The Dutch GP guidelines advise eyelid margin hygiene as initial treatment for blepharitis. For symptoms lasting longer than one month, topical antibiotics are recommended. Motives for prescribing and treatment choices GPs make are unknown. Also, experiences of patients are unknown.What is the epidemiology of blepharitis in general practice? How often, and what medication is prescribed? How often do recurrences occur? How often is referral to ophthalmology made? What factors play a role in deciding on treatment? How do patients experience these treatments?We used data from 2023 from the Nivel Primary Care Database. To calculate incidence and prevalence, we included all patients with ICPC F72 (blepharitis/hordeolum/chalazion). For prescriptions and referrals, we looked at ICPC F72.01 (ICPC subcode blepharitis). A recurrence was defined as a new contact after a contact-free period of at least eight weeks. A contact within eight weeks was considered part of the same episode. We looked at prescribed medications and referrals. Also, we conducted a brief questionnaire survey  about treatment choices, motives and experiences among GPs and patients, in which we differentiated between new and a follow-up contacts.We included 17,973 patients with F72, of whom 5,817 had F72.01. The incidence of F72 was 13.8 per 1,000 people and the prevalence was 15.3. Recurrence occurred in 8% of patients that were certain to have blepharitis (F72.01). 66% of F72.01 patients were prescribed medication for blepharitis (artificial tears, antibiotics, corticosteroids). Fusidic acid was prescribed most frequently (39.7% of all patients with blepharitis, of which 85% at the first contact). 3% of patients with blepharitis (F72.01) were referred to an ophthalmologist. 222 GP and 16 patient questionnaires were filled in. Outcomes of the survey-analysis are pending and expected to be finalized by the time of the conference.By the time of the conference, we expect to have more insights on the found discrepancies between guideline recommendations and our real-world GP data, by adding the results of our GP and patient questionnaires.Our study shows that GPs prescribe antibiotics for a large proportion of blepharitis patients. The majority is prescribed during the first contact, despite the opposing guideline recommendation.

Vertigo is a prevalent condition in general practice and is highly burdensome for patients. Although general practitioners manage the large majority of patients with vertigo, their ‘diagnostic toolkit’ has serious limitations. Evidence supporting diagnostic tests is largely received from patients in a secondary or tertiary care setting. Benign paroxysmal positional vertigo (BPPV), the most common peripheral cause of vertigo, has not been systematically reviewed for diagnostic tests suitable for primary care.To assess the empirical evidence on diagnostic tests for patients with suspected BPPV in primary care.A systematic search was performed in PubMed, Embase.com, and Web of Science from 1 January 2010 up to 3 June 2024. Studies are included if they evaluate diagnostic tests in adults with vestibular symptoms, and the target condition is suspected BPPV. The tests must be feasible in primary care. Two reviewers will independently assess the methodological quality of the included studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). The full-text screening and methodological assessments are currently ongoing.Preliminary screening identified studies evaluating diagnostic tests in adults with vertigo suspected or diagnosed with BPPV. These studies assess a range of diagnostic tests, such as history taking, physical examination, positional assessments and questionnaires feasible in primary care. Although full-text screening and independent methodological QUADAS-2 are ongoing, the exact number of studies eligible for data extraction and the diagnostic accuracy outcomes are not yet available.Our preliminary findings illustrate that there is a range of diagnostic tests for BPPV that may be feasible in primary care. A systematic appraisal of these tests is needed to determine which elements of history taking, physical examination, and positional assessment can reliably support the diagnosis.This ongoing systematic review aims to identify evidence gaps and inform which diagnostic tests or test combinations may be most suitable for diagnosing BPPV in primary care. This will guide future research and support more efficient, targeted diagnosis.

Complaints of “red eye” are common in primary health care. When associated with the absence of conjunctival hyperemia, there is a risk of clinical underestimation, potentially delaying the diagnosis of serious corneal disease. This case highlights the role of focused history-taking as a patient-safety measure.A 33-year-old woman with no relevant medical history presented to a basic emergency unit with a five-day history of “ocular redness” without discharge (Manchester triage: green; afebrile). She had self-medicated with topical chloramphenicol without improvement. During history-taking, the patient reported photophobia, mild ocular pain, and tearing, symptoms she initially did not value. She denied contact lens use, pruritus, trauma, visual impairment, or foreign body sensation, although she reported recent exposure to dust during house cleaning. Physical examination revealed no palpebral skin changes or edema, conjunctival papillae, discharge or hypopyon. Ocular motility and visual fields were preserved, and pupils were reactive and regular. A small inferonasal corneal opacity was noted on close observation under light exposure. Ocular irrigation and topical anesthetic provided partial symptomatic relief. After consultation with the on-call ophthalmologist, intensive topical antibiotic therapy was initiated, and the patient was referred for urgent ophthalmology assessment where a small superficial corneal ulcer of the left eye was confirmed. The ulcer was nearly healed, with focal fluorescein uptake and no anterior chamber reaction. Topical therapy was maintained for 15 days.In ophthalmological complaints, systematic assessment of red-flag symptoms—such as pain and photophobia—should prevail over initial appearance or the patient’s presenting complaint. Focused clinical history and clear referral criteria may reduce avoidable diagnostic delays in general practice and emergency settings.This case highlights corneal pathology presenting without typical ocular redness, illustrating the limitations of appearance-based assessment. In complaints such as red eye, what is not immediately visible may be more clinically relevant than what is.A directed clinical history centered on associated symptoms allows recognition of relevant corneal pathology even in the absence of apparent hyperemia, strengthening patient safety in first-line care.  

Ruptured abdominal aortic aneurysm (rAAA) is rare but it is the second most frequently missed diagnosis reported as sentinel adverse event (‘calamity’) at out-of-hours services in primary care (OHS-PC).We aimed to identify characteristics that could be useful for telephone triage of suspected rAAA at the OHS-PC.In a matched case-control study (1:4 ratio), we compared patients with a missed rAAA (cases) to patients with the same age and sex, and with similar entrance complaint (controls). Data were collected from OHS-PC triage call recordings that were re-assessed by researchers blinded to the case-control status. Patient and call characteristics were univariably assessed with conditional logistic regression analysis.Twenty cases of missed rAAA between 2013 and 2023 were matched to 80 controls. 40% of the cases presented with abdominal pain, and 35% with back pain. Cases compared to controls more often had a pain onset < 12 h (odds ratio (OR) 15.2; 95%CI 1.9-123.8), reported more sweating (OR 10.1; 95% CI 1.2–86.9, p = 0.035), more often verbally expressed their concern (OR 13.6; 95%CI 3.0-61.3, p = 0.001), and more often called during the night (OR 3.8; 95% CI 1.1–12.7, p = 0.029).This is the first study that assessed determinants related to missed rAAA diagnosis in the OHS-PC setting. The original triage call recordings offered a unique data source and the case-control design avoided hindsight bias in contrast to root-cause analyses that are usually done in case of sentinel events.Triage, with recognition of and adequate urgency allocation in rAAA patients calling the OHS-PC, remains challenging given its rare occurrence and lack of disease specific symptoms. Nevertheless, this case-control study identified factors that could be useful in triage of patients calling the OHS-PC with symptoms possibly indicating rAAA.

In general practice, superficial venous thrombosis (SVT) is considered a benign condition, not requiring anticoagulant treatment. However, a small but not insignificant subgroup of patients will develop serious thrombotic complications: deep venous thrombosis (DVT) and/or pulmonary embolism (PE). Tailored anticoagulant treatment in high-risk patients might prevent these complications, yet tools for clinical decision-making are currently lacking.To develop a prediction model to predict DVT and/or PE risk in SVT patients for clinical use in general practice.Retrospective data from general practices participating in the longitudinal routine care UK CPRD Aurum database were used, covering a period between 2000 and 2021. A multivariable prediction model was developed in adult SVT patients, predicting the outcome of DVT and/or PE within 90 days after the first consultation for SVT. Prespecified predictors were biological sex, age, (history of) cancer, history of DVT/PE, and absence of varicose veins. The performance was evaluated using bootstrapping and internal-external cross-validation.Of all identified patients with SVT (n = 293,166, median age 61 [IQR 46 to 73] years, 33% male), 10,301 (3.5%) developed DVT or PE within 90 days. The risk was highest in the first days after SVT consultation: 51% of DVTs/PEs were diagnosed within one week, and 77% within 30 days. The c-statistic of the model was 0.66 (95%CI 0.66 to 0.67), and the model showed good calibration (intercept 0.04, slope 1.01). High-risk patients with a predicted risk of >5% (9.7% of the total population) had (i) a history of DVT/PE or were (ii) male with (a history of) cancer.The prediction model showed good performance predicting the short-term risk of DVT/PE and identified high-risk SVT patients. Future impact studies should confirm whether this high-risk strategy is better than routine everyday care.In community SVT patients, the average risk of DVT/PE development within 90 days of follow-up is 3.5%. This simple prediction model could be used to target anticoagulant treatment in high-risk SVT patients.