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Methods: Glycaemic control and the prevalence of modifiable cardiovascular risk factors, and micro- and macrovascular morbidity was examined in 637 Type 2 diabetic patients in general practice, of whom 405 consented to undergo a more extensive examination.Results: In these 405 patients, HbA1c was > or = 7% in 56.6%, and hypertension and dyslipidaemia were found in 59.8% and 46.5% of the patients, respectively. The level of cardiovascular risk factors was acceptable, according to the European guidelines, in the following proportions of patients: BMI 45.0%; total cholesterol 69.1%; HDL-cholesterol 68.1%; triglycerides 67.8%; current blood pressure 89.8%; and smoking 21.0%. Retinopathy was present in 12.5% and microalbuminuria in 27.0% of the patients. In all 637 patients, the prevalence of angina pectoris was 17.7%, of myocardial infarction 11.4% and of congestive heart failure 10.7%.Conclusion: The care for Type 2 diabetic patients needs improvement and should focus on cardiovascular risk factors as much as on glycaemic control. [ABSTRACT FROM AUTHOR]

Van Eijk J, Smits A, Huygen F and van den Hoogen H. Effect of bereavement on the health of the remaining family members. 1988; 5: 278–282. This investigation focusses on the effect of the death of a family member on the number and type of diagnosed illnesses of the remaining members. The data on mortality and morbidity were obtained from a continuous morbidity register. A total of 225 cases of death were selected, involving 313 family members. A control group of 4909 people who had not been confronted with a death of a family member were selected. A comparison of morbidity rates for the two groups showed that morbidity rates, both for minor and serious illnesses, were affected by the death of a family member. Increases in minor illnesses occurred more often when people had been confronted with death after a chronic illness; increases in serious illnesses were mainly found among people confronted with sudden death. Surprisingly, people with nervous disorders in their medical history showed fewer diagnoses for minor illnesses after a sudden death of a family member. An explanation may be found in the basic principles of family medicine. [ABSTRACT FROM PUBLISHER]

A project of group-based peer review by general practitioners is described. Attention is given to the motivation of general practitioners to participate in audits, to the threat posed by peer review and to the use of criteria. The recruitment and motivation were successful. A total of 253 general practitioners took part, divided into 23 groups. This represented approximately 30% of all general practitioners in the area and 72% of all general practitioners specifically approached by us. The threat posed by audit disappears rapidly for most physicians once they have started auditing. The use of predefined criteria developed by ‘experts’, representing an optimal way of work for the general practitioner, appeared to be quite feasible in this project. From the results several conclusions are drawn as regards the planning and implementation of peer review under general practitioners. [ABSTRACT FROM PUBLISHER]

Grol R (Department of Family Medicine, Nijmegen University, St Annastraat 284, Postbus 9101, 6500 HN Nijmegen, The Netherlands), Mokkink H, van Eijk J, Beek M, Mesker P and Mesker-Niesten J. Work satisfaction of general practitioners and the quality of patient care. 1985; 2: 128–135. The emotional reactions of 57 general practitioners to three aspects of work was assessed by means of questionnaires. The quality of patient care was assessed by means of observations of general practice consultations, assessment of audiotaped consulting hour contacts and an analysis of the referral and prescription figures. A distinction was made between the degree of positive and the degree of negative feelings general practitioners have about their work. Many positive feelings (satisfaction, feeling at ease) correlated with more openness to patients, more attention to psychosocial aspects of the complaints but also with a higher rate of referral to medical specialists. On the other hand, many negative feelings (frustration, tension, lack of time) correlated with a high prescription rate and with giving little explanation to patients. To some extent the way that work is experienced by general practitioners correlated with the quality of care for the patients, but what constitutes cause and effect requires further study. A reflection of a doctor's own feelings about work should become part of training, continuing education and medical audit programmes. [ABSTRACT FROM PUBLISHER]

439 papers on the irritable bowel syndrome (IBS) were listed in the Index Medicus and FAMLI in the period from the beginning of 1985 to the end of 1990. From these 439 papers 58 research reports were selected for a literature study into new insights into the aetiology, diagnostics and therapy of IBS. After these research reports had been evaluated according to eight criteria, the relevance of the research results for general practice was assessed. Many studies had methodological flaws. Often no hypotheses had been formulated. Only one-third of the research reports addressed the question of the validity and reliability of the measuring instruments used. Most of the investigations involved a strongly selected research population. The aetiology of IBS remains obscure. The general practitioner can make the diagnosis of IBS himself using straightforward diagnostic methods. No specific form of therapy is effective in the case of IBS. The policy of physicians concerning patients with IBS will have to be directed towards helping them cope with chronic complaints for which there is no adequate explanation.

We conducted a survey among two random samples of Dutch doctors in order to determine whether they acted prudently with regard to euthanasia and assisted suicide. The doctors completed an anonymous questionnaire and those who at one time or another had applied euthanasia or assisted suicide (52%) were asked about several aspects of the requirements for prudent practice. 'Pointless suffering' was the most important and most common reason for requesting euthanasia or assisted suicide; 'pain' was rarely the most important reason. In 7% of the cases alternative forms of treatment were still available; these were hardly ever therapeutic. A total of 12% of the doctors had applied euthanasia or assisted suicide without having had any kind of consultation or discussion with a colleague, a nurse or any other health care professional; 26% had not issued a certificate testifying to death from natural causes. We conclude that some of the family doctors do not observe the procedural requirements, but that the majority satisfies the material requirements for prudent practice.

A survey was conducted among family doctors to determine the frequency with which they were requested to administer euthanasia or assist in suicide, and how often they actually applied these procedures. Two random samples (in each n = 521) were taken from the population of Dutch family doctors (n = 6300) and requested to complete an anonymous questionnaire. The response was 67%. The entire body of Dutch family doctors practices euthanasia or assisted suicide about 2000 times per annum; 48% have never engaged in these practices. An average of 40% of all requests are complied with. We conclude that far fewer family doctors are involved in euthanasia and assisted suicide than was previously supposed. Euthanasia or assisted suicide was administered to 1 in 25 persons who died in their own homes.

This study deals with a replication of a previous research project on the correlation between medical and behavioural skills of general practitioners. The PREVARA observation schedule was used to assess these skills of 75 general practitioners. Fifteen surgery contacts were tape-recorded for each GP and were rated by trained observers. The study shows that fundamental dimension underlies the surgery behaviour of the GP: the various skills appear to be equally developed. More specifically, a positive correlation was found between performing obligatory physical examination and paying attention to psychosocial aspects. The results are discussed in the context of the evaluation of the vocational training and medical audit of GPs.

This article examines the effect of an acute serious illness in one member of a family on the health behaviour of other members. The number of consultations made by 92 family members before and after an acute serious illness was measured and compared with a control group of 102 people who had experienced no serious illness in their family. The coping resources of the family--defined in terms of flexibility of parental relationships, conflict avoidance and family strain - were assessed and related to the changes in consultation pattern. It was shown that an acute serious illness affecting one member of a family which lacks adequate coping resources can lead to an increase in reporting of serious complaints in other family members. In families which have adequate coping resources, however, the health of the remaining family members can apparently improve. This refutes the view that a serious life event necessarily has only a harmful influence on health.

This article examines the effect of an acute serious illness in one member of a family on the subsequent health behaviour of that patient. The number of consultations made before and after their acute serious illness was measured for 35 patients and compared with a control group of 708 family members who had not experienced an illness. An increase in the number of minor and serious complaints was noted in the year after the illness. In the case of minor complaints the changes ranged from four more complaints to six less, thus enabling the effect of background family characteristics--flexibility, conflict avoidance and family strain--to be investigated. More flexibility and lower family strain correlated with less presented morbidity. Other variables such as age and size of family also correlated with morbidity. The role of the general practitioner in giving assistance to patients affected by a life-threatening disease and their family members therefore goes much further than just the treatment of the acute illness itself.