The Training of Undergraduate Medical Students in General Medical Practice and Primary Health Care: A Scoping Review

Background: Undergraduate medical students are trained to acquire a general medical practice overview on qualifying. This training forms a foundation for primary health care service or further training towards a specialty of choice. Objective: The aim of the study was to determine the scope of published scientific literature on the training of undergraduate medical students in “general medical practice” and “primary health care,” exploring how these two concepts are understood, the pedagogical approaches employed by the trainers, the training platforms and the challenges encountered during the training. Methods: The review followed the five steps recommended by Arksey and O’Malley. Using the specified eligibility criteria, the research team systematically screened titles, abstracts, and full articles. Data were entered into Google Forms spreadsheets, which was followed by inductive data analysis of key themes. Results: 130 articles were eligible for inclusion in the study. Thematic analysis yielded eight themes: definition of “general medical practice” and “PHC”, pedagogical approaches (conventional, PBL, teams and CBME), training platforms (tertiary and rural), medical students’ trainers (faculty, GPs and patients), training content, trainers’ and trainees’ perceptions, and challenges encountered. Conclusion: This scoping review has revealed that general medical practice and primary health care are approaches to holistic patient care taught at undergraduate medical training. Primary health care and general medical training are mainly undertaken in GP practices and rural settings. Competency-based medical education is emerging as an appropriate pedagogical method towards ‘fit-for-purpose’ training. The inclusion of patients as trainers in general medical practice and primary health care is yielding positive results.

Modern approaches to the diagnosis and treatment of mixed anxiety-depressive disorders in primary health care

The relevance of this work is due to the wide prevalence of mixed anxiety-depressive disorders among general medical practice patients. At the present stage of development of the psychiatric service in the Republic of Kazakhstan, a new concept has been developed that assumes the transfer of a number of borderline mixed anxiety-depressive disorders to the competence of PHC doctors with the need for their treatment with modern antidepressants. The purpose of this work. Development and implementation in general clinical practice of modern methods of diagnosis and treatment of mixed anxiety-depressive disorders. Material and methods. 30 patients with mixed anxiety-depressive disorders of the borderline level, who were treated on an outpatient basis (Nursultan) was examined. The study was conducted using international psychometric scales: Hospital Anxiety and Depression Score (HADS), Hamilton Anxiety and Depression Rating Scale (HDRS, HAM-A). Results and discussion. As a result of the study, it was found that among patients with mixed anxiety-depressive disorders who were treated on an outpatient basis, young people of working age from 21 to 50 years (83.3%) prevailed, in whom psychogenic anxiety-depressive disorders accounted for 60%. In the course of clinical observations, objective data were obtained indicating that when treating depressive states of mild and moderate severity with Mianserin drug on an outpatient basis, by the end of the second week of treatment, there is a fairly pronounced positive dynamics in the reduction of symptoms of depression. By the end of the second month of taking this drug (8 weeks), most patients had no symptoms of depression. Conclusions. Practical clinical observations have shown that the modern Mianserin antidepressant, possessing a wide range of clinical effects combining thymoanaleptic action proper with anti-anxiety, sedative and hypnotic effects is well tolerated by patients and can be recommended for widespread use in the treatment of mixed anxiety-depressive disorders in general medical practice. Keywords: depression, anxiety, primary health care, general medical practice, antidepressants.

Historical and medical aspects of the formation and development of regional general medical practice

The results of the historical and medical analysis of the processes of formation and development of primary care in the Orenburg Region are quite relevant, especially in connection with the renewed demand for resolving urgent issues that have arisen in the system of domestic health care. Consideration of the above aspects on the example of a separate territory, the Orenburg Region, is significant, given that public health care is formed by various structures of territorial systems in the context of demographic, social and economic gradations.

The effectiveness of the treatment of sleep disturbances in anxiety-depressive disorders of neurotic and organic genesis

Sleep disturbance is one of the most frequent complaints of patients in general medical practice. The highest comorbidity of dysomnias was observed with anxiety and anxiety-depressive disorders. A bi-directional relationship has been found, suggesting that sleep disorders and anxiety-depressive disorders may aggravate each other, complicate treatment and provoke a relapse. The aim of this study was to evaluate the efficacy of the treatment of sleep disorders in patients with neurotic and organic anxiety-depressive disorders. In order to reach this goal 120 patients with anxiety-depressive disorders with sleep disorders (60 patients with disorders of neurotic genesis and 60 — with isorders of organic genesis), who were divided into 4 groups according to the genesis of the disorder and the treatment regimen, were studied. The evaluation of the dynamics of sleep disturbance correction was carried out using clinical and psychopathological methods supplemented by the Insomnia Severity Scale (Morin Ch. M.), descriptive and analytical statistical methods. It was found that combined treatment (psychopharmacotherapy and psychotherapy) of sleep disorders in patients with anxiety-depressive disorders of neurotic and organic genesis was more effective compared to patients who received only pharmacological treatment aimed at the correction of the underlying disease.

Е. Stransky (Wien med. Woch. № 41, 1931)

(Wien med. Woch. No. 41, 1931) indicates the great importance of psychiatry in general medical practice and therefore the need for all doctors, regardless of their specialty, to have a good knowledge of psychopathology.

Specific features of interaction of nurse in general practice with other specialists

The crisis of a unified infrastructure of the health care system requires a transformation of the provision of medical care by bringing it directly to the patient, to the family, combining the elements of treatment and prevention, medical and social assistance at its level. All over the world, the important role of primary medical and social care (PHC) in protecting the health of the population is recognized, while the main place in the organization of out-of-hospital primary medical care is general medical practice. By actively modifying certain aspects of family life, GPs have the opportunity to make wider use of the possibilities of preventive medicine, in many ways to prevent the onset and development of diseases.

Clinical and genetic parallels of the classification and diagnosis of Ehlers-Danlos syndrome

Статья посвящена обсуждению подходов к классификации и обзору доступных литературных данных о клинической вариабельности и молекулярно-генетических основах патогенеза редкого наследственного заболевания - синдрома Элерса-Данло. Представленный обзор расширит представление о патогенезе и позволит оптимизировать диагностику данного синдрома, определить тактику лечения и медико-генетического консультирования отягощенных семей как клиническим генетикам, специалистам в области изучения орфанных заболеваний, так и врачам терапевтам, специалистам семейной медицины и общей врачебной практики. The article is devoted to the discussion of approaches to the classification and review of the available literature data on clinical variability and the molecular genetic basis of the pathogenesis of a rare hereditary disease - Ehlers-Danlos syndrome. The presented review will expand the understanding of the pathogenesis and allow to optimize the diagnosis of this syndrome, to determine the tactics of treatment and medical and genetic counseling of burdened families, both to clinical geneticists, specialists in the study of orphan diseases, and to general practitioners, specialists in family medicine and general medical practice.

METHODOLOGICAL APPROACHES TO ASSESSMENT OF THE ACTIVITY OF THE GENERAL PRACTITIONER

After the launching of the health reform in the sphere of primary medical aid and a comparatively successful 20-years' accomplishment, a need has arisen for an update of the medical standards ratifying the activity of the general medical practice (2011). The study of the work of the general practitioner in an ergonomic aspect requires the construction of a reliable complex of methodological studies providing a realistic assessment of the organization of the working process and of basic psycho-physical functions in the daily and weekly dynamics, carried out on the background of a dominant attachment of the physician to the chosen area of expertise. The basic approaches for determination of the structure and expenses of the working time, or the efficiency coefficient (EC) respectively and intensity of labour involve the photochronometric- and the method of linear timing (also tracing the synchronization of the activity of the medical team); the spatial timing measuring the working trajectories, evidencing the degree of provision of functional working equipment and the objective conditions of labour. Sociological studies provide data on the style of communication with the patient and the occurrence of dilemmas of bioethical nature, as well as the strategies for their overcoming; sanitary and hygienic conditions of the working environment and their observation in accordance with the required criteria and indicators. The methodologies enable objective assessment of the workload and structure of the physician's working time and the resulting fatigue. Preconditions are created for the implementation of optimal organizational and technological operations in the provision of medical services, aiming to increase in the efficiency of the working process, and establishment of a physiological regime of labour in the general medical practice within the framework of the effective legislation.