Background:
Ambulatory patients with low urgency medical problems often present to the emergency room (ER), which results in long waiting times for the patients and the use of ER resources. Establishing General Practice (GP)-led urgent care practices (UCP) adjacent to ERs allows to triage patients from the ER to the UCP. However, patients may perceive themselves as an emergency case and expect ER treatment including extensive diagnostics.
Aim:
To access satisfaction of patients with low urgency medical problems treated in the UCP vs. ER. To find out what factors influenced their satisfaction.
Methods:
From 10/2019-01/2020 a survey was conducted at the University Medical Center Hamburg-Eppendorf addressing ambulatory patients that received ER treatment and ambulatory patients that were treated in the adjacent UCP. UCP-patients either presented directly to the UCP or were sent by ER-triage staff during UCP-opening hours (Mo-Fr 6pm-12 am, Sa/Sun 8am-12 am).
Results:
1378 ER-patients and 2121 UCP-patients answered the survey. ER-patients had lower overall satisfaction rates regarding their treatment (90.3% vs. 95.7%; p<0.001). They also deemed the waiting time as too long (32.8% vs. 21.4%; p<0.001) which correlated with the actual waiting time of 199 min (95%CI: 185-214) ER vs. 98 min (95%CI: 93.9-101) UCP. 85.6% of ER-patients disagreed with the statement that today´s problem could have been treated by a GP (vs. 42.1 % of UCP-patients) or by another specialist in an outpatient clinic (61.9% ER vs. 31% UCP). Only 20% of ER-patients reported that no further treatment regardings today´s problem had been recommended to them (vs. 76.9% of UCP-patients). 32% of ER-patients were advised to see a specialist, whereas UCP-patients were told to follow-up with their GP (39.9%). Uncertainty regarding the health problem after the visit was equivalent in both groups (38.1% vs. 39.7%)
Discussion:
Most patients were satisfied with their treatment in the UCP.

1. Establishing UCPs adjacent to ER may reduce waiting time for patients.
2. Waiting time correlated with patient satisfaction.
3. Treating patients with low urgency medical problems in the ER did not lead to less perceived uncertainty by the patients (compared to patients treated in the UCP.)

INTRODUCTION
A case of emergency airway will be illustrated as an example of using surgical skills when you need to act fast. You may be in an unfamiliar environment, unprepared and most likely stressed. The patient will be desaturating and peri arrest with no definitive airway. This is often a skill left to anaesthetics, trauma, emergency, or ENT, but it may just be you, at your skill level with one key instrument.

AIM
This extremely challenging situation can effectively be managed with clear headed judgment and the confidence of having practiced the technique to improve the odds stacked against your patient, even if you have never performed it in an emergent scenario. The basics of managing this will be revisited, with the emphasis on individual repeated practice in simulated sessions.

CONTENT
In this case, the patient was substance affected, had a huge physique with a bull neck and difficult landmarks. As he became more agitated, he was rapidly sedated, unfortunately aspirated and began turning blue. An emergency airway was declared.

The case will discuss how this was managed with a disposable 15 blade scalpel, lots of packs and an endotracheal tube in less than ten seconds. The patient was then connected to a portable ventilator and taken to theatre for a definitive tracheostomy. He remained in ICU for treatment of aspiration pneumonia and was discharged thereafter.

DISCUSSION
The confidence that can be achieved by consistent practice where routine drills become normal and emergency becomes routine is much left to the individual. This case reflects more widely “Lessons from the Flight Deck” in anaesthesia where drills and checklists themselves are routine, and leadership in functioning teams ensure everyone holds the same mental model. When an emergency is declared, it is managed more safely by the whole team, no matter the situation.

At the end of the presentation, attendees will:
1 Have revisited the basics of managing this emergency
2 Be shown how to practice this reasonably simple skill
3 Be confident in delivering a lifesaving procedure safely

Introduction:
The increasing frequencies of disasters and health crises, as well as climate change, have driven the need to develop strategies for addressing communities' emergency public health needs. Community resilience describes a community's capacity to withstand and successfully manage emergencies and disasters. Primary care providers play an important role in fostering community resilience by ensuring that their patients and communities are prepared for emergencies. This study aims to systematically review the existing literature, including policy statements and working papers, on the bearing of multidisciplinary emergency preparedness in primary care on community resilience.
Methods:
A comprehensive scoping review was carried out by using a predefined search strategy in databases, including PubMed, Google Scholar, and CINAHL, as well as by searching the websites of relevant organisations, like the World Health Organisation and professional associations. Included in the study were peer-reviewed articles in the English language published between 2012 and 2022 focusing on emergency preparedness in primary care. The data were analysed using a thematic analysis approach.
Results:
The final analysis comprised 15 studies in total, along with pertinent working papers and policy documents. The findings demonstrated that the themes that emerged from the thematic analysis included the significance of interdisciplinary collaboration, the pivotal role that primary care providers play in emergency planning and response, and the need for continuing education and training for primary care practitioners.
Conclusion:
This study provides important insights into the role of primary care in promoting community resilience through multidisciplinary emergency preparedness. The findings highlight the need for further research on educational and training programmes for primary care providers. Additionally, the results suggest that primary care providers should prioritise interdisciplinary collaboration, continuing education and training, and effective emergency planning to enhance their ability to promote community resilience, which can inform future policy and practice.

• The importance of primary care providers in promoting community resilience during emergencies and disasters
• The need for interdisciplinary collaboration in emergency preparedness at the primary care level
• The significance of further research on educational and training programmes for primary care providers in emergency preparedness

Background: Early marriage is a violation of the basic human rights and is considered a public health problem. It has a profound range of physical, intellectual, psychological and social consequences on the teenager girls and their future children. Objectives: The current study aimed to assess the prevalence of early marriage and the associated social and health hazard.

Methods: A cross-sectional study was conducted among 1080 married women in the most deprived areas in Menoufia Governorate. All women were interviewed personally using a structured valid reliable Arabic questionnaire. It assessed the socio-demographic characteristics of the participants and their husbands, the socioeconomic state, social and health hazards of early marriage.
Results: About 48% of women were married before the age of 18 years. The early marriage was significantly higher among illiterate women (59.9%), those who were housewives (99.1%), and married to illiterate husbands (48%). The main social hazards among the early married group were the conflicts with the husband’s family and isolation of women from her family. While anemia and recurrent chest problems were the main health hazards among their first child.
Conclusion: Early marriage has a wide prevalence in the selected areas. It was more prevalent among low-educated women, housewives, and married to low-educated husbands. It is continued to cause different social and health consequences for women and their children. Early marriage is a prevailing problem that needs a plan of action to be implemented with the support of the policymakers.

1- Early marriage had a wide prevalence about in Menoufia Governorate.
2-It was more prevalent among low-educated women, housewives, low-educated husbands, and among low-economic state families.
3-It’s continued to cause different social and health consequences for women and their children

Background and Aim: The individual's unique healthcare requirements and expectations serve as the primary determinants of decision-making in patient-centred care (PCC). The PCC implementation in Indonesia is still unknown. The purpose of this research is to determine how far PCC has been implemented in Indonesia, as well as its recommendations, through the reflection of family medicine residency programs located in various types of health facilities.
Method: Residents in the family medicine specialist program were asked an open-ended question. The questions focused on current implementation, difficulties, and suggestions for better practice. The resident's response was analysed for themes and keywords.
Results: Indonesia has a diverse culture as well as patients from various socioeconomic backgrounds who visit health care facilities. Doctors have communicated with patients from various backgrounds to find the best management for patient complaints, but there is still a lack of an active role and discussion space with the patient's family. The causes that can be identified are that not all health workers recognize the importance of patient and family participation in determining the treatment process, the patient's personality tends to be passive, and the limited service time. To overcome this, effective communication with patients and families is required: build trust, ask open questions, actively listen, respect patients as individuals, and provide education based on their biopsychosocial factors. By system, it is necessary to educate health workers about PCC and conduct evaluations through periodic patient satisfaction surveys.
Conclusion: The involvement of patients and families is critical to maximizing the treatment program in the hope that the patient's problems can be addressed holistically and comprehensively. Family physicians who act as a liaison between professional care providers facilitate collaboration and open an active communication space for patients and families to discuss treatment plans tailored to the patient's needs.

1. Patient-Centered Care is an essential component of healthcare delivery.
2. When dealing with a patient's problem, consider family as part of the patient's closest environment.
3. It is critical to spend adequate time with the patient and his or her family in order to optimize the treatment program.

Oral poisoning patients admitted to our emergency department between December 16, 2021 and June 15,
2022 at the Emergency department of the Provincial Hospital in Janakpur Dham, Nepal were the subject of a retrospective study. The patient files contained information regarding age, gender, occupation, type of agent, route of
poisoning, clinical effects of cholinergic overactivity, laboratory findings, and mortality rate. During the study period,
220 patients were admitted to the ED with oral poisoning caused by a known agent. The estimated mean time of
admission to the emergency department after exposure was 3.9 3.1 (1-14) hours. There were 131 female patients
(59.5%) and 89 male patients (40.5%). 40.5% of both males and females between the ages of 15-24 were affected. Oral
ingestion was found to be the most common route of poisoning (86.5%). attempted suicide was the most frequent
cause of poisoning (75.9 %). The most frequently encountered oral compounds were dichlorvos, diazinon, and parathion-methyl. Miosis, respiratory system findings, tachycardia, loss of consciousness, and hypertension were the
most common clinical manifestations. Twenty patients (9.1 percent) perished as a result of respiratory and cardiac
arrest (45%), respiratory failure (25%), CNS depression (5%) and septic shock (25%).

Oral poisoning, Emergency, Nepal, Janakpur

Background and Aim:
Continuity of care is an important principle in comprehensive health care that every patient requires. Similarly, the concept is used in transitional care. The family physician must continue the patient's care plan and engage with all social components surrounding the patient during the patient's transition from hospital to community. The purpose of this study is to identify the gap between transitional care theory and implementation in Indonesia.
Method:
Residents in the family medicine specialist program were asked an open-ended question. The questions focused on current transitional care implementation, challenges, and recommendations for better practice. The response was examined for themes and keywords.
Results:
The only type of transitional care provided in Indonesia today is referrals, also known as return referrals, from hospitals to primary care, especially for patients who previously used a BPJS (national health insurance). This system's flaw is that it only concentrates on diagnosing patients and dispensing the same medications that the prior doctor prescribed, rather than providing comprehensive care for the patient. Implementing transitional care in Indonesia is difficult because of a lack of human resources, health financing, and understanding of areas and responsibilities. Patients in Indonesia typically have chronic illnesses and require comprehensive care, not just medication therapy.
Conclusion:
In order to maintain patient quality of life and lower re-admission rates of the patient to the hospital, it is necessary to evaluate the implementation of existing Return Referrals, outreach to health workers, and mapping of patient care needs, including policies on the role of a family physician.

1. Transitional Care in Indonesia is still a challenge
2. Need more socialization of transitional care in healthcare professionals
3. Transitional care will not be well executed if there is no policies on the role of family physician

Abstract
Aim: With the horizon project of the Göktaş Definition, a global health care model will be developed on the basis of family medicine.
Content: Family medicine, which is at the core of health systems and directs the organization of health services, has a complex structure. Family medicine, which is an individual-oriented clinical medicine discipline, is intertwined with medical and non-medical institutions and thus the health administrations of countries with its inclusive, holistic and continuous service feature. Countries configure the family medicine practice according to their own management characteristics and therefore offer health services in different styles. This situation makes it difficult to establish common standards of family medicine in different health systems. With its multidimensional structure, family medicine practice and the duties, responsibilities and characteristics of the family physician have a wide definition.¹ There is a global need and it has become a necessity for these standards to be established and put into practice in family medicine, audited and updated. At this point, WONCA (World Organization of Family Doctors), WHO (World Health Organization) and UN (United Nations) have an important position. In this context, the Göktaş Definition of Family Medicine/General Practice values these institutions and directs these institutions to a common ground.
Goal: There is a need for common understanding and cooperation in order for the model project to be created to turn into a universal application that will appeal to the whole world. The Göktaş Definition of Family Medicine/General Practice is the pioneer of this project.

¹ Göktaş O. The Göktaş definition of family medicine/general practice. Aten Primaria. 2022 Sep 19;54(10):102468. doi: 10.1016/j.aprim.2022.102468. Epub ahead of print. PMID: 36137443.

Keywords: Family medicine/general practice, Göktaş definition, horizon project

1.The Göktaş Definition of Family Medicine/General Practice
2.Global health care model on the basis of family medicine
3.The Göktaş Definition of Family Medicine/General Practice is the pioneer of this project.

The current primary care workforce landscape is a result of multiple old and new forces such as increasing health needs, pandemic impacts, and declining career aspirations. Nonetheless, Institutional Entrepreneurship (IE) theory from the business domain articulates that crises and problems in a situation can make it ripe for innovation and reform. IE illuminates three requisites for successful innovation and reform – convincing rationales, collaborative relationships, and collecting resources.

Using IE as a theoretical basis, the authors studied the establishment of new medical schools to address workforce needs in medically under-served areas across three continents. Their Multiple Case Study research examined new medical schools in Australia, Canada, and Botswana. Adapting and expanding IE, they devised a novel conceptual framework – the Eight C’s Framework (8CF). 8CF explains that successful innovation and reform is possible when “Catalysts act within their Contexts to undertake various tasks of Conducing, Convincing, Collecting, and Connecting in order to produce desired Consequences and overcome Challenges”.

Catalysts are the human agents of change and innovation. They are creative, visionary leaders who use mechanisms of agency and power to collectively and individually effect change. They identify beneficial or detrimental aspects of their Context and utilise them to advantage. They use entrepreneurial skills when Conducing (making more favourable) their Contexts. They use socio-political devices such as power, persuasion, trust, symbiosis, sharing, and bricolage when Convincing stakeholders with various arguments; when Connecting with various partners, and when Collecting required resources. Catalysts harness the utility of field structure, human agency, power dynamics, political diplomacy, and social accountability to produce desired Consequences and overcome Challenges.

Particularly illuminating was the impact that socially accountable medical schools can have on primary care workforce. This paper will present the research findings and its implications for recovery, reconnection, and revival in the current primary care situation.

At the conclusion of this presentation, attendees will understand that:
1. Medical education and business research can help our recovery, reconnection, and revival in primary care
2. Socially accountable medical schools can positively impact the primary care workforces of their regions
3. A theory-based, empirically-supported conceptual framework such as 8CF could aid stakeholders such as academics, clinicians, administrators, politicians, universities, health facilities, health systems, and communities, to strategically address primary care workforce issues