[Thrombophlebitis of the leg: diagnosis and treatment by the general practitioner]. / Tromboflebitis van het been: diagnostiek en behandeling door de huisarts.

We reviewed the literature for the association between superficial vein thrombosis (SVT) and venous thromboembolism (VTE) and for evidence of treatment of SVT with low-molecular-weight heparin (LMWH). There is some evidence for an association between SVT and VTE. This association seems stronger for proximal SVT as compared with distal SVT. In general practice, the absolute risk of VTE with or after SVT is low, approximately 3%. There is evidence that treatment of SVT with LMWH may have a beneficial effect on its course. NSAIDs have a similar effect. There is indirect evidence that LMWH is effective in the prevention of VTE, if the treatment is continued for more than 4 weeks. In case of a proximal SVT, we suggest an ultrasound examination be carried out and LMWH treatment given if the diagnosis is confirmed; in other cases, NSAIDs can be considered.

[Laboratory input. General practitioners positive about reflective testing]. / Eigen inbreng van het laboratorium. Huisartsen positief over 'reflecterend testen'.

OBJECTIVE: To investigate the opinion of general practitioners on reflective testing, i.e. the practice of additional tests being performed and comments added to the results by laboratory staff when appropriate. DESIGN: Descriptive. METHOD: In the eastern South Limburg region 155 general practitioners received a list of 10 fictitious patient cases, each involving the possible addition of a specific test. The general practitioners could choose what they preferred the laboratory to do: add tests, phone the general practitioner, add a written comment or do nothing. In addition the general practitioners were asked to judge the effect of additional tests and comments on patient management with respect to diagnosis, treatment and referral, using 200 laboratory reports from their own patients. RESULTS: The response to the fictitious cases was 45%. Most general practitioners favoured the laboratory taking the initiative by adding on tests and commenting on the results in the given clinical scenarios. 78% of the questionnaires accompanying the lab reports were returned by 87% of the general practitioners. In nearly all cases (99%) the service was marked as useful. In more than half of the cases (53%) reflective testing affected the measures taken by the general practitioners. CONCLUSION: Reflective testing was in general welcomed by the general practitioners. In the majority of cases this led to an improvement in the diagnosis or adjustment of treatment.