Morbidity in primary care' is a medical textbook that presents a selection of diseases, disorders and clusters of symptoms registered in 'Family Medicine Network' (FaMe-Net). FaMe-Net is a Dutch ...primary care registration network with decades of experience in the accurate registration of all morbidity presented to the GP. This registration is embedded in the daily practice of GPs providing regular care to their enrolled patients. All morbidity data from 2014 up to and including 2021 can be accessed at www.famenet.nl/morbidity-data.Each chapter presents the incidence and prevalence of the selected condition and the age and sex groups in which this condition is most common. Common reasons for encounter are described: symptoms, complaints or requests that patients present to their GP at the beginning of the episode of care. In addition, each chapter discusses common GP interventions (policy). The clinical course and registration of the condition are also described.Reading the chapters in this book familiarises the user with how epidemiological numbers can be found on the website. The chapters contain links to the web pages where the relevant data are displayed. This makes it an interactive textbook, as the user can apply their own selections and look up their own epidemiological question. For example, change the calendar period or answer the same question for a different condition, including conditions not yet described in this book. The accompanying text in the chapters helps interpret the numbers correctly and guard against potential pitfalls.This book is thus dynamically linked to the website. The topics have been carefully selected and present epidemiological data of both brief episodic and chronic conditions, harmless and more serious conditions, and also include so-called symptom diagnoses that occur regularly in primary care, such as 'sleep disorders'.The database and this book are updated periodically.The FaMe-Net registration network is unique in systematically recording the patient's reason for encounter in every contact with the GP (practice), and the interventions carried out, such as radiology/imaging, laboratory diagnostics, prescription of medication and referrals to primary and secondary care. This allows the correlation between reason for encounter, final diagnosis and interventions to be visualised.This book is written by general practitioners practising in registering practices, many of whom are also affiliated with Radboud University Medical Centre as researchers, lecturers or trainers. The book is intended for general practitioners, GPs in training, medical students and researchers.
Alpha-glucosidase inhibitors (AGIs) are drugs that inhibit the absorption of carbohydrates from the gut and may be used in the treatment of patients with type 2 diabetes or impaired glucose ...tolerance. There is currently no evidence that AGIs are beneficial to prevent or delay mortality or micro- or macrovascular complications in type 2 diabetes. Its beneficial effects on glycated hemoglobin are comparable to metformin or thiazolidinediones, and probably slightly inferior to sulphonylurea. In view of the total body of evidence metformin seems to be superior to AGIs. More long-term studies are needed to study the effects of AGIs compared to other drugs. For patient with impaired glucose tolerance AGIs may prevent, delay or mask the occurrence of type 2 diabetes. A possible beneficial effect on cardiovascular events should be confirmed in new studies.
One of the worst outcomes of acquired brain injury is the vegetative state, recently renamed ‘unresponsive wakefulness syndrome’ (VS/UWS). A patient in VS/UWS shows reflexive behaviour such as ...spontaneous eye opening and breathing, but no signs of awareness of the self or the environment. We performed a systematic review of VS/UWS prevalence studies and assessed their reliability. Medline, Embase, the Cochrane Library, CINAHL and PsycINFO were searched in April 2013 for cross‐sectional point or period prevalence studies explicitly stating the prevalence of VS/UWS due to acute causes within the general population. We additionally checked bibliographies and consulted experts in the field to obtain ‘grey data’ like government reports. Relevant publications underwent quality assessment and data‐extraction. We retrieved 1032 papers out of which 14 met the inclusion criteria. Prevalence figures varied from 0.2 to 6.1 VS/UWS patients per 100 000 members of the population. However, the publications’ methodological quality differed substantially, in particular with regards to inclusion criteria and diagnosis verification. The reliability of VS/UWS prevalence figures is poor. Methodological flaws in available prevalence studies, the fact that 5/14 of the studies predate the identification of the minimally conscious state (MCS) as a distinct entity in 2002, and insufficient verification of included cases may lead to both overestimation and underestimation of the actual number of patients in VS/UWS.
Diabetes mellitus is a progressive disorder of glucose metabolism. It is estimated that about 285 million people between the ages of 20 and 79 years had diabetes worldwide in 2010, or 5% of the adult ...population. Type 2 diabetes may occur with obesity, hypertension, and dyslipidaemia (the metabolic syndrome), which are powerful predictors of cardiovascular disease. Without adequate blood-glucose-lowering treatment, blood glucose levels may rise progressively over time in people with type 2 diabetes. Microvascular and macrovascular complications may develop.
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of blood-glucose-lowering medications in adults with type 2 diabetes? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 194 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: alpha-glucosidase inhibitors (AGIs), combination treatment (single, double, and triple), dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) analogues, insulins (including conventional human and analogue, different regimens, different length of action), meglitinides, metformin, sulphonylureas, and thiazolidinediones.
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