The specific skills needed to deal with a frequent problem such as pain are not particularly well-established and we can come across practices that are not always correct and, at times, influenced by real taboos.

This may result in inappropriate management of the "patient with pain", be it cancer or non-cancer, acute or chronic, situation swhich, in order to be successfully addressed, require competence, management skills, integration of their competences and / or roles with those of other operators and ... empathy.

The role of the General Practitioner in pain therapy and palliative care is of particular importance as the first interlocutor of the patient, therefore it is important that he has specific skills and knowledge.

Role and Tasks of General Practitioner

1) Detect pain during the outpatient and / or home visit;

2) Periodically reassess the intensity of pain;

3) Treat any side effects of drug therapy;

4) Instruct family members to manage the "critical" phases;

5) Evaluate when the analgesic treatment becomes a specialist competence;

6) Collaborate with the specialist of the analgesic therapy center in the management of complex patients (for example: Invasive analgesic therapy, etc ...)

7) Promote the education of patients and family members in the correct detection of pain and the correct administration of drugs.

Conclusions

The establishment specific training courses in palliative care and pain therapy related to neoplastic and / or chronic degenerative diseases,

both in the university study plan and in post-graduate training is still to come, except for the masters, moreover established patchy.

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1. Background

Having an organized “mindset” helps us navigate the stressful times we are living in today. In our professional lives, good organization is key, contributing to problem solving, confidence, time management, and the overall well-being of the individual. Even though this ability does not come naturally to everyone, we can learn techniques to stay organized and develop the mindset of an organized person, both personally and professionally.

2. Aim and learning objectives

This workshop aims to review and analyze organizing skills and tools that may be useful for family doctors. Participants will :

-Gain an awareness of the different methods for developing organizing skills,

-Learn how to implement them in real-life practice (personally and professionally)

- Discover how to develop an organized mindset and increase confidence in their abilities.

3. Methods and timetable

In a 60 minutes Workshop :

1. Introduction and icebreaker; including session overview/outline

2. Review and comparison of different organization skills models and theories Divide into groups to discuss personal experiences, challenges, and successes of the following topics:

-Organizing skills

-Traditional Planning

-Technological Planning

-Time management

-Decluttering

-All in one tool

3.Each group will present the summary of their discussions, including their key learning outcomes. Debriefing discussions will reflect on how we can implement ideas in practice. Questions and goodbyes.

4. (Proposed) Results / Conclusions

After this workshop, the participants should be able to evaluate their own needs in terms of professional and personal organization, as well as implement tools and skills for improving and developing their “stay organized” process.

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Background:
Since the rapid increase in infections of Covid-19, The both caseswere reported on the 13 th of March, both of whom had recently travelled from Italy. Both cases were also reported in the town of Klina, and this area was effectively
‘ground zero’ for the infection in Kosovo. Information about the measures taken in Klina, particularly by the MCFM (QKMF) to control the spread of the virus, as well as the relaxation of restrictions, will be used to analyse the effect of variation in restrictive measures and its effect on management of the Covid-19 pandemic.

Method:
We compared the number of tests, cases and mortalities for Covid-19 in Klina.. In addition to this, certain
dates between the beginning of the pandemic, will be taken as inflection points, to assess how the difference in measures affected key outcomes of testing, cases and deaths.

Results:
The approach of contact tracing and testing was applied more broadly, and a policy of 14 days of self-isolation for those who had been travelling, for example visiting members of the Diaspora, was also pursued.
An important aspect of the management of the pandemic in the QKMF was collaboration with other
institutions.
In July, 3 patronage teams were formed to perform home visits to suspected Covid patients, and separate
rooms in QKMF were used for such patients, thereby allowing them to receive normal medical care without exposing other patients to the risk on infection.

Conclusions:
Tracking of cases and contacts.
Providing home health services for these patients
Genuine triage in QKMF
Special rooms for Covid 19 patients

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Background: Bullous pemphigoid is a rare auto-immune disorder characterized by reddish and itching fluid-filled blisters, typically seen in the elderly. The immune targeting leads to the deposition of specific anti-BP180 and BP230 IgG antibodies. Pathophysiology remains unclear, although several factors have been suggested such as medication, UV radiation, infections and trauma. Among the most common drugs associated with the disease are antibiotics, anti-hypertensives and oral antidiabetics in which dipeptidil peptidase-4 (DPP4) inhibitors are associated with the greatest risk.

Materials and Methods: 72-years old female with Diabetes and Hypertension, taking Metformin, Vildagliptin, Olmesartan and Hydrochlorothiazide, goes to the Hospital Emergency with a pruritic dermatosis, lasting for 6 weeks, with lesions spread all over the trunk and limbs. Initially given topical steroid with no improvement. Blood count revealed leucocytosis, neutrophilia, eosinophilia, with an increase in inflammatory markers, despite controlled glycated haemoglobin.

During hospitalisation, she was given Vancomycin (after MRSA isolation from blood culture), Doxycycline, Prednisolone, and topical Betamethasone with Fusidic Acid. Skin biopsy was compatible with Bullous Pemphigoid and anti-BP180 IgG antibodies were also present. The lesions got progressively better, being released from the hospital with referral to a dermatology appointment and suspension of DPP4 inhibitors.

Conclusion: Bullous Pemphigoid should be taken into consideration in patients under DPP4 inhibitor treatment, particularly if symptoms match the starting of the drug. It seems it may play as a contributor in a predisposed patient rather than having a direct cause-effect role.

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1. Background and purpose

The estimated prevalence of diabetes among adults aged 25 years and older in the European Region are about 10.3% for men and 9.6% for women. The large majority of patients have type 2 diabetes. More health care resources are estimated to be spent on diabetes than any other condition. The diabetes-associated complications contribute to the impact in both the patient’s quality of life and health care costs.

2. Methods

We present a case of a 57-year-old male who was referred to the emergency department due to complications of perforating plantar disease. This patient had a past medical history of type 2 diabetes mellitus (DM) with poor metabolic control with its multiple complications – retinopathy, nephropathy, neuropathy and peripheral arterial disease (PAD).

3. Results

He was admitted in hospital to perform intravenous antibiotics in order to control the infection associated with the perforating plantar disease. Meanwhile he was infected with SARS-CoV-2, causing a deterioration of his overall condition, resulting in multiorgan failure and death.

4. Conclusions

In type 2 diabetes, disease onset is often insidious, and diagnosis is therefore delayed.

Morbidity from diabetes is a consequence of both macrovascular (atherosclerosis) and microvascular (retinopathy, nephropathy, and neuropathy) complications. Therefore, it is important to educate patients on diabetes self-management and improve adherence to lifestyle and pharmacologic interventions in order to reduce its morbidity.

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BACKGROUND AND PURPOSE

In the current pandemic situation, in the presence of respiratory symptoms we suspect COVID-19 coronavirus, with the risk of postponing the diagnosis of other pathologies.

Dyspnea has multiple causes:pulmonary, cardiovascular, anxiety, anemia...

METHODS

23-year-old woman. Sanitary.

History:migraine with aura, asthma and venous insufficiency. She takes oral contraceptives(OCs). No toxic habits.

She consults for headache and odynophagia. Diagnostic Guidance:Possible COVID-19. Negative rapid antigenic test(RT).

She reconsults after 48h due to dyspnea. Normals blood test, temperature, oxygen saturation, electrocardiogram and chest x-ray. Negative RT-PCR and coronavirus serology.

24h later she was admitted to hospital with dyspnea at rest, tachypnea, tachycardia and paraesthesia in the right arm.

Differential diagnosis:COVID-19/reacute asthma/pulmonary thromboembolism(PTE).

RESULTS

Chest X-ray, electrocardiogram, saturation, and blood test with D-dimer were normal.

Normal CT-angiography, lower extremities Doppler and cranial resonance. Pulmonary perfusion SPECT with CT perfusion defects in the left lung, diagnostic of PTE.

More detailed anamnesis:primary antiphospholipid syndrome in mother and maternal grandfather. Pending results of the patient’s trombophilia study

Treatment:

-OCs suspension

-Oral anticoagulants.

CONCLUSIONS

1-Focusing visits for possible coronaviruses only on this pathology can lead to not asking for antecedents that could lead to other causes of equal or greater severity.

2-A family history of thrombotic pathology indicates that antithrombin III(AT-III) should be determined,especially before starting OCs, which was not done at the time.

3-Although there is variability in protocols on screening for AT-III, protein C and S before starting OCs, the current evidence does not recommend it, except for women with a family history of coagulopathy or a history of thromboembolism before the age of 41.

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Background and purpose

Family assessment is an essential component of Family Medicine. Consulting the process and integrating the pathological and family context of the patient, becomes especially important when we attend the patients for the first time.

Methods

Case report of an 18-year-old man, with Diabetes diagnosis since age 9 without any drug prescription.

Results

An 18-year-old man, attending for the first time by a family medicine intern, on diabetes appointment, with ICPC-2 code T90 active since age 9, without any drug prescription. Only the maternal family is part of the health archive and the known clinical family history is irrelevant.

The first thought was that there would probably be a coding error, but he brings a glycated hemoglobin (HbA1c) result of 6.3%.

For better understanding, clinical records were consulted, and the family genogram was carried out, which showed 3 generations with a diagnosis of diabetes at a young age without need for insulin treatment.

Conclusions

Children and young adults with non-characteristic diabetes, occurring in successive generations, should be tested for MODY-type diabetes. If the family assessment had been carried out, the diagnosis would have been earlier. Although in this case it has no influence on the natural course of the disease, early diagnosis can be essential for other pathologies.

Abstract Body

Background and purpose:

Patients with diabetes mellitus (DM) have an increased risk of cardiovascular morbidity and mortality. Therefore, they have to maintain perfect control of all risk factors for cardiovascular diseases, which, unfortunately, is not always achieved. This study aims to assess the extent to which diabetic patients in a rural mountainous area in Greece achieve therapeutic goals, identifying factors that influence this achievement.

Methods:

The study included 164 patients with DM who first visited our health center. Glycosylated hemoglobin (HbA1c) and blood lipids were measured in all patients, while systolic and diastolic blood pressure (BP) was estimated twice, at rest. Body mass index (BMI), marital status, diabetes duration and immunization against influenza and/or pneumococcus were also recorded.

Results:

Ninety-five patients (57,9%,) had satisfactory glycemic control, with mean HbA1c<7%. Therapeutic goal for BP was achieved in 52 patients (31,7%). Levels of low-density lipoprotein cholesterol (LDL) reached therapeutic goal in 20 patients (12,2%), while for high-density lipoprotein cholesterol (HDL) and triglycerides this was achieved in 103 (62,8%) and 102 (62,2%) patients, respectively. Only 1,8% of the study population achieved all therapeutic goals. Factors that adversely affect this achievement, in a significant manner, were high BMI (p=0,022), single life (p=0,005) and long DM duration (p=0,029). Patients vaccinated for influenza (74,4%) and/or pneumococcus (34,8%) had better glycemic control (p=0,022 and p=0,02, respectively).

Conclusions:

The majority of patients with DM do not achieve therapeutic goals. This emphasizes the role of primary health care physicians in continuous monitoring and treatment adjustment in diabetic patients.

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Urinalysis – How to handle with abnormal results?

Abnormal findings in urinalysis are regularly seen in routine test results of asymptomatic patients. How should we interpret these results? Should we continue to investigate and search for common or rare diseases?

We will start this workshop with a brief theorycal introdution and then we will describe the diagnostic workup steps in general practice and give simple methods to handle these abnormal results. The participants will be invited to work in different situations frequently faced in general pratice. It adresses to students, young and senior doctors who feel uncomfortable in the interpretion of urinalysis.

Abstract Body

1. Background

Diabetes Mellitus is one of the most frequent non-communicable diseases in our daily work and its importance and costs are progressively growing up. It is one of the reasons why we are focusing on its prevention and treatment by diet interventions, which has demonstrate to be a very cost-efficient tool in GPs consultations.

2. Aim and learning objectives

Learning objectives:

-reviewing current recommendations on diabetic nutrition.

-announcing recent evidence about this topic.

-giving ideas about how to put in practice this novelties.

3. Methods and timetable

We will use a presentation, which includes a brief introduction on the topic refreshing current recommendations and comparing them with actual evidence by Kahoot or similar system. After it, we will divide the participants into small groups in order to discuss some clinical cases that, they would present back to the general group. At the end, we will open a round of question for doubts or curiosities.

The activity will take 60 minutes:

-5’: presentations of the speaker and the topic

-20’: for theory and questions.

-30’: for clinical cases

-5’: doubts and questions

4. Conclusions

This workshop intention is to talk about the changes on diabetic nutrition recommendations and how could it be applied in our daily consultations.

Abstract Body

Background and purpose

Prostate cancer is the most frequent cancer in males, and is associated with some risk factors as afroamerican ethnicity, older age and family history of prostate cancer, specially in a father or a brother. Screening of prostate cancer with prostate-specific antigen (PSA) is controversial, as it can be associated with significant overdiagnosis and potencial overtreatment, and has no effect on overall mortality, despite the reduction in metastic disease and disease-specific mortality. Screening decisions are part of the daily routine of family phisicians and, for this reason, it is important to clarify if and/or when to screen for prostate cancer.

Methods

A literature search was conducted in PubMed and BMJ Evidence-Based Medicine databases, and international guidelines, using the keywords: prostate cancer, screening, prostate-specific antigen, overdiagnosis. It was found 29 articles and 5 were selected, based on the exclusion of the studies related to prostate cancer diagnosis, management and treatment approaches.

Results

The screening for prostate cancer with PSA should not be done on a systematic basis. It should be considered individually between the ages of 55 and 69 years old or through and individualised risk-adapted strategy, and men should have the opportunity to discuss the potencial benefits and harms of screening with their clinician, and to incorporate their preferences in the decision.

Conclusions

Family phisicians should be aware of the significant overdiagnosis and potencial overtreatment associated with prostate cancer screening using serum PSA, and should be prepared to discuss screening decisions with their patients, in order to achieve a shared screening strategy.

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Background and purpose: Insomnia is one of the most prevalent health concerns in primary care. In later life, insomnia is traditionally wrongly considered as a part of ageing and therefore underdiagnosed. Our aim was to evaluate the prevalence of insomnia amongst older people and identify its causes.

Methods: We undertook a cross-sectional study. Participants were identified based on a random selection at a GP surgery in Tunis. 70 participants, aged 65 years old or above, consented to participate. Participants responded to an anonymous questionnaire about sociodemographic data, quality of sleep, the impact on the quality of life and questions screening for causes of insomnia. Insomnia was defined based on the joint consensus statement of the American Academy of Sleep Medicine. Obstructive Sleep Disorder (OSD) was identified based on STOP-BANG questionnaire.

Results: The study sample consisted of 45 women (64%) and 25 men (36%). 32 (46%) had insomnia. Among them, 29 (91%) were women (χ² (1) = 17.812, p < 0.005). In the insomnia population, OSD, which had not been previously identified, was found in 27 cases (84%). Arthrosis, anxiety, depression, substance use disorders and restless legs syndrome were found in 16 (50%), 10 (31%), 9 (28%), 3 (9%) and 2 (6%) cases respectively.

Conclusions: Insomnia is common in older age, more prevalent in women. Although the most common cause of insomnia was Obstructive Sleep Disorder (OSD), this aetiology was underdiagnosed in primary care. Therefore, we encourage clinicians to screen for insomnia amongst older people and consider OSD when present.

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Microscopic colitis is a chronic inflammatory disease of the colon that is characterized by chronic, watery, non-bloody diarrhea (usually of an insidious onset) and normal or almost normal endoscopic appearance of the colon. It has a female preponderance, with a mean age at diagnosis of 65 years.

We present the case of a 74 year old female patient, referred to the Gastroenterology department due to an 8 month history of diarrhea (no blood or mucus), preceded by colicky abdominal pain (relieved after defecation). There was no history of fever or weight loss. She reported a change in her bowel movement pattern a year earlier. Her medical history was notable only for osteoarticular disease, medicated with NSAIDs (sos), which she took more frequently over the last year.

Physical examination revealed lower quadrants tenderness to palpation. Laboratory evaluation showed only CRP 41.7 mg/L. Abdomen X-ray and Abdominopelvic CT showed dilated colic segments with hydro-aeric levels.

Colonoscopy was performed with normal findings, but no biopsies. Despite some clinical improvement with symptomatic medication there was still a reference to diarrhea. Following this, flexible rectosigmoidoscopy was requested to exclude microscopic colitis, and biopsies were compatible with collangenous colitis.

This condition is complex and multifactorial. Medications (such as NSAIDs, PPI) have been associated with an increased risk. As it is associated with significant symptom burden and an impaired health-related quality of life, it is crucial to discuss the clinical and treatment aspects of this condition among general practitioners, often the first contact care for most patients.

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Background and purpose

Polymyalgia rheumatica is an inflammatory rheumatic disease, with it being the second most frequent rheumatic disease. Its main diagnosis characteristics are: Starting at the age of 50 and increasing in prevalence with age; clinically it presents pain and morning stiffness symmetrically in the neck, shoulders and/or hip; And lastly, increased sedimentation velocity and c-reactive protein.

Methods / Results

Case: Woman, 70 years old, with medical history of arterial hypertension, dyslipidemia and depression. She attended a medical appointment in June 2020 for asthenia, anorexia and anhedonia, without any change in physical exam. Regarding unspecified symptoms blood tests were requested where thrombocytosis and increase of sedimentation velocity (110 mm/h) and of C-reactive protein (7,48mg/L) were found. In July, the patient reported weight loss, symmetrical pain and morning stiffness in the shoulders, hips and knees with pain at articular mobilization. After excluding the presence of diseases such as cancer or other rheumatic diseases, rheumatic polymyalgia was considered the most likely diagnosis. The patient started 10mg of prednisolone per day. Two months later a reassessment was made, where the patient reported improvement in symptoms, gaining autonomy on her daily activities, and on the control tests there was a normalization of the platelets and a decrease of C-reactive protein (0,61mg/L) and of sedimentation velocity (29 mm/h).

Conclusions

It was initially difficult to understand the cause of the patient's symptoms and limitations. However, with a correct anamnesis performed by the family physician and analysis of the blood tests results it was possible to diagnose the patient with polymyalgia rheumatica and to treat accordingly.

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Giardiasis is an intestinal parasitological infection caused by the protozoan Giardia duodenalis (G. lamblia / G. intestinalis). Epidemiologically, it is a global disease, being common in developing countries. In developed countries it appears mainly in children and immunocompromised people. The dissemination route is oral-fecal and, in Portugal, it is a disease of which notification is mandatory.

We describe a case of a 23-year-old immunocompetent man, living in a region in the interior of Portugal, with basic sanitation and good living conditions. There was no epidemiological context or recent travel.

He resorted the primary health care due to a very frequent daily diarrheal discharge, with four days of evolution. Additionally, he had abdominal colic, vomiting and nausea. A first therapeutic approach was made with the prescription of probiotics, but, due to no resolution of the complaints, analytical study , microbiological examination of the feces and colonoscopy were required 3 weeks after the onset of symptoms.

The microbiological examination of the feces was positive for Giardia lamblia. The remaining complementary exams did not reveal any changes.

He started therapy with metronidazole 250 mg PO, 3id, for 7 days, with clinical resolution.

Facing a situation of non-resolution of symptoms with the recommended measures for the most common causes of diarrhea, it is important to investigate its etiology. In this case, we were surprised by the diagnosis of Giardiasis, a rare cause of diarrhea in our young adults without risk factors

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Background

Statins are widely used to prevent cardiovascular morbidity and mortality in patients with known risk factors. It appears that statins have profound multisystem effects that extend well beyond lipid metabolism. Certain adverse effects are well-known. Statin-induced interstitial lung disease (ILD), nevertheless, is a lesser known complication. Diagnosing ILDs at a point that clinical course can be changed by withdrawing the contributing agent is thus important.

Methods

A 57-year-old female presented to the primary care with fatigue for low intensity activity (mMRC 2), chest tightness and cough with sputum for 2 years. She denied weight loss or any other associated symptoms. Pulmonary Function Tests and echocardiogram were normal. A chest CT was requested and it showed ground-glass opacification. The patient was then referred to a Pneumology consultation where she underwent a lung biopsy.

Results

The lung biopsy identified a chronic interstitial pneumonitis probably due to a drug. According to the patient’s prescriptions simvastatin was assumed as the probable cause. The patient discontinued the statin and started inhaled fluticasone furoate/vilanterol. At 1-year follow-up she had improved, although she still had complaints of fatigue for medium intensity activity (mMRC 1).

Conclusions

Many conditions can cause ILD and identifying them can be challenging. Despite being a rare complication, as the number of patients taking statins rises, awareness of this potentially severe complication is increasing, especially for primary care physicians, so they can know when to refer to a specialist.

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Background and purpose: Diabetes Mellitus type 2 prevalence among the Portuguese population was around 13,6% in 2018. Metformin is one of the first line drugs recommended by several Diabetology societies and articles have been published linking its continuous use with decreased serum levels of vitamin B12 (cobalamin).

Evaluate the deficit of cobalamin in a sample of diabetic patients treated with metformin from a primary care unit - UCSP S. Miguel (Castelo Branco, Portugal). Patients using cobalamin supplements or previously gastrectomized were excluded.

Methods: A retrospective, observational study evaluating cobalamin levels in diabetic patients treated with metformin for 24 months. Cobalamin deficit was defined as having a blood value under 211mg/dL.

Results: 35 outpatients were included, with an mean age of 75.5 (± 10.89) years. 18 were males (52%). Mean daily dose of metformin was 1771 (± 441,80) mg. Deficit of cobalamin was reported in 9 patients (25,71%), with a mean age of 82.78 (± 9.85) years and mean metformin daily doses of 2005.56 ± 558.15 mg.

Conclusion: The results show that 1 out of 4 patients in the sample have cobalamin deficit. These patients were older and under higher doses of metformin than patients with normal values.

The results demonstrate the importance of assessing cobalamin levels in diabetic patients. Despite previous studies demonstrating this deficiency, there is still scarce evidence regarding risk factors which can lead to this deficit. Cobalamin levels should be closely monitored by physicians and supplementation should be implemented in those patients who have low serum levels or suggestive clinical findings.

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Primary Sense is a data extraction, analysis and reporting and decision assist tool for general practice developed and administered by Gold Coast Primary Health Network in Australia that has been in 79 practices on the Gold Coast since 2019 covering 670,000 individual patients. The tool has real-time medication safety alerts that, unlike the clinical software alerts, captures what the GP intends to do, tracks if the suggested interventions are done, and has the ability to monitor patient outcomes overtime.

The alerts are 13 alerts which don’t duplicate those proved by the clinical software. The GP is provided with options to manage them as shown below

The alerts were released without any training or education. Since 9 April 2019 to 11 January 2021, 3,679 alerts have triggered for 340 GPs:

agree and I’ll take action - 41% ( n=1503)

agree but I’ll override - 21% (n=775)

wrong for the patient - 5% (n=180)

remind me next time - 15% (n=547)

Ignored - 16% (n=592)

Further analysis reveals that where the GP indicated they would take action for these patients, 812 had the medication in question omitted or the dose changed and 390 patients had the suggested pathology done (some fall into both categories). Interestingly, where the alerts were ignored the rate of intervention is about the same as where the GP said they would take action

GPs will interact with decision assist alerts where there is high clinical relevance and will take action even if they choose not to interact. The interactions enables tracking interventions and linking to patient outcomes

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Managing respiratory symptoms’ treatment of our chronic patients is challenging. It becomes more difficult when the patients are in an advanced stage of the disease. Primary Care and Palliative Care professionals, including doctors and nurses, need theoretical knowledge and practical skills about managing therapies during this end of life stage.

In our workshop we will explain the most common treatments, techniques and how advice to our patients and their caregivers.

Interactive tests will be presented to our colleagues that assist at the workshop.

The aim of this workshop is to increase knowledge and practical skills of our participants, hopefully mostly young family doctors, family medicine residents, general practitioners and nurses.

Abstract Body

Background an purpose

The elderly are the most vulnerable to COVID-19, mainly those with chronic disorders. In March 2020, Portugal created a platform, Trace COVID-19, allowing the monitoring of SARS-CoV2 positive patients by primary healthcare. The patients are monitored through daily telephone contacts carried out by the physicians. The goal of this study is to characterise the geriatric population tracked through this platform.

Methods

An observational retrospective study was carried out examining the geriatric population monitored through Trace COVID-19 by four Healthcare Centers in Oeiras. Patients were older than 65 years, with a positive test for SARS-CoV2 and signed as cured or died due to COVID-19, between March 26th and August 31st 2020. A descriptive analysis of sociodemographic characteristics and comorbidities was performed.

Results

42 patients were included, with an average of 73 years, the majority women. About 85.7% had comorbidities, most commonly hypertension and dyslipidemia. 54.8% were symptomatic, most commonly dry cough and myalgia. 85.7% required medical observation and 26.2% required hospitalisation. 54.8% were unaware of an epidemiological link. 11.9% lived in institutions. There were 6 deaths, mainly women, whose average age was 86 years.

Conclusions

There were a large number of asymptomatic patients. Respiratory disease was not the most prevalent comorbidity; out of the three symptoms used as test criteria in Portugal, only cough appeared to be a frequent symptom. Few patients needed hospitalization. This study requires a critical review since the most severe cases were followed up at hospital care and not in primary healthcare.

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Background/ Purpose: Physicians are limited in their ability to treat because it is guided by the information they are provided from their patients. Internet searches of patients raise multiple ethical considerations and are generally unadvised in the management of care. In this case, we describe a patient for whom an internet search proved vital in her medical treatment.

Case Report: A woman with no identifying information was found obtunded by EMS and transported to our emergency department. The patient was sedated for uncooperative and aggressive behavior and was unable to provide any meaningful information. A limited physical exam revealed a disheveled appearing patient with constricted (2mm) pupils, and spontaneous movement of all 4 limbs elicited by a sternal rub. Basic metabolic panel was significant for hypokalemia, urine drug screen was negative, and alcohol levels were undetectable. The patient remained altered for the for multiple days. On the fifth day of hospitalization the patient was able to state her name and a Google search was conducted that identified the patient as a missing person from her adult foster care home. We were then able to find her hospital records that revealed an extensive psychiatric history and multiple psychiatric inpatient admissions for psychosis secondary to schizophrenia. Antipsychotics were initiated and the patient was transferred to an inpatient psychiatric hospital for further management.

Conclusions: This case demonstrates the benefits of using the internet to help with patient care. Patient-targeted internet searches raise ethical considerations but should be contemplated for patients with this presentation.

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Background/Purpose: Portuguese general practitioners (GPs) are responsible for the remote assessment of patients with suspected COVID-19 symptoms, and for the follow-up of confirmed cases during the isolation period, directing the patient to observation if needed, and continuing the telemonitoring after they are dismissed. The purpose of this case report is to illustrate the essential role of primary care in responding and handling the aftermath of COVID-19.

Methods: Case study.

Results: The patient is a 57-year-old male construction worker, with multiple cardiovascular risk factors. On December 14, the patient developed cough, intermittent fever, dyspnea and pleuritic pain, which led to a positive test result for SARS CoV-2 and indication for home isolation with GP daily assessment. During the first days of telemonitoring, the symptoms gradually worsened and the patient was guided to observation in the emergency department. He is then admitted in an intensive care unit for three days, being dismissed home after a week. During the remaining isolation period the patient sister, also infected, passes away, triggering natural grief reactions. Following the infection phase, the patient presented a poorly controlled diabetes and remained severely fatigued, anorexic, with marked physical activity limitation, resulting in the need for respiratory and musculoskeletal rehabilitation plus nutritional and psychological support.

Conclusions: This case report validates primary care as the first medical contact during a pandemic, managing the great majority of COVID-19 related care, from the first symptoms to handling the consequences of the disease in all its dimensions, for the patient, family and community.

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Background: Internal Regulation Center (NIR) implementation in Campo Limpo’s Unidade de Pronto Atendimento III (UPA-CL), a public-private partnership Public Healthcare System(SUS) and the Instituto Israelita de Responsabilidade Social(IIRS), was conducted during the COVID19 pandemic. Patients with Severe Acute Respiratory Syndrome(SARS), demanded NIR’s implementation to manage patients transfer.During the pandemic, healthcare institutions had, to restructure processes, physical areas and human resources. NIR was implemented in units after a sudden surge of occupancy rate higher than beds availability, it was needed to create a sector to quickly and safely transfer patients to final treatment units and ensure a safe number of available beds to new cases.

Methods: Experience report in patient quality and safety

Results: In May, 409 transfers were made: 57.5% to HC and 42.5% to HF, 58 to ICU, the average stay time was 51h and 39m and in June it was 27h and 49m. June, 356 transfers, to HC 41.9% and to HF 58.1%, 35 to ICU, 348 SUS unit, 8 to UP. July, there were 305 patients, to HC 31.8% and to HF 68.2%, 46 to ICU and 162 to infirmaries, 300 SUS, 5 UP. August, 152 patients, to HC 15.1% and to HF 84.9%, 29 to ICU, 148 to SUS, 4 directed to UP. The average time between assigned hospital bed and ambulance request was 270m in May to June–182 minutes, July–172 and August–140.

Discussion/Conclusions: During the COVID-19 pandemic, healthcare institutions had, to restructure processes, physical areas and human resources. NIR implementation was an efficient management action translated into great improvement in health care quality to the population.

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Introduction:

Low back pain is common in clinical practice and one of the main reasons for medical consultation. The etiology is diverse: from physical effort and bad posture to structural spinal anomaly and inflammatory or systemic diseases.

Transitional vertebra (VT) is an anomalous vertebra, which results from a congenital anomaly and can occur at the transition from the cervicodorsal, dorsolumbar or lumbosacral spine.

Description of the Clinical Case:

53-year-old woman, married, Duvall cycle phase VI, with no relevant medical history. Consulted the primary care physician for mechanical low back pain without radiation to the lower limbs. A x-ray of the lumbar spine reported “Dorsolumbar transitional vertebra (on the right an intact hypoplastic vertebra and on the left a fractured hypoplastic vertebra) and a lumbosacral transitional vertebra, which presents a right transverse megapophysis and it’s neoarticular to the sacrum, with a reduction in the amplitude of the intersomatic space”. The patient was treated with analgesic treatment.

Discussion / Conclusion:

A lumbar spine radiography identified the cause of this patient’s symptoms. The treatment of VT is usually conservative and surgery is reserved for specific cases.

The lumbosacral transitional vertebra occurs with a significant prevalence (4-35%) and should be considered in the etiology of lower back pain. Its study can be bypassed if there is clinical improvement with medical treatment. Nonetheless imaging exams should be considered for the identification of these findings. In this clinical case, besides finding the probable cause of lower back pain, a dorsolumbar vertebrae was also identified, a rare finding.

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CASE REPORT: IT'S NOT ALL ABOUT CARPAL TUNNEL SYNDROME

1. Background:

The carpal tunnel syndrome is a common medical consultation. However, a clinical-diagnose test dissociation or a non responding to treatment should make the physician to reconsider the diagnose and go beyond a simple carpal tunnel syndrome.

2. Methods:

We report the case of a 53 year-old man , hairdresser occupation, who related five month of numbness and tingling on left hand and fingers. The paresthesias didn't get better with gabapentin and non-steroidal anti-inflammatories.

The electromyography showed radicular C6 radiculopathy with a slight recruitment deficit and a minor carpal tunnel syndrome.

Magnetic resonance imaging - cranial : hyperintense lesions with microvascular appearence in white matter. Other demyelinating lesions in both hemispheres, periventricular, corpus callosum, centrum semiovale, union bulge pons, medulla oblongata, right hemimidbrain, right cerebellar mespeduncle.

Magnetic resonance imaging - cervical: Demyelinating lesions at medulla oblongata, posterior cords C3, C4, C6 and C7. Vertebral disc prolapse C6-C7 with a reduction of the cervical canal and right spinal radiculopathy.

3. Results:

The patient is refered to Neurology department to study a Multiple Sclerosis.

4. Conclusions:

Although Carpal tunnel syndrome is a very typical lesion in Primary Care, clinicians need to be aware and make a differential diagnose when the patient do not respond correct to treatment .

Abstract Body

Background

Benign paroxysmal positional vertigo (BPPV) is the most frequent cause of vertigo. It mainly affects women around the age of 60 and has a significant impact on their quality of life. Its etiology, in the vast majority of cases, is idiopathic. Approximately 90% of cases result from stimulation of ciliated cells in the posterior semicircular canal of the inner ear and these can be diagnosed using Dix-Hallpike Maneuver and be treated by the Epley Maneuver, considered the first line therapy for BPPV.

Aim and learning objectives

The aim of this workshop is to review the pathophysiology and clinical aspects of BPPV, as well as to review and practice the Dix-Hallpike and Epley Maneuvers. General practitioners (GP) should be able to perform it safely in primary health care (PHC).

Methods and timetable

The workshop will take approximately 1 hour and 30 minutes. It will have an introduction with a theoretical review, followed by video tutorials on the maneuvers and afterwards a brief discussion to answer questions and clarify concerns.

Results / Conclusions

It is expected that GPs feel comfortable making this diagnosis and recognise the indications for applying Epley Maneuvers as first-line treatment. It is an effective maneuver, with immediate results, without major side effects or additional costs, which can resolve BPPV in PHC, reducing the hospital burden.

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The uterine cervix cancer is the third most common cancer in women. The most used test for it's screening is the Pap Smear Test. Breast cancer is the most prevalent among women. The brest self-examinatiom is a self-awareness action, which is not recommended as an early detection method. The purpose of this study was to report the experience of undergraduate medical students at a private university in the countryside of Brazil, putting into practice the National Policy for Integral Attention to Women's Health (PNAISM).

To develop this activity, the students performed the supervised cytopathological examination of the cervix, explained to the patients the possible complications of the test, and taught them how to perform de breast self-examination, in a basic health unit in Presidente Prudente, SP.

Nine women, between 25 and 40 years old, were benefited from this action. This activity enabled the acquisition of knowledge, skills and attitudes by the medical students on how to perform the Pap Smear Test, in addition to the health education for the patients.

The promotion of prevention and health education activitys like this has an epedimiological impact, by reducing the incidence, morbidity and mortality indicators of gynecological cancers, apart from saving financial resources of the Unified Health System (SUS). Thus, the students had the opportunity to promote affective, social and economical health. The future of medicine lies on the hands of the students, therefore they must know epidemiology, so they can direct the future of Unified Health System's users, who are the great majority of brazilians.

Abstract Body

The correct management of stop-carts and advanced cases for urgent care in Primary Care is a key element for patient safety and its variability can be a source of potentially serious adverse events.

Goals:

1.Patient safety in urgent care

2.Homogenize the resources.

3.Involve healthcare professionals.

Organization: A multidisciplinary working group was formed that drew up an Urgent Care Equipment Manual, which includes the provision of the necessary material/medications in the stop car and the advanced briefcase and establishes the need for a responsible professional of its review and maintenance, through checklists and an audit procedure led by the Management based on the Lean Healthcare methodology through the Kaizen 5´S.

Duration:November 2018 and currently active.

Results: Non-conformities were detected and corrected both due to defect (most frequent due to expiration) and due to excess material (usually due to duplication). The mean number of non-conformities per center was, in the stop cart: material(2.49) and medication(6.58), and in the advanced briefcase: material(10.60) and medication(9,70).

Among the strong points identified, the great involvement of the person in charge (76%), the correct distribution (68%) and good functioning of the stop trolley apparatus (40%) prevailed.

In relation to the areas for improvement, they highlighted the need to reorganize the medication and the material of the briefcases(40%) and the cart(28%), as well as the replacement of the absent or expired(24%); in 16% excess material was removed.

Conclusions: The results have made it possible to detect areas for improvement and the implementation of actions that benefit patient safety.

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Background and purpose

Shoulder pain is the third most common musculoskeletal complaint in primary care. The international guidelines for general practitioners (GPs) recommend a stepwise treatment of shoulder pain. Little is known about the actual distribution of these treatments in current practice.The purpose of this study is to gain insight in the incidence and current management of shoulder complaints in Dutch general practice.

Methods

A retrospective cohort study was conducted using a healthcare database containing the full electronic medical records of approximately 200,000 patients in Dutch general practice. A search algorithm was constructed to identify incident cases of shoulder complaints from January 2012 to December 2017. Data on the management of shoulder complaints were manually validated in a random sample of 1000 cases.

Results

The overall incidence of shoulder complaints was 30.3 (95%CI 29.9-30.7) per 1000 person-years. More than half of the patients (58.6%) consulted their GP only once, 44.4% two times or more and 19.7% three times or more. For most patients (58.1%) the GP applied a wait and see policy or prescription of oral medication in the first consultation. However, no less than 42.9% of the patients were referred or received an injection already in the first consultation.

Conclusions

There is a wide variety of treatments for shoulder complaints applied by the GP. Some patients are referred or received an injection already in the first consultation. The stepwise approach recommended by the guideline, might not always be applicable due to the diversity of patient- and shoulder characteristics presented in general practice.

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INTRODUCTION: When treating patients with borderline personality disorder we must take under consideration high risk of self-har and suicidal behaviours.

BRIEF CLINICAL HISTORY: A 19-year-old female with a history of borderline personality disorder and bulimia contacted her GP requesting an urgent visit because of a sudden suicidal ideation, that delivered in a suicidal attempt – the patient jumped under the car on the road in the town, but luckily the driver managed to stop the car without hurting her. As a manifestation of the anger the patient banged her hand against the wall, provoking the fracture of two metacarpal bones. On examination she appeared calm, she declared the will of treatment; according to her words she felt “empty” and “not belonging to anywhere” – that was a direct reason of the suicidal attempt. The Advanced Life Support Ambulance transported the patient immediately to the local University Hospital where she was examined by the psychiatrist. The blood test revealed no drugs except for cannabis. The patient stayed in for 1 day, was attended by the psychiatrist and traumatologist and, finally, was discharged with an appointment for psychologist and psychiatrist for an outpatient clinic for the follow-up.

DIFFERENTIAL DIAGNOSIS: depression, bipolar disorder, psychotic episode

FINAL DIAGNOSIS:suicidal ideation in borderline patient

DISCUSSION: Facing a difficult situation of a patient after a suicidal attempt, we should behave in a discrete, but efficient way. We need to reassure the well-being of our patient and his/her proper treatment. The first step is the psychiatric evaluation, but it is also necessary to consider close follow-ups in our clinic.

Abstract Body

BACKGROUND
Head trauma occurs often in childhood, concussions, considered a type of mild traumatic
brain injury (TBI) , are increasing in incidence in pediatric population and becoming a health
problem globally, most of the concussions are minor and not associated to brain injury but an
small number of children may have a clinically important brain injury in wich case is a principal
cause of disability and death. Family Doctors usually are the first in evaluate children who has
suffered a concussion, must be competent in the evaluation and management of concussions
during the initial presentation, the recognition of clinical signs or symptoms are fundamental
to make a clinical diagnosis and appropriate referral.
LEARNING OBJECTIVES
– Management of concussions
– Recognition of clinical signs or symptoms in an initial evaluation.
– Make a correct referral if necessary

ORGANIZATION
– We will make an introduction with a clinical case and explaning characteristic
Features, Diagnosis, and Management.
– We will make 4 groups and provide to each group a different clinical case and ask
to make an evaluation, management and if it is necessary a correct referral,
afterwards each group make a presentation and discuss the case with the other
groups, realizing a group debate.
– Finally We will use Kahoot and ask everyone to participate and evaluating if the
principal topics have been learned.

CONCLUSIONS
We aim that the participants will be able to manage and evaluate a children who has suffered
a concussion, providing key tools following evidence-based medicine.

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Background and Purpose: Pain is invariably present in the majority of the primary care medical requests. This review aims to provide up-to-date information in order to create a protocol, improving and coordinating the medical team´s overall approach.

Methods: A literature review was conducted, using the standards and guidelines published by Direção Geral de Saúde, a departmental body of the Portuguese Ministry of Health. Research was supplemented by actualized information from pain courses.

Results: The physician should do a patient´s detailed history and examination, characterizing the pain in terms of temporality, topography, pathogenesis, ethology, rhythm and intensity. In case of inflammatory rhythm, alarm symptoms must be excluded. Pain´s intensity must be evaluated regularly through appropriate indexes, in order to correctly classify the pain intensity and prescribe the correct drug in the right posology (Mild: non-opioid; Moderate: weak opioid; Intense: strong opioid). Rescue therapy should always be instituted. If the pain is neuropathic, a tricyclic antidepressant or a gabapentinoid should be primarily used. An appropriate opioids rotation should be performed when the patient has intolerable side effects or when it is impossible to increase its dose and the pain isn´t controlled. Nevertheless, the physician must be alert to the appearance of opioids´ side effects, swiftly recognizing and orienting them.

Conclusions: Chronic pain doesn´t have a protective function and can be itself considered a disease. The general practitioner plays a key role in its adequate diagnosis and managing and must be aware when a timely referral to specialized pain consultation is needed.

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Background and purpose: The reproductive cycle has a major influence in women's mental health. It is important to determine the impact of hormone fluctuations and to distinguish physiological from pathological symptoms. This presentation aims to bring awareness to Premenstrual Dysphoric Disorder (PMDD) and differential diagnosis with other mood disorders.

Methods: A state-of-art review was performed to determinate the current knowledge, as well as priorities for future investigation and research.

Results: PMDD affects 3 to 8% of woman. It presents as mood and behavioural symptoms, including irritability, tension, depressed mood, tearfulness, and mood swings, with great impact in personal and family functioning. It is also described as a severe form of Premenstrual Syndrome. The symptoms are limited to the luteal and menstrual phase of the menstrual cycle. Women are asymptomatic during follicular phase, which is the key to differential diagnose with other mood disorders. The treatment should focus on symptom relieve and improving functional impairment. There is strong evidence of the benefit of selective serotonin reuptake inhibitors and/or combined oral estrogenprogestin contraceptives. Lifestyle measures (exercise and relaxation techniques) and cognitive behavioural therapy are also recommended and effective.

Conclusions: PMDD is underdiagnosed and, therefore, undertreated. Prospective studies are necessary to determine the true prevalence of this disorder. The author intents to emphasize the importance of valuing the influence of menstrual cycle in women’s mental health, namely the correct diagnose and approach of PMDD.

Abstract Body

Family physicians (FPs) follow-up their COVID-19 PCR + patients and the ones who contacted these patients to control the disease. Phone calls are still the most frequent tool to reach this aim.

Our case was 25-year-old male patient who was tried to be contacted after being added to the monitoring list because he had PCR + in April. Not the first day but the second day, his mother answered the recurrent calls. She stated that her son was staying with her. On the 3rd day, she called on the patient's phone and stated that her son was addicted to a substance, the isolation forced him too much, they took his phone so that his son would not provide substance and wanted to escape from the house. Conversations with the family continued for the support they can provide to the patient and for the follow-up of his illness. When communication was established with the patient again, starting from his acute complaints, additional complaints were questioned. In the subsequent daily evaluation interviews, the patient himself stated that he was addicted to substances and didn't want to share what he used. The presence and severity of withdrawal symptoms were discussed, and if there were an increase and difficulty coping, he was asked to continue communication. After covid treatment and a 14-day follow-up period, it was recommended to make an appointment with AMATEM.

Long-term communication in family medicine increases the trust relationship between the patient and the physician. The management of chronics diseases, mental health problems are in need of consideration even COVID-19 times.

Abstract Body

BACKGROUND: Intramuscular injections are a useful technique but not without risks, especially if they are applied by a person without proper training.

CASE: 50 years-old man consults for 24 hours back pain, right sciatica, pharestesies and stumble when walking. History of glaucoma and corticosteroid intolerance. Denies taking drugs. He doesn’t identify triggers. Physical exploration: sacrum pain, preserved spinal mobility. Positive Lassegue maneuver, decreased cutaneous sensation in the distal third of the leg, paresia 2/5 in foot mobility with gait disorder. No fever. No skin injuries.

Referred to traumatology service. Hospitalized for study with diagnosis of nonspecific neurological deficit. In there, he acknowledges self-administration of anabolic injections for 6 weeks, 3 times/week. Last injection coincides with the start of the clinic.

Lumbar tomography: no signs of acute pathology or root involvement.

Pelvic tomography: cellulitis of the subcutaneous tissue, involvement of perimuscular fat of gluteus maximus, both gemellus, quadratus femoris, biceps femoris, semitendinosus and adductor magnus muscles, signs of myositis without collections. Impairment of fat surrounding the right sciatic nerve, without being able to discard nerve injury at this level.

Blood analysis: leukocytes 11.89*10⁹/L, neutrophils 8.92*10^12/L, globular sedimetation rate 13mm

Treatment with dexketoprofen with good evolution, achieving the normalization of analytical parameters and sensory and motor improvement.

CONCLUSIONS: Patients are often unaware of the dangers of self-medication, both because of the drug itself and the method they use. Sciatic nerve injury is one of the most common complication of intramuscular injections and can take weeks to resolve or even may never resolve.

Abstract Body

Multiple myeloma, characterized by the clonal proliferation of plasma cells, producing a monoclonal paraprotein, is the second most common hematologic malignancy, is more frequently in men and the average age at diagnosis is 60 years. The diagnosis is established by blood and urine exams and medullary biopsy. Typical clinical features include anemia, renal failure, hypercalcemia, and skeletal lytic lesions, bone pain, fatigue. Treatment involves irradiation and chemotherapy Despite significant advances in treatment it has high morbidity and mortality.

Case presentation:

A 76 year old man, not previous disease, with a 1 month history of left shoulder pain, without any trauma, repetitive stress or trigger factors, and worsened with time He was peviously treated with Acetaminophen, Dexketoprofen, and intramuscular betamethasone, persisting a partial limitation of mobility, an X-ray was made with not findings, Subsequently an MRI revealed numerous lytic lesions in the humerus diaphysis, acromion, CT scan showed multiple lytic lesions throughout the bony skeleton but also a left cervical mass lesion involving from the C2 to the C6 vertebral bodies with canal stenosis and spinal cord compression. Concurrently the patient noted dysphonia, hypophonia and a progressive weakness of right upper extremity. bone marrow biopsies were undertaken, demonstrating infiltration by plasma cells, Thus a diagnosis of aggressive multiple myeloma was made, intiating palliative radiotherapy

Conclusions

Multiple myeloma is a diagnosis based on clinical, laboratory, and radiographic assessment, This case stresses the importance of supplementary tests in a patient with severe pain with not reponse to painkillers

Abstract Body

A 60-year-old male attended the primary care consultation for a fever of three days of evolution with no apparent focus. Upon arrival, he only presented discreet urinary urgency without associated respiratory or digestive symptoms. A quick urine test was performed being normal. He has no medical history of interest. It was decided to send to emergency department of the hospital where he was diagnosed of urinary tract infection and treated witg cefuroxime 250mg/12h.

On examination, the patient was sweaty and fever was observed. The rest was bland.

After 5 days with treatment the fever persisted, he was reevaluated by his primary care physician observing non-pruritic annular erythematous lesion with a necrotic center in the second phalanx of the fourth finger on the right hand, he commented that he had been fishing in the river and "walking in the countryside".
Serology was requested for Rickettsia conorii, Borrelia burgdorferi and Coxiella burnetii being the positive result for IgG antibodies against Borrelia burgdorferi proteins. He was treated with doxycycline 100mg/12h orally.

The differential diagnosis includes more than 200 possibilities and these can be grouped into 4 groups: infectious, neoplastic, inflammatory and miscellaneous; and at the same time in 4 subgroups: classic, nosocomial, neutropenic and associated with HIV.

The key to a correct assessment is a detailed medical history and physical examination. The presence of both IgM and IgG against Borrelia burgdorferi is considered current infection. The efficacy of prophylactic treatment after a tick bite with single dose doxycycline has not been demonstrated, therefore its use is only recommended in case of infection.

Abstract Body

Metamizole agranulocytosis

ABSTRACT:

Backgrounds and purpose:

Agranulocytosis, defined as severe neutropenia, is often related to taking medications. It is an underestimated differencial diagnosis, and can be suspected with a simple clinical interview.

Case presentation

A 27 years old male with a history of Crohn´s disease. He went to the emergency room for abdominal pain and fever of 39º of two days of evolution. He has been on amoxicillin and metamizole treatment for dentalphlegmon up to three days ago. He denies nausea, vomiting or alteration of the stool habit. Normal stools. The pain does not remind him of the previous outbreak of his autoinmune disease. Anodyne physical examination, highlighting a CRP of 8.67 and 100 neutrophils in the analysis. Blood cultures, urine cultures and stool cultures are collected that are normal. Empirical antibiotic treatment is started and colony stimulators are administered.

During admission, he remained clinically stable, with good evolution after the antibiotec. Due to the patient’s history, it was decided to perform a colonoscopy, in which an outbreak of Crohn’s disease was ruled out. A definitive diagnosis of agranulocytosis due to metamizole is established.

Conclusion

Agranulocytosis due to metamizole is a common disease that should not be underestimated in primary care consultations or in the emergency services, since a suspected diagnosis and early empirical antibiotic treatment can prevent undesirable outcomes, such as septic shock or sepsis.

Abstract Body

Defensive Medicine and its perception in Primary Healthcare

Background and purpose

Defensive medicine (DM) is defined as a deviation from standard medical practice for fear of medical malpractice claims and has serious consequences for patients, doctors and public funds. Our aim is to understand the perception of the practice of DM in Primary Health Care, specifically in the Health Centers Group of West Lisbon and Oeiras (HCG WLO).

Methods

We conducted a cross-sectional study between May 2019 and September 2020, including all 182 physicians working at HCG WLO. Each participant received a questionnaire to answer within two months and the results were analysed through SPSS® version 27.

Results

We included 138 questionnaires (11 excluded and 33 not answered). 61% of physicians consider DM a moderate problem and 92.2% have already practiced DM, which includes ordering additional exams (93,7%), referring more to secondary care (53,2%) and scheduling further appointments (34,9%). The main reasons for DM are the need for more information to make safer decisions (63,8%) and patient insistence on performing extra procedures (55,9%). 68.3% believe that practicing DM reduces malpractice claims.

Conclusions

Most physicians practice DM, although they consider it a problem and recognise its elevated costs. They believe that protocol development, legal support improvement, consultation time adjustment and health literacy promotion may diminish the problem. It was not possible to establish a statistical association between workplace, medical category, and DM practice due to the low number of participants. The research team aims to apply this protocol nationwide for more valid results and to promote new policies.

Abstract Body

Background and purpose: In this study, family physicians' views on Cognitive behavioral therapy (CBT) were taken in a small sample.

Methods: 36 participants participated in the study. An online questionnaire consisting of 27 questions was applied (8 open-ended, 13 closed-ended questions included 6 likert-type questions). A purposeful sample was selected. Questions about sociodemographic, views on CBT in family medicine (Response rate = 72%).

Results: The median age was 40.5 (min-max = 24-58) and most were male (n = 20; 56%) and married (n = 26, 72%). They worked in the public sector (n = 30, 82%), had a median of 9 (min-max = 0-33) years of professional experience, and most had no psychotherapy training (n = 31, 86%). Most patients were referred to a psychiatrist (n = 28, 78%). Prescribing medication (n = 21, 58%), referral to community health center (TSM) (n = 9, 25%), giving psychotherapy (n = 6, 17%) were other approaches. “The reason for referring a mentally ill patient directly” was the most common reason for consulting a specialist (n = 9). Additional explanations of family physicians were " high workload", "Family physicians should have psychotherapy training", “exhaustion and need of therapy”.

Conclusion: Family physicians are among the first to see individuals with mental problems. Their support (time, location, fee, prescription authority, place to receive consultation, etc.) will further increase the quality of the health care they provide. Although they are not expected to provide psychotherapy, increasing their cooperation with psychotherapists will help individuals with mental problems.

Abstract Body

Background: To establish the diagnostic accuracy of the Turkish version of the General

Practitioner Assessment of Cognition (GPCOG-Tr) in Turkish individuals.

Methods: The cross-sectional study was conducted in Antalya, Turkey, from February 2016 to April 2017. The purposive sampling method on of consecutively visited or attending participants was used in the study. MOCA Scale, GPCOG , and SMMT Scale were applied to the participants. Face validity was determined by two experts in this field. Construct validity was determined by factor analysis with principal component extraction method.

Results: 301 participants participated in this study (participation rate: 95%). Most of the participants were men (n=183, 60.8%). Their mean age were 71.02 years (SD=4.7 years, min-max= 65-87, n=301). Using The MOCA Scale as a reference (gold) standard, GPCOG showed accuracy (AUC=0.774). Using The SMMT Scale as a reference (gold) standard, GPCOG showed accuracy (AUC=0.752). Cronbach’s α coefficient was 0.515 for GPCOG scale. Intraclass Correlation for single measures and for average measures were 0.106 (p<0.001) and 0.515 (p<0.001), respectively. The area under the ROC curve (AUC) for GPCOG scale versus the MOCA Scale was 0.774. A cut-off point of 6 or lover for GPCOG was applied and indicated the sensitivity of 84.4%, and specificity of 55.8%. The area under the ROC curve (AUC) for GPCOG scale versus the SMMT Scale was 0.752. A cut-off point of 6 or lover for GPCOG was applied and indicated the sensitivity of 64.8%, and specificity of 75.7%.

Conclusion: The GPCOG-Tr is clinically well-suited for use in clinical practice

Abstract Body

1. Background: Training residents how to work with other health professionals and how to engage patients in the difficult work of lifestyle change is becoming progressively more important. Geriatrics is no exception. Most of the effective interventions to delay cognitive impairment and to prevent frailty are lifestyle based, including exercise, dietary improvement, cognitive stimulation, and socialization. These interventions are also what Dean Ornish found useful in reversing coronary artery disease.

2. Aim and learning objectives: WE aim to show that successful lifestyle change for geriatric patients requires a different approach than conventional medical care. Patients are more likely to change in response to peer advice than to professional encounters. An integrated team of doctor, nurse, and behavioral health specialist tends to be more effective than isolated, brief medical encounters.

3. Methods and timetable: In this workshop, we show how to teach GP trainees to lead group medical visits, including how to interact with other health professionals in a group medical visit context, how to facilitate peer communication for lifestyle change, how to communicate to patients in such a way that lifestyle change happens, and how to evaluate effectiveness in this context. We consider strategies for addressing the common obstacles to group medical care, especially those posed by medical cultures emphasizing individual visits and resistance to new ways of billing.

4. Results and Conclusions: GP trainees can learn how to conduct group medical visits in which the focus changes to supporting lifestyle changes known to improve cognitive function. These visits include cognitive enhancement exercises, movement, dietary counseling, exercise, and opportunities for socialization.

Abstract Body

Background

The tracker is a figure that has existed for decades used in Public Health (PH) for identifying and stopping chains of transmission of infections. In Catalonia, they have been incorporated after the appearance of COVID-19 as a strategic element to stop the pandemic.

Method

After first pandemic wave, the figure of the COVID manager (CM) was incorporated into the Primary Care (PC) teams. In our 3 urban centers 7 CMs are incorporated. They are professionals with a non-healthcare profile specifically trained to:

Identification and contact lists

Isolation and quarantine information

Assessment of the suitability of the follow-up

They enter the data in a common computer tool with PH. They also work with PC's computer program.

Join weekly follow-up meetings.

Results

The incorporation of the COVID manager in the PC facilitates identification of cases, contacts and the detection of outbreaks.

It allows those diagnosed and their contacts to receive information to avoid new infections and helps close contacts to protect their health and identify the appearance of symptoms.

Their relationship with the healthcare team in the recognition and monitoring of symptoms facilitates the management. It is the communication link between the PC team and PH thanks to the computer system.

Weekly meetings facilitate ongoing training and problem detection and correction.

Conclusions

Addressing the pandemic requires the use of new strategies. The incorporation of the COVID manager in PC has been essential in the detection of cases, the control of close contacts and the dissemination of health information. Their ongoing training, interrelation with the healthcare team and the link with PH facilitate pandemic management.

Abstract Body

Background &Aim: Infantile hemangiomas (IHs) are vascular neoplasms being the most common tumors of childhood being characterized by aberrant blood vessel architecture.

Although most of them involute without treatment there is a subset that will develop complications which may lead to functional impairment or disfigurement.

Since proliferation occurs during early infancy primary care providers most times assume the role of in the management of IH and evaluate whether intervention is necessary.

Physical examination for determining which lesions require early consultation with a specialist implies a knowledge on evolutionary phases and categorization of IH.

In this review, we present a methodical approach to risk stratification, essential for determining which lesions require early consultation with a specialist

Methods: Literature review through PubMed, from 2015 to 2020, using the MeSH terms “Infantile Hemangioma”.

Results:

Clinical observations on soft tissue depth, anatomic appearance and associated structural abnormalities are the first considerations in the management of IH allowing the stratification of risk.

Emergency intervention is necessary in IH with life-threatening complications like airway obstruction as well as liver IHs associated with high-output congestive heart failure. Urgent treatment of IHs is needed when exist bleeding, pain or imminent functional impairment.

Some lesions require specialist evaluation to identify structural anomalies associated with IH and also to evaluate elective treatment to reduce the likelihood of long-term or permanent disfigurement

Conclusions:

For most infant’s involution of IH can be observed without treatment, however many others benefit from medical or surgical intervention being essential the recognition of IH risk characteristics.

Abstract Body

1. Background and purpose

Clinical genetics is increasingly permeating all areas of knowledge of Medicine. The integration of genetics in primary care requires the gradual incorporation of certain specific elements of this discipline that would ultimately become part of the gold standard procedures on diagnostics, carried out by general practitioners (GP). As a matter of a fact, the UK is the only European country that includes specific competencies in clinical genetics as part of their GP’s educational programme.

2. Methods

Being the starting point enlightened by the authors to bring awareness of these limitations, in 2006 it was also created a specific working group called “semFYC’s Clinical Genetics and Rare Diseases” (i.e. semFYC stands for Spanish Society of Family and Community Medicine) aiming to take action on the aforementioned limitations. The group’s research activity includes a paper published in 2007 describing the ten competencies that a Spanish general practitioner should carry out for the management of clinical genetics problems. In 2008 another publication was released adding knowledge on the management of the inherited cancer in primary care, and, in 2016 the Group contributed on a Decalogue of new skills in clinical genetics for the Spanish GPs.

3. Results

The investigation proposes the spread and implementation of a Decalogue of competencies and six skills that every GP in Europe should incorporate actively into his educational background.

4. Conclusions

Training in clinical genetics reference unit for a month is considered necessary to acquire and implement the knowledge of this discipline in the activity of the European GP.

Abstract Body

1. Background and purpose

Currently, in this time of COVID that we all live in, and with an indication to privilege teleconsultation, important clinical situations sometimes arise, and a correct face-to-face assessment is necessary.

2. Methods

We present the case of a healthy young man, 22-years-old, with no significant personal or family history. He goes to the consultation for painful abdominal swelling with about 3 months of evolution. From the objective examination, there is a painful abdomen on palpation of the right hypochondrium, where there is hard hepatomegaly and regular edges about 5 cm below the costal grid. Additional diagnostic tests were requested: abdominal ultrasound shows a solid nodular formation measuring 113x94 mm involving the left lobe and part of the right hepatic lobe, which translates into potential new liver formation. We asked for CT scan, where a bulky, heterogeneous mass, with lobulated contours and well delimited, with 13x10cm in the apparent dependence of segment IV B, V and VI, was identified. It presents arterial internal vascularization, suffering peripheral nodular enhancement in the most external aspect in the arterial phase.

3. Results

The patient was referred to the IPO, where he is currently being followed. The lesion has already been biopsied, and the result is pending. The therapeutic decision meeting will be held soon, and it is expected that later this month he will undergo surgery.

4. Conclusions

This case demonstrates that there is much more than COVID disease and that young and apparently healthy patients can develop serious pathologies for which we have to be aware of small symptoms.

Abstract Body

Introduction: Skin lesions observed in the context of SARS-CoV-2 infection are a target of growing interest in the scientific community. Their early identification may be useful for establishing an accurate diagnosis and prognosis.

Case description: DF, female, 39 years old, geriatrics assistant, without previous pathological history, oral contraceptive as the only usual medication, reported a mild skin reaction in her limbs, four days after administration of the flu vaccine. This reaction lasted less than 24 hours without any treatment. Three weeks later, DF reported appearance of pruritic stains all over her body including pelvic area. She went to the hospital emergency department and was treated with an oral antihistaminic and a local corticoid, without clinical improvement. Five days later, she tested positive for COVID-19. Her only symptom during clinical surveillance by her family doctor was tiredness. After completing an isolation period, DF was referred to a dermatology consultation due to rash persistence. She had confluent patches in her abdomen, post-inflammatory hyperpigmentation areas on her trunk and limbs, and secondary abrasions, which corroborate urticaria diagnosis. The analytical study didn’t reveal any change, and DF was medicated with a different oral antihistaminic with partial improvement.

Discussion: Urticaria is one of the first skin manifestations of COVID-19 infection. It may occur at the beginning, previous to or simultaneous with other symptoms. In this case report, although we can’t exclude a possible adverse effect of the influenza vaccine, SARS-CoV-2 seems to be the trigger factor for first presentation and exacerbation of a dermatological disease.

Abstract Body

Background and purpose

All medication has the potential to cause adverse effects. The allergic reactions to drugs may vary from mild angioedema and skin rash to anaphylaxis. Therefore, one way to decrease the risk of this last form of reaction is to register allergies or their inexistence in the assigned area of SClínico, where it is readily available.

This work is expected to increase allergies reporting in SClínico.

Methods

Studied dimension: Technical-scientific adequation of the healthcare professionals at USF Viseu-Cidade. Internal evaluation, retrospective. Unit of study: selective, of institutional base, constituted by patients registered in the USF. Evaluation period: 1^st cycle –completion until June 2019; 2^nd cycle – until June 2020. Quality criteria: SClínico reporting rate of allergic reactions or lack of them. Process data obtained annually by the doctor through the SClínico. It was performed an educational intervention at 11/10/2019, portraying the current levels of reporting and the features enabled by it.

Results

According to the first cycle of quality improvement, the compliance rate was 4.16%, wich equated in 607 reports made since 2012, showing a generous margin for improvement. So, by the end of May 2020, when the 2^nd cycle ended there were 5262 reports, which translate in a compliance rate of 36.75%, and an increase of 767%.

Conclusions

Due to the potential severity of an allergic reaction to a drug, the filling of this field on the SClínico will help to prevent these events. This fact seemed to be understood by the professionals, who increased their report. Despite that, there is room to improvement.

Abstract Body

NAFLD is a global public health issue, which progressively covers a spectrum of liver pathology, including steatosis, steatohepatitis, fibrosis, and cirrhosis, and their incidence increases exponentially. This study aimed to evaluate the diagnostic accuracy of the multiparametric-liver-ultrasonographic-screening with uses of artificial-intelligence performed by family doctors, compared to the evaluation performed by a specialist, at the targeted patients with a high-risk of NAFLD/NASH.

2.Methods

We conducted a multiparametric-liver-ultrasound-screening(MLUS) on 4751patients, with a high-risk of NAFLD/NASH, which presented as inclusion criteria: mixed dyslipidemia, obesity(BMI≥30), type2-diabetes, metabolic-syndrome(NCEP-criteria), chronic-lithiasis-cholecystitis, liver cirrhosis, chronic-hepatitis-B/hepatitis-C. APRI-score was initially calculated to stratify the fibrosis risk.

We use "standard-protocol", which could improve reproducibility and facilitate dynamic comparison, in grayscale, color/power-Doppler-US, and Strain-Elastography in standard-liver-scans as:transverse,oblique,and longitudinal-views. We established the cut-off/median-values(morphometric-ultrasound) of normal-ratios, between the anterior-posterior-diameters of the normal-liver-segments(Couinaud)/lobes, with the kidney/spleen-long-axis(not influenced by fatty-tissue-loading).

The high-risk-patients identified with NAFLD were first examined by a experienced-family-doctor subsequently compared with ultrasound-review by the specialist. We have developed a Smart-Computerized-Diagnostic-Algorithm to NAFLD/NASH-pathology for US-diagnosis by family-physicians. The agreement between family-physicians and specialists on each finding was evaluated using:Cohen’s-kappa-coefficient.

4. Results

We identified 4751-patients with NAFLD/NASH,or cirrhosis and subsequently confirmed by the specialist. The positive-results of this screening were:2592-steatosis, NASH/steatofibrosis-971persons, and 22-cases with Cirrhosis. The accuracy of liver-US-screening by FP was:95,87% with95%CI=95.27%to96.42%,Sensitivity:97,12%,Specificity:91,59%, which were subsequently confirmed by the specialist as the"Gold-Standard"-method through fibroscan. The prevalence of liver-pathology was:77,48% with 95%CI:76,26%at78.66%. Reports of the two groups of specialists for identifying NAFLD/NASH showed a very-good-strength of agreement-k=0.875;95%CI=0.864–0.887,standard-error:0,005.

Conclusions:

The uses of Multiparametric-Liver-Ultrasound-Screening(MLUS), morphometric-US(MUS), and artificial-intelligence(AI), performed by trained-family-physicians are comparable to diagnostic-liver-ultrasonography performed by the gastroenterologist.

Abstract Body

BACKGROUND AND PURPOSE

To know and compare the mortality rate -fatality by Covid-19. Describe the profile of the patient: Institutionalized or not, attended in a health center, AMG (Adjusted Morbidity Group), associated comorbidity and period (waves of covid-19) in BHA Canaletes-Fontetes. Barcelona. Urban population.

METHODOLOGY

Review of computerized medical records since february 17, 2020 until february 17, 2021.

Including death from viral pneumonia confirmed by PCR (Viral Polymerase Chain Reaction) or Rapid Antigenic Test (RAT) positive.

Variables: Age, Sex, AMG, Date of death, period and assigned area: CAP Canaletes, local clinic Les Fontetes, Geriatric Residences and Non-geriatric Residences.

RESULTS

1819 covid19 cases (1429 Canaletes, 75 LC Les Fontetes, 246 geriatric residences, 69 non-geriatric).

66 deaths due to positive covid-19 pneumonia (Canaletes 18, Fontetes 12, Geriatric residences 22, non-geriatric residences 14)

Age: 74.23 +/- 14.6 years. 36 women (55%) 30 men (45%)

Overall mortality rate: 252.29 x 100,000/habitants (Canaletes: 115, LC Fontetes: 904, Non-geriatric residences: 2898, geriatric: 18965)

Global fatality rate: 3.62%, LC Fontetes: 16%, Geriatric residences: 31.88%, Non-geriatric: 5.69%

HBP 61%, DM 39%, Dyslipidemia 39%, Obesity 32%, CKD 26%, COPD 20%, Atrial Fibrillation 15%

Mortality by period: 1st wave 41 (62%), 2nd wave 13 (20%), 3rd wave 12 (18%)

AMG 2: 5% (3), AMG 3: 42% (28), AMG 4: 53% (35)

CONCLUSIONS

1. Mortality in BHA is lower than Spain. Superior in LC Fontetes and residences.

2. Fatality rate in BHA is greater in the 1st wave and for AMG 4.

3. Associated factors: HBP and advanced age (> 74 years)

4. AMG 4 predominates in 2nd-3rd wave, Canaletes-Fontetes and geriatric residences. In non-geriatric GMA 3.

Abstract Body

Introduction

Cancer (Ca) is the 10th most common chronic condition among patients with multimorbidity (MM) in Lithuania. MM negatively influences patients‘ attendance in Ca prevention programs. Despite 4 national Ca screening programs (cervical, prostate, colorectal and breast Ca) being conducted in Lithuania, they don’t include other frequent Ca localizations – like lung, skin, kidney and pancreatic. MM causes difficulties for timely diagnosis and is associated with advanced stages of Ca at detection, which is related to higher economic burden.

„Telelispa“ project, funded by EU, is aiming to provide better quality and accessibility of medical care for MM patients and will be carried out in 2020-2022 in Lithuania. Early Ca detection among MM patients is one of the planned aims of the project.

Method

At least 385 patients with MM and 385 in control group from 7 different urban and rural primary health care facilities will be enrolled in this project.

The family physician, along with well-trained case manager, will perform the holistic evaluation for MM patients, including:

1. An extensive evaluation of risk factors and family history for Ca, a comprehensive review of attendance in the national Ca screening programs using originally developed Holistic Questionnaire

2. Physical examination, including teledermatoscopy.

3. Assignment of routine primary care tests if not performed within a year – blood tests, chest X-ray and abdominal ultrasound.

4. In case of suspected Ca, family physician will refer the patient to appropriate specialist using pre-arranged direct-access consultation (nationally not available).

Results and conclusion

Ongoing project.

Abstract Body

Background and purpose: Nursing home residents often have high prevalence of chronic diseases resulting in polypharmacy. Inappropriate drug use is very common among elderly patients and may cause worsened cognitive impairment, increased risk of falls, decreased quality of life, hospitalization and even death. Our aim was to detect if in nursing home residents were prescribed inappropriate drugs according to STOPP (Screening Tool of Older Persons' Prescriptions) criteria in sections D (Medication related to Central Nervous System and Psychotropics ) and K (Medication that predictably increase the risk of falls in the elderly).

Methods: 27 nursing home residents from a portuguese institution, aged over 65, average age of 83,93 (minimum 66, maximum 96), 23 female and 4 male, were included. The files of the subjects were surveyed retrospectively for the 1-year before, using the nursing home digital medical records, including regular medication.

Results: We detected 21 cases of inappropriate drug use related to Central Nervous System and Psychotropics being quetiapine and risperidone the most prevalent psychotropic drugs , 9 cases of benzodiazepine use and in 7 residents combination of different classes of neuroleptics. There were 33 cases of inappropriate medication that predictably could increase the risk of falls in the elderly.

Conclusions: We found a significant amount of residents with inappropriate drug use in this nursing home. This study proves there is still a need for awareness of physicians on this topic. The use of STOPP criteria as a tool for prevention drug interactions, and avoidance of side effects in the elders should be widespread.

Abstract Body

Background: After the “first wave” in spring 2020, a small minority of the German population actively protested against measures to control the pandemic. The extent to which general practitioners (GPs) share related views is unknown. We investigated different viewpoints of Bavarian GPs and identified related subgroups.

Methods: A questionnaire was sent to all 210 practices accredited for under-graduate teaching of family medicine at the Medical Faculty of the Technical University of Munich. Questions addressed COVID-19 case-load, personal fears, symptoms of depression and anxiety, and personal opinions regarding risks, dilemma, restrictions and their relaxation associated with COVID-19. Subgroups of GPs with a proximity to extreme viewpoints were identified in the range of opinions by the statistical archetypal analysis.

Results: 162 GPs sent back a questionnaire (response rate 77%), and 143 (68%) with complete data could be included into the analysis. We identified four extreme viewpoints with subgroups of GPs tending in these directions of opinion: a small group of “Skeptics” (n=12) considering threats of COVID-19 as overestimated and measures taken exaggerated; “Hardliners” (n=34) considering threats high and supporting strong measures; “Balancers” (n=77) who also tended to consider threats high but were more critical about coercive measures and measures potentially impairing the quality of life of elderly people and children; and “Anxious” GPs (n=20) tending to report more fears, depressive and anxiety symptoms.

Conclusions: Among the participating GPs, opinions varied widely and there was a small group who considered the threats of COVID-19 and the measures against the pandemic exaggerated.

Abstract Body

Patients with stress‑induced exhaustion disorder (SED) demonstrate cognitive dysfunction similar to patients with minor traumatic brain injury (TBI). We have previously detected elevated concentrations of astrocyte‑derived extracellular vesicles (EVs) in patients with TBI. As such, we hypothesized that astrocyte‑derived EVs could be higher in patients with SED than in patients with major depressive disorder (MDD) and healthy controls. Patients with SED (n = 31), MDD (n = 31), and healthy matched controls (n = 61) were included. Astrocyte‑derived EVs (previously known as microparticles) were measured in plasma with flow cytometry and labeled against glial fibrillary acidic protein (GFAP) and aquaporin 4 (AQP4). In addition, platelet EVs and their CD40 ligand expression were measured. Patients with SED had significantly higher concentrations of AQP4 and GFAP‑positive EVs and EVs co‑expressing AQP4/GFAP than patients with MDD and healthy controls. Patients with MDD had significantly higher concentrations of GFAP‑positive EVs and EVs co‑expressing AQP4/GFAP than healthy controls. Platelet EVs did not differ between groups. CD40 ligand expression was significantly higher in patients with SED and MDD than in controls. In conclusion, the present study suggests that patients with SED, and to some extent, patients with MDD, have increased leakage of astrocyte‑derived EVs through the blood–brain barrier.

Abstract Body

Since 2011, quality and safety are being promoted in our territory. In 2014 we were accredited according to this Model of regulation and accreditation of primary care teams. We implemented proactive and later reactive security systems for continuous improvement.

OBJECTIVES

Ensure adequate availability of all products at any time.

expiration and stock control

Carry out a correct management of the incidents detected

Method

In 2011, proactive patient safety systems were created: check lists were prepared that were computerized through a tool to be able to be reactive with the incidents detect.

we start with the control of drug expiration dates from the storeroom . Secondly, a record of temperatures was established to verify that there was no break in the cold chain. Thirdly, the emergency area and crash cart, Thirdly, the control of the clinical material . Finally, the control of material and drugs in the office For each step, a training workshop has been held.

RESULTS / CONCLUSION

We have managed to carry out 99% of the control of material and expiration dates in the emergency box, control of vaccines and thermosensitive medication and consultation material. Ensuring adequate and safe material and medication availability at any time.

We have managed to involve all the staff in carrying out the checklists for the correct control of expiration dates and stock of clinical material and drugs.

Improvement teams have been created to update circuits due to the incidents detected.

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Objectives: To identify baseline analytical parameters and risk factors that may influence mortality in patients diagnosed with COVID-19 in Spain.

Methods: Descriptive cross-sectional study. A total of 48370 subjects diagnosed with COVID-19 on cronic treatment, were selected in both Primary Care and Hospital Care in Castilla y León, using a database from Castilla y León Government from March 1, 2020 to June 1, 2020. Average age 59.22 years (SD 20.32); 20389 men(42.2%), 27981 women(57.8%), 30975(64%) positive covid test, 17395(36%) no test performed. We recorded the baseline analytical parameters (haemogram, biochemistry, vitamins and others), risk factors and mortality by COVID-19.

Results: Of the 48280 subjects analysed, 46010(95.3%) were diagnosed with Coronavirus 2019 disease and 2270(4.7%) with Coronavirus Sars-CoV2 pneumonia with a mortality of 2022(4.2%) subjects. In the hospital admission register 1728(3.6 %) are diagnosed with diabetes, 2840(5.9 %) with hypertension, 37(0.1%) with angina and 615(1.3 %) with obesity. In the logistic regression analysis we found that in the haemogram these parameters were associated with increased mortality: neutrophilia(OR=1.21), lymphopenia(OR=0.79), thrombocytopenia(OR=0.99) and decreased red blood cells(OR=0.57). In the biochemistry only serum creatinine(OR=2.38) increased the risk of mortality. No association was found with vitamins, iron or thyroid function. In addition, we found associations with increased mortality: being male(OR=2.61), covid positive(OR=3.07), hypertensive(OR=3.61), angina(OR=3.50), obese(OR=2.42) and diabetic(OR=3.01).

Conclusion: Mortality due to COVID is associated with older age, being male, being diagnosed with hypertension, obesity, diabetes, ischaemic heart disease and having a positive diagnostic test. In addition, neutrophilia, lymphopenia, thrombocytopenia, decreased red blood cell and impaired renal function are associated with a higher risk of mortality.

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Background

It has been demonstrated that clinical outcomes of COVID-19 are significantly worse in persons with advanced age and those with “traditional” medical comorbidities (cardiovascular disease, pulmonary disease, diabetes, etc). It’s essential to know how it affects others with non traditional diseases who suffer chronically from pain, fatigue, and functional decline such as patients with fibromyalgia.

Methods

CAP Terrassa Est patients with fibromyalgia infected with SARS CoV2 from may 2020 to january 2021, clinical characteristics and associated comorbidities were collected from primary care informatic program eCAP of Catalan health system.

Results

A total of 14 patients with fibromyalgia were infected with SARS CoV2.

All women with median age 64 (range from 51 to 75 y.o.).

Prevalent comorbidities such as hypertension in 11 patients, obesity in 10 patients, dyslipemia in 8 patients, chronic venous insufficiency and anxiety in 6 patients and diabetes in 5 of them were described.

Symptoms most commonly described were headache, low-grade fever or fever, cough, odynophagia, arthromyalgia, asthenia and diarrhea. Less common anosmia and ageusia in only 4 patients. From total, 5 patients described dyspnoea associated with previous symptoms.

50% of these patients (7) required hospital referral for laboratory analysis or x ray, only 4 patients required hospital admission: one patient with a stroke (probably due previous COVID-19) two patients developed bilateral pneumonia with oxygen supply and one patient with pericardial effusion (no related to COVID-19).

No patient required ICU.

Only 1 patient remained asymptomatic.

From all 14 patients, 4 remain with fatigue and asthenia.

Conclusions

Further studies of the post-COVID19 patients are being carried out in order to discover whether the worsened symptomatology continues because of their hypersensitised state.

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Most patients are supported by an informal caregiver who provides care, services and psychosocial support critical to the patient’s recovery or quality of life. However, they are often unknown to health professionals. The repercussions of caregiving can lead to exhaustion, psychological fragility, and injuries, leading caregivers as users of the health system. We explored the little-known phenomenon of mistreatment of family caregivers and the parameters that would allow health systems to treat these invisible caregivers well.

Methods

A review of the literature has shown a lack of awareness of this phenomenon. We therefore developed interviews and focus groups with 110 family caregivers across Quebec and with 43 social workers.

Results

The analysis of the 53 articles and of the interviews made it possible to establish 4 sources of mistreatment towards caregivers: institutions through health professionals, the entourage, the assisted person and the caregiver. There are 7 manifestations of mistreatment: the imposition of the role, judgments on the expression of the role, normalization of the role, denial of the expertise of the caregiver, denial of needs, use of psychological violence, physical or sexual and the contribution to impoverishment.

Conclusions

The lack of policy to support family caregivers plays a major role in the mistreatment they experience. But we also note that the beliefs, attitudes and lack of recognition of health professionals lead to mistreatment and contribute to the normalization and negation of the needs of other actors surrounding caregivers. Training of health professionals, including physicians, is necessary to promote the well-being of its allies essential to the health of patients.

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FOCUS is a complement of the clinical exam, for the evaluation of the structural and functional abnormalities of the heart, to the hemodynamic critical patient. Just a few studies have assessed the value and accuracy of focused cardiac ultrasound (FOCUS) performed by family physicians. This study aimed to evaluate the diagnostic accuracy of FOCUS performed by family doctors compared to echocardiography performed by a cardiologist.

Method:
We made FOCUS on the patients which present after clinical-examination the suspicion of cardiac pathology(cardiomegaly,valvulopathy, pericarditis,endocarditis,congenital malformations,aneurysms,and arrhythmias) and used five-standard-cardiac-scans:Subxiphoid-view, Parasternal-long/short axis, Apical-four-chamber-view,and IVC-assessment. We conducted a prospective-observational-cross-sectional-study of 1780 patients with high-cardiovascular-risk. High-risk-patients identified on inclusion-criteria, were first examined by a family-doctor with expertise, subsequently compared with ultrasound review by cardiologists, to determine the accuracy of this application. We have developed a Computerized-Diagnostic-Algorithm of the cardiac-pathology detected by non-cardiologists. The agreement between family-physicians and cardiologists on each finding, was evaluated using Cohen’s kappa coefficient with 95%CI.

Results:
We identified 585 patients with cardiac-pathology and subsequently confirmed by the cardiologist. We did the descriptive-statistical-analysis of the echocardiographic-cases detected. The accuracy of FOCUS-screening in primary care, was 96.07% with a sensitivity:95.12% and specificity:96.57%,p<0.001, for all 1780 emergency-patients which were subsequently confirmed by the cardiologist as the"Gold-Standard"method. The prevalence of cardiac-pathology was:34.55% with 95%CI:32.34%at36.81%. Reports of the two-groups for identifying cardiac-pathology showed 95%-agreement(k=0.88;95%CI=0.81–0.95),standard-error:0,037.

Conclusions:
FOCUS performed by trained-family-physicians is comparable to echocardiography performed by cardiologists. It could be a reliable tool and screening-test for the initial diagnosis of patients suspected of cardiac-abnormalities and we propose as a complementary-diagnostic tool followed by referral to the cardiologist.

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The objective of study was to verify if Primary Care teams that have better structured Primary Health Care (PHC) attributes are able to offer good care in Mental Health (MS). Cross-sectional study from the 2nd cycle of the Program for Improving Access and Quality in Primary Care. Types made: Quality of care in MS and Structuring of PHC according to essential attributes, The Delphi technique was used for consensus and the variables were endorsed by specialists. With multinomial logistic regression analyzes, associations between types were sought and it was identified which attribute most contributed to the quality of care in MS. One third of the teams are in poor quality of care in MS. Regional differences are maintained both for structuring PHC and for the quality of care for MS. There was a 14.7 times greater chance of producing a better quality of care in MS when PHC is better structured. A high level of comprehensiveness is associated with a high level of quality of care in MS. It is concluded that there is a predominance of low levels of quality of care in the area of MS, highlighting the need for integrated and coordinated actions for PHC in Brazil.

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1. Background and purpose

COVID-19 pandemic forced primary care centres to have separated areas, so we decided to concentrate suspected COVID-19 outpatients’ attention of three primary healthcare centres (49560 citizens as population reference) in a new primary care centre in the city of Barcelona.

Main objectives:

- Provide care to suspected COVID-19 patients of three nearby primary care centres of Barcelona in a new and united primary care centre.

- Restart chronic disease management interrupted by COVID-19 pandemic to improve continuity of care and accessibility.

2. Methods:

This primary care centre opened on the 17th of November 2020, it is a new space reconverted from a sports hostel and will be open until the 30^th of April 2021.

Two daily shifts with two general practitioners (severe symptomatic patients), two nurses (mild symptomatic COVID-19 patients and screening patients), three nursing assistants (PCR and RAT performance) and two COVID-19 contact tracers attend suspected COVID19 infection patients.

3. Preliminary results from January 2020 to December 2020

- Accessibility (defined as “probability to book an appointment with GP or nurse Practitioner in a 5 days-time period” decreased from 58.2% to 47%.

- Continuity of care declined from 68.9% to 63.5% in our area.

- Comprehensive geriatric assessment was performed in an 88% of cases in comparison to 59% at the end of year.

4. Conclusions:

We need to wait for further months’ data analysis to know if there has been an improvement in quality of long-term patient care.

Abstract Body

Background:

Humanity has always been accompanied by different pandemics and according to the tools that were available we dealt with them. Our ability to survive has been spectacular, but the different microorganisms have also adapted and survived with us.

Aim/Learning objectives:

Official recommendations for healthcare workers in contact with covid-19 recommends the use of gloves, gown, respiratory and eye protection. But, do we know what type of equipment we should use according to the type of transmission and how to put it on and take it of properly? Are we trained to work safely and protect ourselves and others?

We will address how to use the PPEs in daily activity, according to the risk of getting infected with COVID-19 and other pathogens.

Methods/Timetable:

- Presentation: 10 mins.

- Game: participants will have to place different microorganisms in different boxes according to the transmission mechanism (and will take the opportunity to review clinical and epidemiology concepts): 25 mins.

- Imitating virtual card game representing the different parts and objects of the PPEs, the participants will have to order them according to the correct to wear them on/off: 25 mins.

- Using real protection material, we will do a drill on how to put on and take off, step by step, the complete equipment: 20 mins.

- Conclusions: 10 mins.

Conclusions:

The pandemic that we are facing has taught us many lessons that we have to acknowledge as long-time learning. Firstly, because the current COVID19 pandemia is not over, and because we must prepare for new microorganisms that may appear.

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Background and purpose: This case describes a Coronavirus disease (COVID-19) re-positive case after recovery in Portugal and raises the discussion about humoral human response to SARS-CoV-2. Is recurrence of COVID-19 possible? How can we explain this phenomenon?

Methods: The information about patient’s clinical data was obtained through consultation of clinical records.

Results: At March 2020, 50-year women presented with sore throat, cough, headaches, fatigue and runny nose. Examination revealed an inflamed pharynx. She tested positive for SARS-CoV-2 in the respiratory tract and she was followed at home through teleconsultations by primary healthcare professionals. She was treated symptomatically and recovered over time. Fourteen days after the onset symptoms she performed two tests with more than 24 hours of interval, which turned out to be both negative for SARS-CoV-2. She had a medical discharge and returned to work. Four months later she presented with fatigue, arthralgias and headaches, testing positive for SARS-CoV-2 again. Her follow-up and treatment were similar, her health improved and she had a medical discharge. In both occasions she denied having contact with a COVID-19 confirmation case. Her parents, who were her cohabitants, were immunocompromised, had suspected symptoms and never tested positive for COVID-19 in both situations.

Conclusions: There are still remaining questions to be answered about recurrence of COVID-19, its human humoral immunity response and evolution of the disease. It may be necessary to review the follow-up and test methodologies of patients with COVID-19 to better understand this disease.

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1. Background and purpose

Obesity is a chronic, multifactorial disease, related to multiple health issues. Child obesity represents a heavy burden for both individuals and society.

Parents and other caregivers are ultimately responsible for children's obesity, as they determine their feeding habits. As such, it’s of the utmost importance to understand their perception of the “real” and “ideal” body image of their children. If caregivers cannot recognize that their children are obese, or fail to recognize the complications of excess weight, then obesity prevention and treatment programs will fail.

2. Methods

During one year, all 10 year olds will be notified to complete the national vaccination program in our family health centre, and their caregivers will be invited to participate. Anonymously, both will respond to a simple questionnaire with the Collins silhouette scale. They'll be asked to indicate the figure that best represents them, and the one that they would like to correspond to (“real” vs. “ideal” image). We will also calculate children’s BMI, to correspond to the questionnaire answers.

3. Results

The variation between the “real” and the “ideal” image will be interpreted as the level of dissatisfaction with the body image. Negative values correspond to the desire to lose weight, positive values to the desire to gain weight, and 0 will mean body image satisfaction.

4. Conclusions

With this study, we will be able to assess the BMI and the degree of satisfaction with children’s body image. This will allow us to adjust measures and interventions to the population, with the objective of preventing obesity.

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Background: The new technology is a promising, fast, non-invasive test that allows a detailed evaluation of atherosclerotic plaque, thyroid volume and superficial veins mapping. We can visualise shape and ulceration of atherosclerotic plaque. This is an important factor influencing the risk of a stroke. It is simply and with great precision possible to assess the response to treatment by measuring plaque volume, before and after treatment. This method assumes a general thyroid-volume model to estimate the 3d volume. What is an accurate way to asses response to treatment and make the decision about surgery intervention. We can also analyse the course of venous vessels. A detailed evaluation of the size and volume of venous thrombosis is possible.

Method: Using an 8/20 Mhz linear head with connected device transferring data to the computer, we analyse the course of venous vessels and thyroid-volume. In addition to the standard DUS examination/ carotid artery doppler/ additionally using tUS, the author assesses carotid arteries with a linear 8-20 Mhz probe in combination with tomographic ultrasound to acquire 3D volumetric datasets with following image processing.

Results: The tUS can be used to measure and visualize venous vessels, thyroid-volume and the atherosclerotic plaque inside the carotid arteries in detail. The inside of the vessel can also be visualized using a virtual endoscopy.

Conclusion: This new method can be adapted to nearly each linear ultrasound head. The operator needs only exercises and examination is short. Maybe soon we will be able to only scan all human body in our clinics step by step and see every details inside?

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Background and purpose: One of the shared principals of Primary Care (PC) is accessibility, which implies acting as a gateway to the healthcare system and community resources. The services’ proximity to the communities is a particularly important factor. Different countries have developed different policies in this regard. Brazil’s Family Health Strategy has a strong community approach based on participation, in and out the healthcare facilities. The authors aim to compare community health participation policies in Portugal and Brazil based on both theoretical and field knowledge of the Brazilian model.

Methods: A process of reading, selection, discussion and synthesis was made, followed by the comparative analysis between Brazil’s Family Health Strategy and the community health held in Portuguese healthcare centres. The field studies took place in Rio de Janeiro, during an internship by a Portuguese GP trainee.

Results: Brazil’s Family Health Strategy promotes active community participation. The community interventions bring health services closer to the community, leading to increased access to PC and improving the quality of services. The authors highlight five measures that could strengthen the community participation in Portugal inspired on the Brazilian model: creation of the health community agent; development of organized groups for health promotion; inclusion of physical activity in healthcare centres; reinforcement of street intervention health teams; and diversification of shared care resource units.

Conclusions: Portugal has experienced great advances in PC during the last years. Nevertheless, when compared to Brazil, there is space to grow towards a more inclusive, open, and participatory community health. Brazil Family Health Strategy is a successful example and can inspire other countries to follow good practices.

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Background purpose

Anthropozoonoses are frequent, both in rural and urban areas.
The domestic animal is the interface vector between wild animal and man.
Certain professions are exposed, certain hobbies are at risk, from direct/indirect contact with domestic or wild animals.
3 pathologies dominate: toxoplasmosis, alveolar echinococcosis and leptospirosis.
In a "One health" context, collaboration with veterinarians could lead better prevention and better control, or even the disappearance of these diseases.
The Covid 19 pandemic is here to remind us of the role of the human / animal interface in its possible genesis.
Other pathologies are frequent, but often underdiagnosed, such as cryptosporidosis, often found in transplant recipients.
The interview of our patients does not always take into account the risk of exposure (domestic animal, profession, leisure), favoring diagnostic error and increased risk in our fragile patients, including immunosuppressed and transplant recipients.

AIM/ Learning Objectives:
Learn more about Anthropozoonoses
Modify patient interview in order to identify risk factors exposure.
Develop a constructive partnership between GP and veterinary to improve the prevention, special in Rural area.
Know how to think about it in transplants and immunosuppressed.

Methods
Brief presentation of the topic. 10 mns

Participants will be divided in groups. They will discuss two major questions: 30 mns
What anthropozoonoses do you encounter?
What could you put in place to better think about it
What would you expect from a collaboration with veterinarians from a "one health" perspective
Restitution in large group, 30 mns and experts will present concrete situations of anthropozoonoses in Europe and of possible collaboration with veterinary.( 20 mns)

Abstract Body

Background and purpose:

The Barthel Index (BI) is an ordinal scale and consists of 10 items that measure a person’s daily functioning, particularly the activities of daily living and mobility.

This paper aims to evaluate the register of BI in primary care for patients aged 85 and over, and possible improvement after a corrective intervention.

Methods:

Dimension: Technical and scientific adequacy. Study unit: users aged 85 and over (N= 383). Type of evaluation: internal, peer, retrospective. Data source: process files (SClínico®). Evaluation criteria: proportion of users with a BI record. This study compares data collected in two times lag: December 2019 and February 2021, separate with an educational intervention.

Criterion evaluation: very insufficient if registration fee <25%, insufficient if registration fee ≥25% and <50%, sufficient if registration fee ≥50% and <75% and Good if registration fee ≥75%.

Results:

In the first assessment of a total of 383 users, in 53% there was no record of the degree of dependence, being present in 47%, resulting in an insufficient standard of record quality. In the second assessment, the degree of dependency was recorded in 70% of users, which corresponds to a sufficient standard.

Conclusions:

With the strategy implemented, the team improved the quality of the records related to elderly population, who has suffered some of the worst effects of the pandemic. The use of Barthel scale allow us to give better care during this pandemic, with special attention to those who needed specific care, such as home visits and treatments, as well as better vaccination planning.

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Background and purpose - Peripheral lymphadenopathy can be caused by infectious, inflammatory, malignant, or less common diseases, like sarcoidosis. Sarcoidosis is a multisystem disorder of unknown etiology, in which lymphadenopathy is present in up to 40 percent of patients.

Methods - We analyzed a case report regarding a patient with inguinal lymphadenopathy.

Results - 35-year-old male patient, nuclear family, Duvall cycle phase I, with venous insufficiency. He reported left inguinal swelling for several months, with a progressive increase in size and local pain; he also mentioned tiredness, night sweats, and dry cough. Upon observation, he had a left inguinal nodule, 3 cm, mobile, non-adherent; hepatomegaly was also detected. Analytical study with leukocytosis of 15 800/uL, PCR 15.4 mg/dl; inguinal echographic with multiple inguinal adenopathies, especially on the left, suggesting CT. In the thoracic and abdominal CT were detected multiple mediastinal lymphadenopathy clusters, hilars and retro-peritoneal, areas of pulmonary ground-glass opacities, and homogeneous hepatosplenomegaly, suggesting lymphoproliferative disease. It was performed an excisional biopsy of the left inguinal ganglion - histology compatible with the diagnosis of sarcoidosis. After specific treatment, he became asymptomatic.

Conclusions - It is important to exclude severe or potentially fatal causes in the study of lymphadenopathy since the timely treatment of the pathology involved is essential for the prognosis to be favorable. The family doctor is, in many situations, the first contact that the patient has with the health service, so he has to be alert to warning signs that may indicate a potentially serious illness.

Abstract Body

Background and purpose

In the European Drug Report 2020 drug related deaths have increased in the UK, especially in Scotland. (1)

Portugal, in the 1990s, had a high rate of drug related deaths however this has reduced significantly since 2001.

By looking at how we as general practitioners approach addiction and the wider context of drug policy we can better understand this complex problem.

Aims and learning objectives

Improve knowledge of factors which contribute to addiction.

Think about how we interact with our patients and better support them.

In a broader sense think about cultural challenges in attendees’ communities and countries and how GPs can advocate for change and overcome stigma associated with drug addiction.

Methods and timetable

An initial interactive survey to gauge participants’ knowledge of addiction.

The key factors of addiction as a disorder will be presented, including socioeconomic factors and the patient’s journey .

Case example: Mike is a 40 y old man who lives in x. He has been divorced for 5 years and unemployed for 3 years. Presented to A&E multiple times with drug overdose.

Breakout groups will then discuss: 1) GPs approach to consultations involving addictions;

2) How can we help reduce stigma around such patients; and

Ideas for improving future care.

The workshop will conclude with feedback of thoughts and opportunity to ask questions.

Results and Conclusions

Participants will have improved knowledge of how addiction disorders develop and experiences of the individual. Lessons learned from the UK and Portugal will support different approaches and improve confidence undertaking consultations involving addiction within General Practice.

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1. Background and purpose: Cushing's disease is a form of endogenous hypercortisolism, caused by an adrenocorticotropic hormone (ACTH) secreting pituitary adenoma. The chronic excess of cortisol results in Cushing's syndrome, which clinical manifestations include weight gain, lipodystrophy, hirsutism, insulin resistance, high blood pressure or fatigue.

2. Methods: Clinical interview and clinical file consultation

3. Results: 38-year-old woman, with a clinical history of diabetes, urolithiasis, obesity and depression. Six months after her diabetes diagnosis, the patient presented to her Family Doctor with sudden-onset high blood pressure. In the ensuing appointments, a Cushingoid appearance became gradually more noticeable. After a positive urinary cortisol test the patient was referred to an Endocrinologist, and diagnosed with Cushing’s disease secondary to a pituitary adenoma. Her impaired physical condition, after two unsuccessful pituitary surgeries, worsened her depression and insomnia. She’s currently on medical leave of absence from work and has started second-line medical treatment.

4. Conclusions: Cushing's syndrome is associated with high rates of morbidity and mortality, not only due to significant cardiovascular, metabolic and infectious risk, but also neuropsychiatric complications. An early diagnosis as well as a comprehensive approach of this condition from the Family Doctor are fundamental.

Abstract Body

Background

During the COVID-19 pandemic, medical students from clinical years were voluntarily recruited to participate in Primary Health Care (PHC). Three groups were formed. The first group created informative material regarding the COVID-19 and the vaccination. Based on this material, medical students were trained accordingly and have been participating in the operation of Vaccination Centers. The second group, after being adequately trained, assisted PHC units with the follow-up procedure of quarantined at home patients with mild COVID-19. The third group was involved in research regarding the course of patients with mild COVID-19 symptoms and the difficulties of complying with mandatory quarantine.

Aim and learning objectives

The aim of this workshop is to get PHC professionals familiar with ways that graduand medical students can play an active role during a pandemic.The objectives are (1) to discuss innovative ways of utilizing students during the pandemic or other emergency situations along with continuing training them; (2) to provide ideas regarding the involvement of students in PHC research; (3) to designate techniques of training medical students in telephone medicine, doctor-patient communication skills and in the vaccination process, theoretically and practically.

Methods and timetable

We will introduce our project, its educational goals and the exact processes. Then participants will brainstorm ideas into small working groups over the three axis mentioned in the workshop's objectives. Lastly, the outcomes of each group but also our results will be presented.

Results/ Conclusions

At the end of the workshop, we expect the participants to have fully understood the role that medical students can play during such emergency situations in PHC.

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Background and purpose: The population´s aging and increasing multimorbidity has led to a growing need for caregivers. In 2019, there were 827,000 Portuguese informal caregivers, alerting us for the increasing necessity of support programs. This study aims to implement and evaluate the impact of a primary care center´s multimodal intervention in reducing its caregivers ‘burden and improving their quality of life (QoL).

Methods: This is a prospective and interventional study that includes adult caregivers of dependent persons (Barthel index). It will be excluded caregivers/dependents with significant cognitive deficit or residing in nursing homes. During the 6 months intervention, caregivers will have medical support through proactive telephonic contacts and access to a social network channel, email address and a passive telephone line. Caregivers will also have streaming sessions aimed at training previously identified in-need caring skills and access to information via website, social network, e-mail and short message service. Before and after the intervention, it will be applied the World Health Organization Quality of Life-Bref and the Zarit Burden Interview. Caregiver data on 0^th, 6^th and 12^th month will be compared.

Results: Expected outcomes: reduction of caregivers´ burden, QoL improvement and caregiver satisfaction.

Conclusions: Telemedicine can be used to increase the proximity between primary care and caregivers an provide a valid support. Multimedia media means can help to obtain a more in-depth and holistic view of the caregiver in order to offer a more available and targeted health care service.

Abstract Body

Background and purpose: In Greece and worldwide clinicians are being vigilant about the spread of COVID-19 in healthcare facilities and the community. Holistic patient care has shifted to in-home quarantine and strict triage in hospitals. The COVID-19 Unit of the Emergency Department at Tzaneio General Hospital (Piraeus, Greece) is equipped with general practitioners. This case underlines the contribution of general practitioners in unraveling conditions disguised as COVID-19 in such settings.

Methods: In July 2020 a 25-year-old male presented to our hospital with fever and extreme fatigue, following a seven-day quarantine from the onset of these symptoms. While in quarantine, the patient complained of a fever rise and left lateral abdominal pain and was then referred to our hospital. Upon arrival, he was triaged as a suspected COVID-19 case and was transferred to our hospitals' COVID-19 department. A PCR SARS-CoV-2 test came out negative. His blood tests showed pancytopenia. Splenomegaly and hepatomegaly were detected on clinical examination and abdominal ultrasound.

Results: The patient was admitted to the Internal Medicine Department to rule out non-COVID-19 infections and non-communicable diseases. He was then referred to the Hematology Department, where he was diagnosed with Hepato-splenic Gamma/Delta T-cell lymphoma in August 2020 and has been receiving the indicated treatment since then.

Conclusions: This case suggests that close monitoring and a high level of alertness to detect COVID-19 cases, may delay the diagnosis of other life-threatening conditions. General practitioners in COVID-19 units can contribute to promoting public health and maintaining a focus on serious conditions disguised as COVID-19 infection and referring the patients to the appropriate departments.

Abstract Body

Background:

The development of critical illness in Covid-19 appears to be linked with cardiometabolic disease, exemplified by an overrepresentation of cardiovascular disease or its risk factors in severely affected patients.

Aim and learning objectives:

To learn existing evidence on risk tools to identify high-risk Covid-19 patients in the early disease phases, focusing on cardiometabolic predictors (obesity, diabetes, etc.). Additionally, to learn existing evidence to mitigate risk by anticoagulant treatment to prevent thrombo-embolic events and colchicine to prevent vessel inflammation and complications.

To share clinical stories of patients where the distinction of Covid-19 with myocardial infarction or (development of) pulmonary embolism was difficult.

To explore the potential correlation of long-Covid – i.e. persisting symptoms (fatigue, shortness of breath) in patients having survived the acute phase of illness – as a phenomena explained by acceleration of previously subclinical cardiovascular disease.

Methods and timetable

Presentation on risk tools and impact of cardiovascular medication to mitigate risk will take 30 minutes. Thereafter, in break-out rooms, interactive story telling on diagnostic dilemma’s between Covid-19 and cardiovascular disease will take 20 minutes, brought back plenary to summarize learning points in 10 minutes. The final 30 minutes are spend on long-Covid as a possible cardiovascular entity in some patients (15 minutes presentation, 15 minutes plenary discussion).

Proposed Results / Conclusions

This workshop focussed on mitigating the cardiovascular burden in Covid-19 patients from a primary care perspecitve, in terms of understanding and mitigating risk using a cardiovascular periscope, but also by sharing patients stories and diagnostic dilemma's, and finally by exploring underlying cardiovascular pathways in patients with long-Covid.

Abstract Body

BACKGROUND AND PURPOSE:

37-year-old man with no significant past medical history presented with fever, coughing, sore throat, headache and asthenia. The symptoms were compatible with a SARS-CoV-2 infection that was later confirmed, showing a good clinical evolution for the next 14 days. However, 2 weeks later he started feeling pleuritic pain, dyspnoea on mild exertion and dizziness, not presenting any significant findings from additional testing in Primary Care. The symptoms persisted after 2 months so he was referred to Internal Medicine to rule out long-term pulmonary consequences of COVID-19.

METHODS:

- Physical examination with no interest except orthostatism.

- Chest radiograph with reticulo-nodular interstitial pattern in the right middle lobe.

- ECG: Sinus bradycardia at 55bpm.

- Negative PCR nasopharyngeal swab one month after the first positive one.

- Laboratory testing was normal

- No findings in ambulatory Holter monitor or spirometry.

- Thoracic CT scan showed signs of pneumonitis (ground glass opacities) in right upper and middle lobe.

RESULTS: The patient was diagnosed with Post-COVID Syndrome

CONCLUSIONS:

There is growing evidence of signs and symptoms that can affect patients after an acute COVID-19 infection, although we don’t know how permanent they are. The main points of our case are firstly, the patient’s profile: young and with no previous medical history. Secondly, patients with “Long COVID” often don’t show any abnormalities in multiple tests, but in this case there is a clear one. Lastly, the persistence of severe symptoms after 3 months does not always correlate with the severity of the initial episode

Abstract Body

Background and purpose:

COVID-19 has posed a challenge to Primary Care (PC). This study aims to describe the resources required by patients who were seen in an urban PC center during the first epidemic wave.

Methods:

Retrospective descriptive study on a patients cohort seen in a PC center in Barcelona. All patients included presented symptoms compatible with possible or confirmed SARS-CoV-2 infection, between 24th February and 30th May, 2020. Data collected from electronic medical record and by telephone interview were evaluated.

Results:

518 patients were included. 283 (54.6%) were women. Mean age was 50.2 years. Patients took a mean of 3.7±4.7 days to contact the healthcare system. 71.8% contacted PC as their first option. 55.25% required medical work leave. The mean number of days of sickness leave was 35.8±26.4. Doctors made 5.2±4.5 phone calls per patient and nurses made 3±3.7. 137(26.4%) required face-to-face assessment, with 0.4 (range 0-4) visits per patient. 24 (4.6%) required home visits, with 0.1 (range 0-3) visits per patient. 4.2% were seen by the centre's social worker. 31.5% were seen in the hospital emergency department. 20.1% required hospital admission. 2.7% required intensive care. The mean number of days of hospitalization was 15.5±13.7 (range 1-76). 1.7% required admission to a socio-health care centre. 4.6% were admitted to a medicalised hotel.

Conclusions:

PC is the most frequently management resource used by COVID-19 patients. Most of them required exclusive outpatient follow-up. The vast majority could be managed by telephone. The epidemic resulted in high absenteeism from work during the first wave.

Abstract Body

Irelands first drive thru practice flu clinic. the way forward? A cross sectional study to assess patient satisfaction

Introduction

Approximately, 200-500 Irish people will die each year because of flu. In a bad year this can be up to 1000 people (2008-2009).1. It also results in many hospital admissions2. Vaccination is the best protection we can give our population.

Drive through flu clinics are common in other jurisdictions, particularly in America.6. The drive-through model is a feasible alternative to a traditional walk-in ED or clinic and is associated with rapid throughput times. It provides a social distance strategy, using the patient's vehicle as an isolation compartment to mitigate person-to-person spread of infectious diseases7.

Although there is evidence of their use, commonality, and efficiency there is little evidence of patient satisfaction.

While implementing the drive through influenza vaccination clinic, we decided to conduct a patient survey focusing on patient satisfaction of the drive through vaccination clinic

Between September 29th- December 5th, 2020 we vaccinated 1754 adult patients and 908 pediatric patients in Irelands first drive through clinic. The clinic was exclusively booked online which helped us to adhere to HSE guidelines and allowed us to easily provide information leaflets. Based on our practice numbers we estimate 37.41% of our pediatric patients aged 2-12 received the flu vaccine in their car.

The aim of the study was to understand a patient’s perception of a drive through a flu vaccine clinic.

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Zika is an arbovirus of the genus Flavivirus, transmitted by the mosquito bite Aedes and also by sexual transmission. Generally it produces a mild disease but recently there have been described congenital anomalies associated with the infection of this virus.

Description of one clinical diagnosed with Zika in one Basic Health Areas of Girona.

A 74-year-old patient who had travelled for more than two months to Puerto Rico and 3 days later after arrival he presented fever (38.2ºC), arthritis, asthenia and bilateral lumbago. A rapid urine test was performed and showed positive leucosis and it was oriented as a urinary tract infection and it was treated with an antibiotic. After 24h he presented conjunctivitis and a generalized exanthema and the physician though it was an allergic reaction to the antibiotic.

After a month, the patient consulted with his GP to perform allergy tests to antibiotics. During the medical appointment the patient was examined again and given to the history of a recent trip to a Zika endemic country the Arboviruasis protocol was activated.

The diagnosis was confirmed with a positive PCR in urine for Zika. No serum analysis was performed.

The importance of the diagnosis of cases in the viremic phase, as well as taking hygiene-sanitary measures to minimize the transmission and to avoid the autochthonous cases.

Emphasize the value of training primary health care professionals in emerging, imported and/or indigenous viruses, as well as community health education in the implication against the fight of the transmission of the virus.

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ADHERING TO A MEDITERRANEAN DIET. ARE WE, AS HEALTHCARE PROFESSIONALS, SETTING AN EXAMPLE?

Background and purpose

The Mediterranean diet has demonstrated effectiveness in both primary and secondary prevention of cardiovascular diseases. Additionally, it is well known that if the advice is given by a Healthcare professional who has a good knowledge and believes in this diet pattern, the implementation of the advice will be more effective. It is therefore, why we have enquired Health professionals about their own adherence to the Mediterranean diet.

Methods

Survey. We have used the 14 points PREDIMED questionnaire, which was sent on-line to the doctors and nurses of two different Primary Care settings, to test their own adherence to the Mediterranean diet. A score of 7 points or lower denotes a low adherence, a medium adherence in scores of 8 or 9 points and high adherence with 10 points or greater.

Results

A total of 82 questionnaires were received and examined: 84% Females,16% Males; 66% Doctors, 34% Nurses; 3% aged<25; 12% 26-35; 34% 36-45; 27% 46-55 and 24% 56-65 years old. Average score obtained: 7,15 (Standard deviation 1.91).

Conclusion

The final results indicate the doctors and nurses who took part in the survey have a low/medium adherence to the Mediterranean diet. As Healthcare professionals, we should improve our knowledge on the well-proven benefits of the Mediterranean diet. This will likely improve our own health and reflect on more efficacious advice to our patients

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Background

Family medicine is new in the region of Kurdistan, northern Iraq. Since 6 years Dutch-Kurdish projects have been developed to elevate the primary health care to family medicine care level.

Aim To study the effects of family medicine care on the satisfaction of patients in the new Dutch-Kurdish family medicine centre Avro City, Duhok.

Patients and methods A repetitive cross-sectional study design was conducted during a 2 week

period in 2017 and 2020. Included were patients willing to cooperate who presented at the centre. Information was obtained by a semi-quantitative questionnaire.

Results A total of 312 patients were included in 2017 and 312 in 2020. 2017/2020 Demographics 68%/52% female patients, median age of 20-30/20-30 years. Median visit frequency 6/6 times in the past 12 months. Communication skills of the family doctors for: respect, listening, patience, explanation of care: good to excellent/good to excellent of a score of 4 (Excellent, Good, Fair, Poor). Family medicine aspects: enough consultation time, trust in treatment, preventive care, interest and care in personal situation and involvement of decision making were also good/excellent. The centre as a whole was rated good and the treatment experiences very good. Patients rated the centre very good/good to excellent in comparison to earlier experiences with primary health care and 99/99% would recommend the centre to other people.

Conclusions and Recommendations Two successive patient experience analysis with a new family medicine clinic, AvroCity, demonstrate sustained positive results. The important “ambassador” function in middle eastern countries is effective with almost 100% of the patients recommending the centre above standard primary health care.

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Background and purpose: Forestier's disease is usually asymptomatic and therefore latent. However, it can lead to important morbidity and mortality. Osteophytes can develop and lead to extrinsic compression in local tissues. In the cervical region, they can generate otorhinolaryngological manifestations, such as dysphagia, pharyngeal globus, dysphonia and stridor.

Methods / Clinical Case: Female patient, 36 years old and with a history of obesity, arterial hypertension and hypercholesterolemia, who started high dysphagia only for solids with progressive worsening over 1 year and feeling of impact on food. He was evaluated by Otorhinolaryngology, performed cervical X-ray with changes and cervical computed axial tomography and identified massive anterior osteophytosis of the vertebral bodies from C3 to C5 to condition the impression of the posterior wall of the cervical esophagus.

Results: Given the symptoms referred to orthopedics, which guided a more conservative and non-surgical approach, diet, anti-inflammatory and muscle relaxants.

Conclusions: This clinical case aims to remember that Forestier's disease is not a rare disease, but it is often not recognized. This diagnostic hypothesis must be considered in patients who present with dysphagia, dysphonia, sleep apnea, cough, pharyngeal globus or foreign body sensation in the throat, which are common symptoms in otorhinolaryngology practice. Early diagnosis is important for initiating multidisciplinary follow-up that improves patients' quality of life.

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Background and purpose:

COVID-19 has posed a challenge for Primary Care (PC). This study aims to describe the characteristics, symptoms and evolution of patients seen in a PC centre during the first epidemic wave.

Methods:

Retrospective descriptive study on a patients cohort seen in a PC center in Barcelona. All patients included presented symptoms compatible with possible or confirmed SARS-CoV-2 infection, between 24th February and 30th May, 2020. Data collected from electronic medical record and by telephone interview were evaluated.

Results:

518 patients were included. 283 (54.6%) were women. Mean age was 50.2 years. 81.9% were Spanish. 35.1% had occupational exposure to COVID-19. 38.8% had no previous pathological history. Among those with medical history: 19.3% hypertension, 17.8% obesity, 9.5% diabetes, 8.5% cancer, 7.3% anxiety/depression, 6.4% asthma. 45.2% were not on any chronic medication.

The presenting symptoms were: fever 75.7%, cough 72.0%, malaise 70.0%, asthenia 65.6%, arthromyalgia 53.2%, headache 51.1%, dyspnoea 38.9%, anosmia/dysgeusia 37.7%, diarrhoea 37.2%, odynophagia 31.1%, chills 25.3%, nasal congestion 23.6%, expectoration 22.2%, chest pain 22.1%, nausea/vomiting 16.8%, dizziness 14.2%, conjunctivitis 6.2%, haemoptysis 2.9%. The mean number of days with fever 7.1±6.9.

Complications developed were: pneumonia (21.4%), anxiety/depression (6.4%), acute kidney injury (1.5%), PTE (1.2%) and pericarditis (1%).

Mortality was 2.3%. 84.7% recovered completely, 2.3% had sequelae and 10.6% were recovering at the end of the study.

Conclusions:

A significant proportion of patients in the first COVID-19 wave were occupationally exposed to the infection. Most had relevant pathological history. Predominant symptoms were fever, cough, malaise and asthenia. Over 85% of patients made a complete recovery.

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Background: Chest radiography (chest X-ray) is part of the evaluation of many clinical conditions that present in the primary care setting. It is a painless, non-invasive, easily accessible test that provides a snapshot of the patient’s physiologic health and insights into a wide variety of diseases. The correct interpretation by the family physician minimizes unnecessary test ordering and delays in diagnosis.

Aim and learning objectives: Equip family physicians with practical skills and knowledge to:

Identify key technical quality aspects to be assessed prior to interpretation of a chest X-ray;

List the components of a chest X-ray examination to be systematically analysed;

Identify the normal anatomic structures and interfaces routinely displayed on chest X-ray examinations;

Recognise areas where abnormalities are easily missed;

Detail the different patterns of lung disease seen radiographically;

Correctly integrate clinical and imaging data in order to establish a diagnosis.

Methods and timetable: Skill-building workshop based on real life clinical cases, comprising of a dynamic 45 minute presentation, followed by an interactive 45 minute group discussion session. Participants will be given cards with various cases, for which they will be encouraged to discuss and propose a diagnosis with the rest of the participants, as well as raise issues from their own practice. It will be expected 25 to 30 participants.

(Proposed) Results/ Conclusions: Participants will be able to diagnose and develop a treatment plan by integrating the correct interpretation of the patient’s chest X-ray with his complete clinical findings.

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1.Background: Major depression is a highly prevalent pathology that is currently the second most common cause of disease-induced disability in our society. The onset and continuation of depression may be related to a wide variety of biological and psychosocial factors, many of which are linked to different lifestyle aspects. Procrastination is the irrational and voluntary delaying of necessary tasks and it produces serious consequences for mental health and well-being.Our objective was to analyze the relationship of procrastination with depression and lifestyles.

2.Methods: Cross-sectional study. The sample consisted of 140 patients with depression recruited in primary health centers. The variables are: procrastination measured using the Irrational Procrastination Scale; Severity of depression measured using Beck’s Depression Inventory; lifestyles: Physical activity measured using the International Physical Activity Questionnaire-Short Form; adherence to the Mediterranean Diet measured using the 14-item Mediterranean Diet Adherence Screener and Quality and patterns of sleep measured using the Pittsburgh Sleep Quality Index. Correlations and multiple regression analysis were performed.

3.Results: Correlations analysis show that the more procrastination, more depression (-0.333, p = 0.000), less minutes walked (-0.218, p = 0.01), worse sleep quality (0.192, p = 0.023), less adherence to the Mediterranean diet (-0.299 p = 0.000), less age (-0.341, p = 0.000). Taking depression as a dependent variable, procrastination (0.329) and bad sleep quality (0.500) were shown to be predicting coefficients (p = 0.000). The interactions were not significant.

4.Conclusions: These results support the relationship among depression, procrastination and lifestyle.

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Background
COVID impressed upon us the importance of preventing infections including vaccination. Vaccination is important for specific patients (e.g. asplenia) or in specific situations (e.g. travelling). Many stakeholders are involved in the vaccination-proces. It is difficult to stay informed. We developed a model to registrate information on vaccination in the electronic medical file and investigated the usability for sharing this information with stakeholders.

Aim

Orderly presentation of administered vaccinations

Orderly presentation of vulnarability of patients to infections avoidable by vaccination

Methods

By interviewing general practitioners expert on electronic medical files we investigated which information should be recorded in de electronic file concerning administered vaccinations and patient-vulnarability to infection.

Outcomes

Specific information on administered vaccinations is needed (date of administration, administrator, batch-number).

To estimeed the vulnarability of a patient information is needed on all the administered vaccinations, infections that the patient has suffered from and antibody-titers.

We developed a model for the registration and presentation of this information

Discussion and take Home Message

The information needed to estimate the need for future vaccination is complex. Often we are confronted with information gaps: vaccinations may be administered long ago, detailed information is lacking, specific products not (longer) available. Vaccinations may be given by other stakeholders, even abroad. The number of vaccinations is important, but also the route of administration (e.g orally), and the moment of vaccination.

Nevertheless it is possible to standardise the registration of administered vaccins and the vulnarability to infections. We are finetuning our model with other stakeholders in order to facilitate sharing this information with others.

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1.Background and purpose:Clozapine, an atypical antipsychotic, has been used in the treatment of schizophrenia and other psychotic disorders. Although it has good therapeutic effect but many a time it use is overridden by the associated adverse effects which range from minor to severe life-threatening events.

2.Methods:In the context of investigating the cause of the patient’s dyspnea, a variety of examinations were carried out. Between these examinations the x-ray and the chest computed tomography (CT) demonstrated the presence of pleural fluid. In addition the CT scan confirmed that there was no possibility for pulmonary embolism.

3.Results:The samples that were taken from the pleural fluid and the blood excluded the presence of a microbial agent that could cause this pleural disease. Furthermore in both blood and pleural fluid the percentage of eosinophilic cells was superior than the regular reference range. The patient’s ejection fraction was preserved and also the probability of self-immune or rheumaologic mechanism was negative according to unremarkable amounts of ANA antibodies and other serum studies. As a response to the serositis that the CT scan was shown, the patient received cortisone therapy and presented improvement both in his blood examinations and pleural fluid. In conclusion we could suppose that clozapine was the main cause of this eosinophilia pleural fluid reaction in our case.

4.Conclusions: Although there are few references in the international literature clinicians should consider clozapine as a possible cause

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Agranulocytosis. Should we be more careful controlling the medications we prescribe?

Background:Metamizole is an antipyretic and analgesic drug available since 1921. It seems to be a more safe choice compared to other analgesics, that's why it is being more used. Nevertheless, the agranulocytosis risk is an infrequent serious side effect, that is why many countries are concerned about its prescription. Medical experts believe that North European were more susceptible to this side effect, but is there any evidence?

Clinical case

45 years Russian old male patient consulted for asthenia and oral ulcer symptomatology.

Pathologycal history:severe degenerative lumbar disc disease

Treatment: metamizol 575 mg /8h and sometimes extra-dose of 2 mg during 2 months.

Haemogram emphasize Hemoglobin 12,8 platelets 208 x10E9/L, Leukocytes 2,41x10E9/L Neutrophil count 0,25x10E9/L (severe neutropenia)

Results:After 6 weeks without methimazole the haemogram was normal.

Discussion:The available information about metamizole on both, intermediate and long-term safety, is very limited. The agranulocytosis effect produced by metamizole could be linked to specific HLA allele(s), consequently, those individuals with a higher frequency of variant HLA may be at a greater risk.The possibility that north european show higher susceptibility to metamizole‐induced agranulocytosis cannot be ruled out.

Spanish Drug Agency recommends that metamizole should only be used for short treatments(<7d). In case the treatment lasts a longer period the patient should be controlled with haemograms.Metamizole should’nt be used in patients with risk of agranulocytosis and carefully in old people.

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Introduction: Transient hyperphosphatasemia (TH) of infants affects children younger than 5 years, and is characterized by an elevation of serum alkaline phosphatase (ALP) in the absence of bone, liver or kidney disease. In TH, ALP can reach levels 5 to 30 times higher than the reference values, with levels normalization in 4 months. The etiology remains unclear, and diagnosis is usually provided when laboratory tests are required for assessing other conditions.

The authors pretend to alert that TH, an underknown entity, represents the most frequent cause of childhood hyperphosphatasemia.

Case report: A 9 months old boy, with a history of intrauterine growth restriction. Somatometry suitable for birth. At 6 months, due to failure to thrive, an analytical study was conducted with evidence of increase in ALP (2894 UI / L). Physical examination and psychomotor development were normal. The patient was supplemented with cholecalciferol, and there was no evidence of other medication, neither family history of hyperphosphatemia.

In the follow-up, it was excluded renal, hepatic or bone diseases. Child's physical examination was unremarkable and there was a statoponderal recovery. ALP levels ​​normalized (284 IU / L) in 3 months, which allowed to confirm the TH diagnosis.

Conclusion: More than a clinical problem, the TH of infancy is a benign and self-limited entity that should be considered in the diagnostic evaluation of hyperphosphatasemia in children without bone, liver or kidney disease, to avoid unnecessary diagnostic concerns and investigations.

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1.BACKGROUND AND PURPOSE

Onychodystrophies are very common. More than 50% are mycotic. In feet most of them are dermatophytes, especially T. Rubrum. Other causes : psoriatic,traumatic,vascular,lichen...

Nannizzia nana is a zoophilic and geophilic dermatophyte fungus with a worldwide distribution. It causes ringworm in pigs and is in the soil of farms. In humans it produces rare cases of tinea corporis and capitis. Tinea unguium is very rare.

We describe the first case of onychomycosis caused by Nanizzia nana (Microsporum nanum) in our setting.

2.METHODS

35-year-old woman from a rural area of Honduras and resident in our country for more than 1year. Major nail dystrophy in the first toe of both feet for 5 years and without improvement after several treatments.

3.RESULTS

Nail samples are sent to the laboratory, plated in DTM and SGC medium (BioMérieux) and incubated at 30*C. At 9 days a colony grows whose microscopic examination with lactophenol blue allowed to identify as Nannizzia nana.

Lesions disappeared after treatment with oral terbinafine.

Reviewing the literature there are hardly any published cases of Nannizzia nana as an agent of Tinea unguium

4.CONCLUSIONS

1-Relapses and resistance to treatment, along with the need for a correct differential diagnosis, make recommendable mycological examination of onychodystrophies.

2-Epidemiological antecedents: contact with pigs and life in a rural environment are very important for the diagnosis of this dermatophytosis.

3-This is the first isolation of Nannizzia nana in our environment. It coincides with two published cases of patients from South America

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Background

Headache is one of the most common reasons a patient seeks a consultation in primary care, with a prevalence of 66% and a high burden regarding work absence.

Primary headache disorders are the most common, but this complaint may also be a symptom of other pathologies - secondary headache. Although less frequent, the later usually represent severe conditions.

Chronic headache treatment is often suboptimal and many patients that should be taking prophylactic therapy are doing acute treatments, not controlling the disease and also putting themselves at risk for medication overuse headache.

An effective management of chronic headaches can be quite challenging for the General Practicioner (GP), but is mandatory in order to improve quality of life for patients suffering from it.

Aim and learning objectives

This workshop aims to provide the tools for GP’s to effectively manage these chronic syndromes, performing a correct differential diagnosis through history, physical exam, and possibly diagnostic studies. Also, non-pharmacologic and pharmacologic management (abortive, adjunctive or prophylactic) will be discussed.

Methods and timetable

In this one-hour workshop, the most recent evidence regarding this subject will be reviewed in a viewer-friendly environment, leading the attendees to a participated learning process about headache. The basis for this workshop will be the International Classification of Headache Disorders, 3rd edition.

Conclusions

Headache remains an important health problem, very common in primary care and with a high associated burden.

Health providers education about headache is essential to improve its management in primary care, leading to a prompt diagnosis and more effective treatment and follow-up.

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Background and Purpose: Phytophotodermatitis (PD) is a clinical dermatological diagnosis that refers to the phototoxic reaction caused by contact with parts of plants or fruits (PF) rich in phototoxic agents and subsequent exposure to ultraviolet light (UVL). PD is often underdiagnosed due to lack of knowledge about this entity. Our aim is to analyze evidence about the pathophysiology, clinic and treatment of PD.

Methods: A systematic review (SR) was performed using the Pubmed, Cochrane and Uptodate databases. Meta-analyzes, SR, reviews, clinical trials and documents about the purpose of the study were included.

Results: PD occurs when there is topical exposure to substances derived from PF, more commonly furocoumarins and psoralens, and subsequent exposure to UV light. Typically it presents with erythema, edema and bullous eruptions on the skin exposed to the sun and reflect the manner in wich the person have come in contact with the PF. The lesions may evolve to hyperpigmented macules. Treatment consists in the application of topical corticosteroids and analgesia with non-steroidal anti-inflammatory drugs. If there are bullous eruptions, they must be punctured, cleaned and treated with a dressing in order to protect from infection and promote re-epithelialization.

Conclusions: A complete medical history and the typical clinical findings allow an easy diagnosis of PD. Its conservative treatment can be performed in primary health care. The family doctor is, in most cases, the patient's first contact with health care so it is important his familiarization with this entity wich will allow an early diagnosis and correct treatment.

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Background: The aim of the study is to indicate the problem occurring in early puberty in girls which is underdiagnosed gynecological problems.In our general practitioner practice we noticed the occurrence of frequent problems related to abdominal pain in girls around 12-17 years old. The complaints were largely related to the menarche period and the beginning of ovulatory activity of the ovaries. We observe single threatening adnexal tumors among this group.

The problem is the difficult age of patients between pediatrician and gynecologist care, reluctance to gynecological examinations in girls and limited access to pediatric gynecology.

Method: Girls with lower abdominal pain were studied using a 2.5/6 Mhz convex probe over a period of 5/6 years.

Results: Most of the abnormalities were related to urinary tract infections, but in some cases, after careful examination, mainly multicystic adnexal tumors with numerous septa, often much larger than 5 cm in diameter were found.

Conclusion: Most of the tumors were ginecologically-surgicaly removed. Only...Miss Teen’s tumor was not removed, as she refused to undergo surgery because she was scheduled for a photo shoot in Australia and India in a bikini outfit and was afraid of having a scar on her abdomen.

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Background and purpose

In the daily clinical practice of a family doctor, complaints associated with chronic pathology often arise. However, this symptom can sometimes mask a more serious clinical condition.

Methods

A 59-year-old female patient is presented. Relevant personal history: lumbar osteoarticular pathology confirmed by CT scan, with about 10 years of evolution. She goes to the consultation referring sensation of a “stuck leg” on the left, without pain, but that made it difficult to walk, with about 1 month of evolution. After using our consultation several times, and after a variety of complementary diagnostic tests, brain MRI revealed a space-occupying lesion at the intraventricular level. the lesion was excised, and the histology revealed a grade IV glioblastoma, with parieto-occipital location in the right side.

Results

During the post-surgical reevaluation consultation, the patient revealed that, in the context of an accidental TBI in 2009, she underwent an MRI scan where a suspicious lesion with an “epileptic focus” was visible, with the hypothesis that it was a low-grade glioma.

Conclusions

When symptomatology is persistent, it is essential to exclude the most common and known causes, but we must never forget any less frequent pathologies that require more in-depth and targeted investigation.

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Background:

The effects of type 2 diabetes mellitus on bone are complex and the relationship of T2DM with bone mineral density remains inconsistent across studies The objective of this study was to determine the relationship between osteoporosis and T2DM in elderly patients

Methods:

Retrospective study was conducted in osteoporosis clinic in the primary health care center in Dubai health authority.

Elderly aged 60 years and above attended the osteoporosis clinic for screening in the primary health care centre in Dubai health authority in 2018.

Results: The prevalence of osteoporosis in this study was 39.5%. The results showed that, non- diabetic elderly had higher prevalence of osteoporosis in comparison to diabetic elderly (44.0% and 33.1%, respectively). This difference was statistically significant (P = 0.007). It was observed that males had higher femur and lumbar spine BMD in comparison with females.

Discussion:

Our data showed that nondiabetics were at a higher risk of developing osteoporosis than T2DM elderly. This finding is consistent with previous studies in Kuwait, Jordan and Iran which showed that T2DM is a promoter for bone health. Furthermore, studies have reported that Magnesium deficiency is linked to osteoporosis, insulin resistance and Alzheimer’s disease. This could explain that magnesium deficiency in nondiabetics increased the risk for osteoporosis compared to diabetic who consume appropriate magnesium through diet to prevent insulin resistance and therefore prevent osteoporosis.

Conclusion:

The prevalence of osteoporosis in this study was 39.5%. BMD in femur was slightly lower than at lumbar spine. The study findings revealed that Vitamin D and HBA1C were significantly higher in diabetic elderly.

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Background and purpose: Dysphonia describes the impairment of voice production assessed by the clinic, while hoarseness is the perception of change in your voice quality. Dysphonia is very common, affecting nearly one-third of the population and can compromise the quality of life of the individual (socially and professionally). Being such a common symptom, with such a diverse range of etiologies and risk factors, it’s imperative to improve its approach for a better quality of care.

Methods: Search on Scholar Google, National Center for Biotechnology Information database and Pubmed for guidelines, systematic reviews and original articles published from January 2005 to December 2020, using the MeSH terms “dysphonia” and “hoarseness”.

Results: The sound produced by the vocal cords can be affected by various pathologies. The initial evaluation begins with a targeted history and physical examination, while also looking for risk factors and possible causes. It’s important to understand when a laryngoscopy is indicated since an early referral allows an early intervention, and therefore reduces morbidity and mortality associated with certain diagnoses. Voice therapy, vocal cord surgery, and drug therapy for appropriate groups of patients with hoarseness are well documented.

Conclusion: In Portugal, there’s no guidelines about dysphonia and clinicians regulate their practice using international recommendations. This review aims to highlight important information and to outline the approach to dysphonia in primary care. The treatment for dysphonia dependents on its etiology and it should be prescribed accordingly.

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Background:
The COVID-19 pandemic has shone a spotlight on the challenge of marginalised groups and vaccine hesitancy, with significant health status implications. This interactive session draws together recent research and examples of innovation in overcoming vaccine hesitancy from across Europe, to provide opportunities for discussion, sharing of what works, and take-home solutions.

Aims:
Attendees of this workshop will:

- Understand barriers to uptake in migrants and BaME groups identified in recent research from across Europe
- Explore the value of service design tools to improving vaccine uptake in these groups
- Share examples of best practice and innovation
- Vote on the interventions felt to be most likely to be efficacious or feasible in their context
- Reflect on how the workshop will change future practice

Methods / Timetable:
This highly interactive workshop will include:

- 3 x 10 minute presentations drawing together recent research on barriers to uptake of the COVID-19 vaccine in migrant populations across
Europe (30mins)
- Interactive Service Design Exercise on strategies to improve uptake (30mins)
- Participants sharing personal experiences of vaccine hesitancy and how they have handled these (10mins)
- Small group discussion of examples of innovation (10mins)
- Vote on proposed interventions (10mins)

Conclusion: This workshop aims to present evidence of facilitators, barriers, and current best practice, share examples of international innovation, and provide practical solutions to improving vaccine uptake in migrants in our local settings. Intervention strategies such as co-design of vaccine campaigns, innovative provision of digital health advice, and challenging misinformation will be highlighted, and efficacy and feasibility explored.

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Glaucoma is a major cause of blindness. It consists of a heterogeneous group of eye diseases characterized by a progressive optic neuropathy, manifested by cupping of the optic disc and increased intraocular pressure (IOP).

Primary infantile glaucoma occurs in 1:10.000 live births. In more than two-thirds of cases it’s bilateral and approximately 10% are inherited.

Term infant, 3 months of age, with history of maternal gestational diabetes, adequate somatometry and Apgar index at birth, but with transitory tachypnea of the newborn (TTNB) and neonatal jaundice requiring exsanguineous-blood transfusion, without other relevant obstetric, neonatal and familiar history, with normal weight-status and neurodevelopment, presented to the emergency department with somnolence, bilateral difficult eye opening and photophobia for two days. No fever, crying or excessive tearing were noticed.

During physical examination there was conjunctival hyperemia with photophobia. No ocular secretions were present. Lab results were normal and Ophalmology’s opinion was warrented. There were corneal enlargement and edema, Habb striae and increase IOP. Viscocanalostomy with plasty of both eyes was performed along with iTrack and temporal trabeculotomy that underwent with no complications.

Timely diagnosis and proper treatment are crucial, as glaucoma can lead to blindness. A shiny areola in the iris can be a clue during the physical examination of the newborn. It’s particularly important to raise attention from family physician doctors to this disease, whose recognition is tricky but, extremely important to its natural course and prognosis.

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Background and purpose: Scleroderma is a chronic rheumatological disease, characterized by the production of fibrous tissue, mainly in the skin but also in other organs. It’s not common in the daily routine of the family doctor becoming a challenge.

Methods: Case report

Results: Mr.O.A., 57 years old, caucasian, CEO of a radical activities company. Non-relevant medical history, no usual medication. Healthy eater, works out regularly. Denies any rheumatological pathology in the family's history.

Came to acute pathology’s consultation. Complementary diagnostic tests were requested: Hb 7.9 g/dl, HT 27.2%, VGM 60fL, not compatible with the normal physical exam. Repeats blood count and complements study of anemia: signs of gastropathy and H.Pylori infection were identified.

Starts to show signs of raynaud phenomenon associated with diffuse edema of the hands and face, sense of lower physical performance, stuttering and genitourinary symptoms (difficulty in urination, polyaquiauria and sexual impotence). Complemented the study: microalbuminuria ratio 199.4, VS 15, ANA 1:1280.

Was referred to the Rheumatology consultation. Signs of skin thickening were identified (RODNAN 19). In the additional hospitalar study, were found positive Scl-70 antibodies, abnormal capillaroscopy and signs of renal and lung involvement. The diagnosis of diffuse cutaneous systemic sclerosis was established.

Conclusions: Rheumatological pathology is a puzzle in which the pieces are not always all visible or fit in the signs and symptoms described by the patient, turning it into an adventure, shared with the patient, with the aim to reach the diagnosis.

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Background

Chronic Paroxysmal Hemicrania (CPH) is a rare and debilitating headache and it is characterized by episodes of unilateral pain that occurs in association with ipsilateral cranial autonomic symptoms.

Thrombosis of cerebral venous vessels is a rare cause of cerebral infarction. It is very often unrecognized at initial presentation. It has been implicated in mimicking many of the primary headache disorders.

Method

Case report.

Results

37 years-old caucasian woman with a past medical history of Sjogren's Syndrome, Systemic Lupus Erythematosus, hyperthyroidism, depressive disorder and asthma, experienced sudden transient loss of consciousness followed by left-sided headache without any other neurological deficit. Familial history was negative for neurological syndromes. A cardiac etiology for episode was excluded by a continuous cardiac monitoring device.

5 months later similar symptoms occurred, although this episode was complicated with a transient left sided hemiparesis. MR imaging revealed left cerebral transverse sinus hypoplasia and thrombosis of the central venous sinuses.

After 3 months she developed transient neurological symptoms with dizziness, left sided hemiparesis and visual disturbances. Thereafter she visited her Family Doctor describing chronic daily headache for many years, with exacerbations of severe uni/holocranial headache associated with photophobia and nausea, simultaneously with transient neurological symptoms.

These episodes suggested CPH. Therapeutic trial with indomethacin was started, which led to complete resolution of the condition.

Discussion/Conclusion

This case demonstrates that the holistic/patient-centered view and the knowledge of patient’s medical history allows Family Doctor to diagnose many conditions. The accurate diagnosis and treatment had a significant improvement in the patient's quality of life.

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Patients with Angelman Syndrome (AS) appear normal at birth. In the first months of postnatal period, feeding difficulties and hypotonia may occur, followed by developmental delay between 6 and 24 months. The typical characteristics of AS develop from 12 months: severe mental retardation, absence of language, laughter with shaking hands episods, microcephaly, macrostomy, maxillary hypoplasia, prognathism and neurological problems with rigid gait, ataxia and epileptic seizures. Other signs described may include happy behavior, hyperactivity without aggression, inattention, excitability and sleeping problems. There is not a cure for AS, although therapies are available to help a child reach their developmental potential.

We present you the story of a 9-month-old child, healthy until then and always in a good mood. At 6 months started to diversify his nutrition without intercurrences. He has a peculiar head shape (plagiocephaly) and a divergent unilateral strabismus (inconstant). Reaching 9 months, his strabismus and plagiocephaly worsened, observing a big posterior fontanelle and an anterior fontanelle already close. He was advised to a pediatric appointment. At 12 months, we observed him again and verify that the severe developmental delay stood out: he did not swallow liquids, pick up objects (glass, spoon), make pincer grasp, balance himself while sitting, crawl or move in the environment, stand with support, vocalize in a conversational tone. He was admitted to study and diagnosed AS. The child has its own pace of development, in need of emocional support and adjusted therapy but always presents us with his happy face.

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BACKGROUND: Clinical examination is often enough for cutaneous diagnosis. However, in some cases it remains inconclusive and further tools are required to accurately diagnose them.

Dermoscopy is a non-invasive, in-vivo technique that can be conducted within our standard clinical activity. Using it we can increase the sensitivity for skin lesion diagnosis and decrease the number of unnecessary biopies and speciality referrals.

Dermoscopy is most frequently used for the diagnosis of skin cancer. Nonetheless, over the last several years it has been increasingly used to aid in the diagnosis of inflammatory, infectious, autoimmune, and connective tissue skin disorders.

AIM AND LEARNING OBJECTIVES:

- To improve our differential diagnostic abilities in dermatological disorders

- To update family doctors about the latest advanced in the use of dermoscopy.

METHODS AND TIMETABLE: We propose an interactive workshop where we will present several dermoscopy images and discuss them with the participants. Our main objective is to highlight the most important characteristics to look for in skin lesion imagery to improve our differential diagnostic abilities.

Timetable 90 minutes

RESULTS/CONCLUSIONS: After this workshop health professionals will be able to interpretate the most frequent dermoscopy imagery.

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Introduction:

Health screening is a preventive modality practiced worldwide to identify high risk population in order to detect health problems and need for early intervention and health promotion. Adolescents entering into college and universities are a diverse yet distinct population with specific health risks and needs.

Objective:

The objective of this health checkup is to screen and detect health problems and associated risk behaviors which can be managed accordingly through medications and health advice.

Methodology:

All students enrolled in year 1 of the Jinnah Sindh Medical University, Karachi were invited to participate in this study. All students who got admission into MBBS first year were asked to fill health assessment questionnaire after taking informed consent. The analysis was entered and analyzed on SPSS version 19.Baseline information on demographics was analyzed using descriptive statistics. For continuous variables such as age, means and standard deviation was reported.

Results:

A total of 342 student agreed to participate in this research. Out of this 32% were male and 68% females. Majority of these were MBBS students belonging to age group of 19-20years.When inquiring about BMI category majority of the students 56.7% had normal weight, 20% were overweight and 7% were found to be obese. When inquiring about HTN 36.8% were in pre hypertensive group and 5% in stage 1 HTN group.

Conclusion:

Student health checkup is an ideal way of identifying health issues at initial stage especially with asymptomatic conditions. These health issues can then be explored and dealt further in order to prevent any major health hazards.

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1. Background

Chest X-Ray and Pulmonary Ultrasound are two important and helpful complementary tests for General Physicians; its knowledge provides a powerful diagnosing tool in our health centers.

2. Aim and learning objectives

Learning objectives:

-acquiring a systematic Chest X-Ray reading, useful for Family Physicians.

-knowing different factors which influence the reading of an X-Ray

-learning how to evaluate this type of X-Ray “by systems”

-acquiring basic knowledge about Pulmonary Ultrasound and know the advantages over chest radiography

3. Methods and timetable

We will use a presentation, which includes a brief introduction on the topic, the development of the learning objectives using dynamic questions and ultrasound videos along the presentation by Kahoot or similar system. After it, we will include daily clinical examples based on X-Ray or US. At the end, we will open a round of questions for doubts or curiosities.

The activity will take 60 minutes:

-5’: presentations of the speaker and the topic

-35’: for theory and questions interspersed into the presentation through dynamic quiz or games. with dynamic.

-15’: for clinical cases that the participants will have to actively solve.

-5’: doubts and questions

4. Conclusions

This workshop intention is the recognition and learning of radiological signs and patterns in chest X-Ray and pulmonary Ultrasound, arming Family Physicians with powerful tools and little or nothing harmful, which will help us in our daily work.

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Background: Falls are an important health threat among independently living, frail older people. Implementation of targeted fall risk screening with subsequent provision of fall preventive care at GP practices appears to be essential for making falls prevention more accessible to independently living, frail older people.

Aim and learning objectives: To provide tips and practical tools for GPs and practice nurses to implement falls prevention in their daily practice and to explore factors that influence the implementation of falls prevention in the primary care setting.

Methods and timetable: During an interactive presentation, results and tools from three studies will be shared concerning 1. a practical fall risk screening instrument for the primary care setting, 2. the fall preventive care provided in Dutch GP practices, and 3. barriers and facilitators for the implementation of falls prevention. During the interactive presentation, knowledge exchange takes place by asking (online) questions and visualizing answers from participants (graphs, word clouds). After the presentation (±20min), small group discussions will be held (3x ±20min.). Participants will discuss how results from the studies can be translated to their work setting. Based on the study results and participants’ experiences, factors that can facilitate the implementation of falls prevention in the participants’ work settings will be summarized at the end of the workshop (±5min).

(Proposed) Results/Conclusions: Participants will gain knowledge, insights and practical tools to implement falls prevention tailored to their daily practice. In addition, the workshop will provide further insights in factors that can facilitate the implementation of falls prevention.

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Background and purpose

Acute muscle weakness in children is a pediatric emergency. Causes include a wide range of pathologies that can only be investigated using a detailed clinical history, a complete physical examination and directed diagnostic tests.

Finding the etiology is essential to execute treatment in a timely manner, improving the prognosis of affected children.

Methods

A 6-year-old girl presented to the health care center with a 7 day history of fever, cough and nasal obstruction worsened in the last 24 hours with pain of both knees and refusal to walk. There was no history of recent trauma.

Results of her physical examination included painful palpation of both knees, without apparent limitation of passive range of motion of the inferior limbs. The remainder of the physical examination was within normal limits.

Results

The child was referred to an emergency service for further investigation.

Peripheral blood examination showed elevated transaminases and creatine kinase. The remaining results were normal.

The diagnosis of viral myositis and hepatitis was considered and the child was hospitalized. A good clinical evolution was observed during hospitalization, with progressive improvement of pain complaints and analytical parameters.

Conclusions

Many of the conditions that cause acute muscle weakness are potentially life-threatening, so early diagnosis and treatment assume an essential role.

At a primary care health level, where there is no access to complementary diagnostic tests, it is even more important to be aware about the emergent character of acute muscle weakness in order to refer to hospital care in due time.

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Methemoglobinemia (MetHb-emia) is visualized in any period of human life. As a relatively rare (un)health condition among the population in SWBulgaria there is a risk for its non-recognition in the pre-hospital environment and people with co-morbidities.

The aim of the study is to analyze knowledge associated with MetHb-emia in favor of medical practice of the general practitioner (GP) in SWBulgaria.

The method is a retrospective documentary analysis.

The methemoglobinemia can start spontaneously (each day 0.5-3% Hb is converted to MetHb); congenitally; transiently; iatrognic and is possible toxic etiology as well. Cyanide poisoning is shown iatrogenic induction of MetHb (<20%). Some therapeutic drugs can produce toxic MetHb-emia. Illness-associated MetHb is prone to oxidative stress. It seems that tachycardia occurs if the MetHb is over 20%. Arrhythmia, seizure and coma are resulting from acidosis when MetHb level is > 50% and more than 70% - is tantamount to death. There are no symptoms if MetHb is less than 10%. In fact patients with co-morbidities are presented with moderate to severe symptoms even when MetHb level is 5–8%. It is interesting that around 50% of effected people are described with mental status changes. As a specific antidote is used methylene blue. The GP informed that a programme of education and development is needed as a method of primary profilaxis.

Conclusions. As a relatively uncommon MetHb-emia is a potentially deadly. Prognosis generally is good with treatment. Therapy is antidote based. Knowledge of MetHb contributes to the optimization of pre-hospital medical practice of GP espacially about primary profilaxis programme.

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- Background and aim: polytrauma patients are those who have several injures and at least one of them, could be potentially vital. Studies about traumatic patients agree that it represents an important cause of morbidity, especially in younger age sectors of the population. Trauma Registry Systems are yet to compile information about patient´s assistances. Based on them, we can develop quality indicators that allow us detecting opportunities of improvement in prehospitalary and hospitalary mortality, survivor´s functionality and quality of life. This study proposes an analysis of the politrauma patients´ profile in the province of Huelva (Andalusia, Spain), comparing it with patients´ profile in other areas to evaluate knowledge and how this patients´assistance is currently done by healthcare professionals as well as the quality of the assistance in general.

- Methods: an observational, descriptive and prospective study where data collected will be done with extrahospitalary emergency services´ clinical records review from Huelva province for 6 months. Utstein questionnaire´s models will be use for the systematic and uniform compilation of data in defined variables.

- Results: a timeline has been designed, in which data collection will be completed in a 6 months period and analysis and definitive results in an 18 month window.

- Conclusions: obtained data will allow analysis of the politrauma profile in our area, informing us how this patients´assistance is currently done and will evaluate what contributions for improvement could be done in avoidable mortality. This data will shape the basis to create a Trauma Registry System in the province of Huelva.

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Background and Purpose:

Meckel's diverticulum (MD) is the most common gastrointestinal malformation. Meckel's diverticulum is a vestigial remnant of the omphalomesenteric duct that in most cases (53%) is diagnosed in the first two years of life. Although anecdotally, adult patients may present suffer from MD and its symptoms seems to be different, with reported predominance of non-bleeding-related presentations.

Methods: Case report

Results:

An 18 year-old male without any previous pathologies arrived to the emergency department after observing blood in his faeces. Active bleeding was discarded (hemoglobin 13 g/dl) and the patient was sent home with a diagnosis of hemorrhoids. Bleeding continued and the patient suffered from hallucinations and fainted. Blood tests showed that the patient was anemic (hemoglobin 7 g/dl and elevated urea levels). Moreover, melenas were observed after a digital rectal examination.

The patient was admitted to the heavy-bleeding patient unit due a suspected lower gastrointestinal bleeding. After a colonoscopy and endoscopy the origin of the bleeding was not found. Finally, a video capsule endoscopy allowed to observe the diverticulum. The patient was intervened and he evolved positively.

Conclusion:

Meckel's diverticulum commonly occurs in children and therefore, the reports in older populations are very rare. General practitioners should have an open mind about pathologies happening mostly during the pediatric age, as it is possible to observe them exceptionally in adults. In addition, video-capsule endoscopy has an important value in detecting small intestine diseases, specifically those affecting the jejunum and ileum, especially in children with lower gastrointestinal hemorrhage.

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Background and purpose | Suicide prevalence is high in adolescent population. A tailored approach to the subject is important to meet expectations and to prevent unfavourable outcomes. The social (perceived) isolation caused by the new pandemic dynamics may difficult reaching out for support.

Following a request from students of one of the main secondary schools in Madeira Island (the nearest to the healthcare unit) a community intervention was customized.

Methods | An hour long dynamic was created following WHO recommendations for engaging communities in preventing suicide. Assessment questionnaires were applied before, immediately after and at 3-month. An online session took place to fill in the identified gaps and to strength the presence of the healthcare team. Supporting material was published in the school magazine thereafter.

Results | Twenty-one students between 16 and 19 years-old participated in the inperson session. Following intervention, main alarm signs were listed and a safety plan created for each. The (new) resources available in the community were discussed and highlighted those related to healthcare professionals’ availability, namely the youth service at the reference healthcare unit.

Conclusions | Strong knowledge on suicide prevention was acquired. (New) Mental health strategies were implemented by students during this period, and safety plans were considered important tools (no student had the need to use it in the period). Close contact to the healthcare professionals was considered of great value, namely the presence of a medical doctor leading the interventions.

Close contact of the healthcare team is core to meet expectations (and needs) of adolescent/student population when preventing suicide in a community setting.

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Background and purpose

Congenital stationary night blindness (CSNB) belongs to a group of rare retinal genetic diseases. They are characterized by abnormal function in rods, pigment epithelium, and bipolar cells. Color vision is typically not affected by this disorder. The clinical presentation is highly variable. The presence of nyctalopia, makes us consider a wide range of diagnostic possibilities, including high-grade myopia, glaucoma, drugs, cataracts, poorly controlled diabetes, retinitis pigmentosa and keratoconus.

Methods

A 30-year-old woman with no allergies or relevant history. No smoker. Refers for the last 6 months, has had zero vision at night in the right eye, in the left eye the vision is diminished only being able to see the silhouette of the objects, during the day the patient has complete vision without any visual deficit.

Results

Primary ophthalmological examination, unexpanded fundus, a golden reflex is observed. In the ophthalmology consultation, normal biomicroscopy with normal anterior pole and in the fundus of the eye (FE) a golden reflex is observed in the entire retina without further findings at the macular or papillary level. The visual field is normal, as well as the color test. An electroretinogram (ERG) was requested and resulted in an abnormal rod scotopic and mixed scotopic response. Visual evoked potentials were normal.

The clinical history, the alteration in ERG and the appearance of the FE makes the diagnosis of CSNB suspicious. Currently, the patient is pending genetic confirmation.

Conclusions

The general practitioner must be aware of these processes that, although a minority, their suspicion can prevent a delay in the diagnosis and favor early treatment.

Abstract Body

Background:

The use of recreational drugs to facilitate sexual activities (colloquially called chemsex) whether done voluntarily for pleasure, unbeknownst or forced on others, or exploitatively, is on the rise. It primarily affects LGTBI communities, and other social groups living in unsafe conditions such as migrants, and religious and ethnic minorities. It is linked to many different health and legal consequences. Support of the affected population(s), disclosure and evaluation require professional, close, and reliable advice on the risks and consequences. However, this requires primary care professionals to improve their knowledge and develop very specific skills.

Aims and learning objectives:

Provide GPs with knowledge about who, how and why pertaining to chemsex, and practice effective techniques for addressing this challenging multifaceted problem.

Methods and timetable:

3"_Team presentation

10"_Animated icebreaker to feel and reflect

20"_Chemsex definition, pharmacology and cornerstones presentation

7"_Chemsex clinical interview videos

40"_Interactive exercises and role-playing on the clinical cases, where participants will train in the skills for how to integrally assess a patient who engages in chemsex. Paying special attention to clinical interview techniques in Primary Care.

10"_Take home messages

Proposed results:

To attain awareness of chemsex, and the main health concerns and consequences for patients and local communities.

To provide GPs with adequate skills to recognize and tackle the issue among specific populations at high risk.

To inspire colleagues to work in collaboration with other local health providers such as sexual health and drug services.

Abstract Body

1. Background and purpose
Anticoagulation therapy has changed markedly in recent years when it comes to prevent and manage thromboembolic events – each drug with individual characteristics, risks and benefits. We aim to assess if the choice of drug and dose is adjusted to age, weight and kidney function of patients with Atrial Fibrillation undergoing anticoagulation therapy.

2. Methods
Data research from digital medical records of patients accompanied in the last 2 years.

3. Results

168patients were included. 148 with NOACs, 20 with warfarin. 148 with NOACs, 123 were properly medicated and 25 were with a wrong dose considering their age, weight and kidney function. Of the 148 with NOACs, 46 are taking Rivaroxaban 20mg but 8 of them are under a wrong dose and 10 are treated with Rivaroxaban 15mg but 2 of them are under a wrong dose. 21patients are taking Edoxaban 60mg but 2aren´t properly medicated since the reduction of the dose is necessary and 5 with reduced dose 30mg but from them 3 still need an adjustment. 25patients are undergoing treatment with Apixaban 5mg. Only 16 of them the dose is well-adjusted. Reduced dose is required for 20 due to their age or weight. 3patients are treated with Dabigatran 150mg well-adjusted to their features and 18 of them are treated with Dabigatran 110mg only one seems to be with a misfit dose.

4. Conclusions
The adjustment of anticoagulation therapy is still challenging despite recent improvements NOACs vs warfarin. Patients are dynamic so in each consultation this subject must be revised–we can’t let ourselves overwhelm by therapeutic inertia.

Abstract Body

Background:

COVID-19 epidemic period poses many challenges for the healthcare system. The need for medical leaders, who can act in a crisis and assess how the healthcare system should operate, has increased dramatically. In Israel, there is a lack of formal training programs for medical leaders. We designed a pilot leadership training curriculum for a group of 12 residents.

Learning objective: During the workshop we would like to offer a glimpse into this extensive curriculum, dealing with leadership core competencies and specifically for family physicians.

Methods and timetable:

1. Ice breaker- a movie scene - Recognizing Leadership styles 15 min

2. Reflection: What kind of a leader am I? What kind of a leader would I like to be?

Alternative option: Narrative writing: inspiring leader I have encountered, how did he or she influence me? 15 min

3. Working groups: Covid-19 clinical dilemmas, discussions with guiding questions 20 min

4. Plenary session: Key competencies in family medicine. Physician’s skills Vs. leader’s skills - what is required from a medical leader?
Is every physician a leader? What would make him or her a leader? Based on WONCA tree 25 min

5. Time capsule- My vision for the next 5- years: What would I like to lead? 5 min

6. Summary- Standup Meeting-One point I took from the workshop 5 min

Proposed Results:

Identification of "leadership styles"

Characterizing the uniqueness of medical leadership in general, and in family medicine in particular

Strengthening the professional identity of the family physician as the leader of his or her unit and community

Abstract Body

Background and Purpose: The COVID-19 pandemic has led to drastic public health measures across the globe. These shifts have also negatively impacted people, such as post-secondary students for whom recent surveys report high levels of mental stress. Yet, little is known about their specific sources of stress and coping. Addressing this gap, we conducted a qualitative study to elicit perspectives of post-secondary students on their experiences of stressors and coping during the pandemic. Methods: Five semi-structured focus groups were conducted with 36 undergraduate students enrolled at a Canadian university in Toronto. The discussions were audio recorded and transcribed verbatim. All data was inductively analyzed for dominant and unique themes using the constant comparison technique. Findings: Participants discussions focused on disruptions in daily routines, e-learning, income constraints, and lose of social interactions as dominant sources of stress. Their notable coping strategies were physical activities (e.g. walks, yoga, training) and creative work (e.g. baking, painting) while a few adopted meditation. Some negative coping strategies also surfaced like increase intake of caffeine or alcohol, smoking, and screen time. With the 2^nd wave of infection, a few expressed losing hope for better days. They identified access to system-level support for mental health counselling and income as an ongoing challenge. Conclusion: The participant post-secondary students experienced several stressors though adopted an overall active coping style. Nevertheless, their needs to access system-level supports were not likely met and ought to be addressed, especially when negative coping behaviors exist and hope for normality is on a decline.

Abstract Body

Background and purpose

Allergies are an increasingly problem worldwide with high prevalence and important health consequences. Therefore, its identification has major value to minimize the risk to the patient's health.

With this quality improvement project, the authors intend to improve the quality and safety of care of medical and nursing professionals regarding the registration of the patients’ presence or absence of allergies using the existing tool available in the SClínico® program used in most units of the Portugal national health system.

Methods

This quality improvement project included the population who had ≥18 years-old registered in a primary care unit in Vila Nova de Gaia, Portugal. In the first evaluation, there were included every patient who had a face-to-face consultation between january and july of 2019. Then, there were applied corrective measures to medical and nursing professionals working on this unit. The second evaluation included all the patients who had a face-to-face or a telephonic consultation between july and december of 2020, according to the pandemic constraints.

Results