Welcome to the 26th WONCA Europe Virtual Conference Programme Scheduling

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Cells develop in a 3D environment having interactions with ECM and other cells. 3D culturing facilitates differentiation and organization, using micro-structures mimicking in vivo interactions. 3D culturing is used in medical fields, from drug screenings to printing implants.

Aims: (1) to create 3D pancreatic tumor spheroids by magnetic bioprinting and characterize their morphology. (2) to test their behavior after drug treatment and determining IC50 values (3) comer the results of 2D and 3D cultures.

Methods: Two pancreatic adenocarcinoma cell lines, PANC1 and MIAPaCa2, were printed by magnetic bioprinting into 3D spheroids. The spheroid morphology was evaluated in Celldiscoverer7 (Zeiss), while viability determined by Cell Titer Glo assay and xCELLigence system. We tested 6 conventional chemotherapy compounds (e.g., tamoxifen, TIC10, and LCL161) and their novel derivatives.

Results: Both cell lines formed spheroids. Gemcitabine, the widely used anti-tumor agent in pancreas tumor management, showed decreased viability. SMAC mimetic had a spectrum of IC50 values, for LCL161 and another derivative tested of the IC50 was less than 1.85 µM. TIC10 and its derivative and the TMX derivative had very influential results as well. TMX showed the biggest difference between the two culturing techniques; it did not influence the 3D cultures while affecting the 2D cultures.

Conclusion: The 3D culture established by magnetic bioprinting mimics the in vivo cell conditions. the drug treatments on both culturing techniques show similarities in influence, but the degree was different. The novel derivatives tested showed a remarked influence and should be further researched.

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Background and Purpose: Although there are different results in the literature, some studies indicated that low vitamin D levels may be related to increased risk of COVID-19 and related mortality. In this study we aimed to evaluate whether there is such a relation in the urban population of Bursa, which was previously analyzed for the status of vitamin D and found to have relatively low vitamin D levels.

Methods: The data of patients with PCR positivity (n=212) for SARS-CoV-2 infection between 1 March 2020 and 15 December 2020 in the patient population registered to family physicians in 30 different Family Health Centers in Bursa were retrospectively evaluated. Their vitamin D levels were obtained from the previous records and compared with those without PCR positivity (n= 1893) retrospectively. The vitamin D levels of PCR positive patients who survived (n=206) or died due to COVID-19 (n=4) were also compared. Descriptive statistics were given as median (min-max) for continuous variables.

Results: The mean age of 1893 subjects without SARS-CoV-2 infection was 43,47 years, 726 (38,4%) were males and 1167 (61,6%) were females. There was no significant difference in vitamin D levels among 2105 subjects with PCR positivity for SARS-CoV-2 infection and the negative population [16.77 ng/mL (3-50.99) vs 16.27 ng/mL (3-140), respectively, p=0,380] as well as vitamin D levels of those died due to COVID-19 infection or survived [14 ng/mL (10.33-22.76) vs 16.97 ng/mL (3-50.99), respectively, p=0,361]

Conclusions: In this retrospective study, we could not demonstrate any relation between low vitamin D levels and COVID-19 infection and related death in our population.

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1. Background and purpose

The study concept will be one of the indicators of the Regions4PerMed Project - "Interregional coordination for a fast and deep uptake of personalised health" (Horizon 2020).
Personalised medicine (PM) is a treatment tailored to the patient’s characteristics, needs, and preferences. PM categorises patients according to the risk of developing a specific disease or the level of response to a specific treatment using appropriate diagnostic markers.
Objectives:
- Identification of primary barriers and facilitators during PM implementation;
- Indication of actions aimed at removing barriers during the implementation of personalised medicine at micro-, meso- and macro- regional levels;
- Indication of best practices used in European countries supporting PM implementation to healthcare systems at micro-, meso- and macro- regional levels.

2. Methods

- analysis of regional documents (regional strategies);
- a qualitative study, including:
* online surveys;
* individual in-depth interviews (partially structured);
* focus group interviews.

3. Results

- Recommendations specifying the barriers and facilitators of introducing innovative e-health interventions to healthcare systems at the micro-, meso- and macro-regional levels;
- Catalogue of best practices used in European countries supporting PM implementation at the micro-, meso- and macro-regional levels.

4. Conclusions

The results of the qualitative study will provide data for discussion on PM limitations and benefits.

EU grant
The Regions4PerMed Project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 82 5812.

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In Singapore, primary health care is provided by government polyclinics and private general practitioner (GP) clinics. The latter is usually not subsidized by the government and currently providing around 80% of primary care in the country, managing 55% of chronic patients in the community. This landscape has placed the GPs in an ideal position to conduct primary care research to reach out to the general population. However, participation in research is a challenge for the majority of private practicing GPs due to factors such as limitations of research capacity, inadequate research infrastructure and poor provision of support to individual GPs to conduct research in private setting.

The primary care Research network (pcRn), an initiative to encourage and support high-quality research in family medicine in Singapore, had started a clinical research exploring the feasibility of undertaking pharmacogenetic testing with a Medical Decision Support System (MDSS) to manage long term conditions. Seven of the GP members in this network collaborated with the pcRn to recruit 192 patients from the community. The GP’s involvement includes obtaining consent, collecting buccal swabs, completing clinical research forms, utilizing a MDSS to review medication and following up patients for a duration of 6 months.

Research Collaboration Agreement execution, GP’s CITI certification, MDSS training were completed prior to the initiation of this project in October 2020. Within 10 weeks, 80% of recruitment target was achieved. The highly participatory rate seen in this study has proven GPs can play a pivotal role and contribute to primary healthcare research.

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Background and purpose: Current epidemiological research on knee osteoarthritis is largely limited to codified data from electronic health records. This study investigates what the use of narrative data on top of codified data adds on the epidemiology of knee osteoarthritis.

Methods: A retrospective cohort study was conducted using the Integrated Primary Care Information database including 2.5 million patients from Dutch general practices. An algorithm was developed to identify patients (aged ≥30 years) diagnosed with knee osteoarthritis with codified data and/or keywords in narrative data. Annual prevalence and incidence rates were calculated from 2008 to 2019.

Results: The prevalence with codified data increased from 2.12% (95%CI 2.09-2.14) in 2008 to 5.36% (95%CI 5.33-5.39) in 2019. Adding narrative data showed on average 2.08 times higher prevalence; 5.12% (95%CI 5.09-5.16) in 2008 to 10.3% (95%CI 10.2-10.3) in 2019. The incidence rate with codified data increased from 4.72 per 1000 person-years (95%CI 4.43-5.03) in 2008 to 5.77 per 1000 person-years (95%CI 5.60-5.95) in 2019. Adding narrative data showed on average 1.80 times higher incidence; 9.01 per 1000 person-years (95%CI 8.60-9.44) in 2008 to 10.6 per 1000 person-years (95%CI 10.4-10.9) in 2019.

Conclusions: Including narrative data on top of codified data showed on average 2 fold higher prevalence and 1.8 fold higher incidence. This indicates that codified data alone from general practices registries seriously underestimates healthcare demand of knee osteoarthritis. Further research is required to understand when general practitioners use osteoarthritis codes instead of another code with osteoarthritis free text notes in the medical journal.

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1. Evaluate the impact of clinical ultrasound on patient management.

2. Prospective observational study conducted in a semi-urban health center (> 30,000 inhabitants). The selection criteria were: patients of the C.S. have a clinical ultrasound performed according to some clinical scenarios from May 2019 to January 2020.

3. Of the ultrasounds performed, 41 were women and 40 men, with an average age of 51.52 years. Of these, 28 were due to shoulder pain, 2 due to suspected DVT, 2 due to dyspnea and 36 due to suspected abdominal pathology. In 22 of the 81 patients in this study, no regulated ultrasound would have been requested if there was no clinical ultrasound, changing the decision to perform it only in one case, due to the occurrence of an incidental finding. In 59 cases, a regulated ultrasound would have been requested, with a subsequent decision not to make the request in 43 cases (p <0.05). Regarding the referral to a second level of specialized care, it was decided not to refer in 72 cases, finally deriving after the findings found in 13 (p <0.05).In 52 patients (64.2%) there was a perception that ultrasound offered security in decision making (this perception being defined as reassurance in the reviewed literature).

4. Through this pilot study we can conclude that the incorporation of clinical ultrasound in the daily practice of the Primary Care physician leads to an improvement in the adequacy of the request for complementary tests and in referrals to second level specialized care, as well as a key piece to help in the daily uncertainty.

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EPIDEMIOLOGY OF DELIBERATE SELF-POISONING PRESENTING TO A REGIONAL HOSPITAL IN EASTERN CAPE PROVINCE, SOUTH AFRICA

Background

The prevalence of deliberate self-poisoning (DSP) in South Africa is not known due to poor record keeping in the majority of the health facilities across the country.

Aim

This study therefore, evaluated the demographic characteristics, substances abused, circumstances surrounding deliberate self-poisoning, patterns of presentation and clinical outcomes of patients presenting at the emergency department of Uitenhage Provincial Hospital.

Methods

A retrospective clinical audit of DSP attendances over one year period (1^st January – 31^st December 2014) was performed. Details regarding patients’ sociodemographic characteristics (age, sex, marital status, academic status, employment status and number of household), substances abused, precipitating factors for DSP and clinical outcomes were recorded on a specifically designed proforma.

Results

A total of 169 patients with diagnosis of deliberate self-poisoning were identified. DSP was commoner among women (74.6%) and young adults between ages 21-30 years (38%). The most frequently reported substances in DSP were analgesics (15.6%), anti-depressants (11.0%), anti-convulsants (8.4%) and antiretroviral drugs (6.5%). Despite delays of two or more hours to emergency department in the majority of cases (77.9%), only 27 patients had pre-hospital interventions. The length of hospital stay were categorised: less than 24 hours (44.0%), 24-72 hours (42.0%) and above 72 hours (14.0%). Family dysfunction, stressful relationships and marital disharmony are some of the precipitants of DSP.

Conclusion

This information may help identify the trends in substances used in self-poisoning in Uitenhage and its surrounding rural communities, which in turn may help clinicians with more focused and targeted interventions.