Teleconsulting in wound care: Connecting the primary care to the wound specialist reduces unnecessary referrals.

In the Netherlands the primary care (General Practitioner or homecare nurse) encounter a variety of wounds ranging from traumatic to diabetic foot ulcers. According to a recent study 82.4% of the patients with a wound can be treated in a primary setting with the GP as medical supervisor. The remaining 17.6% of patients need more extensive care including advice by a specialised doctor, diagnosis and treatment. Prompt analyses and treatment of underlying causes by specialised doctors in a multidisciplinary setting is necessary for treating patients with complicated wound. This article describes the impact of Electronic Health Consultation on all wounds treated in the primary care. And describes the effect on the duration until referral to the hospital and the influence on the amount of unnecessary referrals to the hospital. All data was collected prospectively from June 2020 until October 2021. The study involved a process where primary care could seek advice from a Wound Physician at the Alrijne Wound Centre through a specialised Electronic Health Consultation. A total of 118 patients were analysed. 41/118 (34.7%) patients required a physical consultation with analysis and treatment in the hospital, after teleconsultation. The remaining 77/118 (65.3%) could be treated in primary care after Electronic Health Consultation. The mean duration of wound existence until Electronic Health Consultation was 39.3 days (range 5-271, SD: 38.5). 3/41 (7.3%) of the referrals were unnecessary. Electronic Health Consultation serves as a valuable and efficient tool for enhancing wound care, ultimately contributing to improved patient management and resource allocation within the healthcare system. This article describes the impact of Electronic Health Consultation on all wounds treated in the primary care and the influence on the duration until referral to the hospital and the influence on the amount of unnecessary referrals to the hospital.

Factors Associated With Asthma Control in 121 Preschool Children.

BACKGROUND AND OBJECTIVES: Data on risk factors for uncontrolled asthma in preschool children are controversial. Objective: This study aims to explore the association between clinical and functional parameters and the lack of asthma control in preschool children. METHODS: Children aged 3-5 years with asthma and healthy controls were recruited. A questionnaire was used to identify potential risk factors for uncontrolled asthma, as defined by the Global INitiative for Asthma criteria. Lung function and bronchial reversibility were evaluated through impulse oscillometry and spirometry. Adjusted odds ratios were estimated based on multivariable generalized additive regression models. The discriminative ability of the models was measured by the area under the receiver operating characteristic curve (AUC). RESULTS: The study population comprised 121 children (107 with asthma and 14 healthy controls). Fifty-three patients (50%) had uncontrolled asthma. After adjustment, the variables associated with an increased risk of lack of control were as follows: "More than 3 flare-ups in the last 12 months", "Moderate to severe rhinitis", and "Relative variation in postbronchodilator FVC and FEV1". The AUC of the final models that included variation in FVC or FEV1 were 0.82 and 0.81, respectively. The R5-20, R5-20%, and AX z-score values of the healthy group were lower than those of children with asthma. CONCLUSION: In preschool children, clinical and functional parameters are associated with uncontrolled asthma. More studies are needed to confirm the usefulness of impulse oscillometry.

Evolution of two-step magnetic transition on nanogranular Gd5Si1.3Ge2.7 thin film.

A multi-functional Gd5Si1.3Ge2.7 thin film deposited by pulsed laser ablation in the form of an ensemble of nanoparticles was studied for 18 thermal cycles via electron transport measurements together with structural and magnetic characterization. A general negative thermal dependency of the resistivity (ρ) is observed, which contrasts with the metallic-like behavior observed in bulk Gd5Si x Ge4-x compounds. This general trend is interrupted by a two-step, positive-slope transition in ρ(T) throughout the [150, 250] K interval, corresponding to two consecutive magnetic transitions: a fully coupled magnetostructural followed by a magnetic order on heating. An avalanche-like behavior is unveiled by the ∂ρ/∂T(T) curves and is explained based on the severe strains induced cyclically by the magnetostructural transition, leading to a cycling evolution of the transition onset temperature ([Formula: see text]/∂n ∼ 1.6 K/cycle, n being the number of cycles). Such behavior is equivalent to the action of a pressure of 0.56 kBar being formed and building up at every thermal cycle due to the large volume induced change across the magnetostructural transition. Moreover the thermal hysteresis, detected in both ρ and magnetization versus temperature curves, evolves significantly along the cycles, decreasing as n increases. This picture corroborates the thermal activation energy enhancement-estimated via an exponential fitting of the ∂ρ/∂T(T) in the avalanche regime. This work demonstrates the importance of using a short-range order technique, to probe both magnetic and magnetostructural transitions and their evolution with thermal cycles.

Effective production of multifunctional magnetic-sensitive biomaterial by an extrusion-based additive manufacturing technique.

A calcium phosphate (CaP)-based scaffold used as synthetic bone grafts, which smartly combines precise dimensions, controlled porosity and therapeutic functions, presents benefits beyond those offered by conventional practices, although its fabrication is still a challenge. The sintering step normally required to improve the strength of the ceramic scaffolds precludes the addition of any biomolecules or functional particles before this stage. This study presents a proof of concept of multifunctional CaP-based scaffolds, fabricated by additive manufacturing from an innovative ink composition, with potential for bone regeneration, cancer treatment by local magnetic hyperthermia and drug delivery platforms. Highly loaded inks comprising iron-doped hydroxyapatite and ß-tricalcium phosphate powders suspended in a chitosan-based solution, in the presence of levofloxacin (LEV) as model drug and magnetic nanoparticles (MNP), were developed. The sintering step was removed from the production process, and the integrity of the printed scaffolds was assured by the polymerization capacity of the ink composite, using genipin as a crosslinking agent. The effects of MNP and LEV on the inks' rheological properties, as well as on the mechanical and structural behaviour of non-doped and iron-doped scaffolds, were evaluated. Magnetic and magneto-thermal response, drug delivery and biological performance, such as cell proliferation in the absence and presence of an applied magnetic field, were also assessed. The addition of a constant amount of MNP in the iron-doped and non-doped CaP-based inks enhances their magnetic response and induction heating, with these effects more pronounced for the iron-doped CaP-based ink. These results suggest a synergistic effect between the iron-doped CaP-based powders and the MNP due to ferro/ferrimagnetic interactions. Furthermore, the iron presence enhances human mesenchymal stem cell metabolic activity and proliferation.

The prognostic value of the clinical ACR classification criteria of knee osteoarthritis for persisting knee complaints and increase of disability in general practice.

OBJECTIVE: To assess the prognostic value of the clinical American College of Rheumatism (ACR) classification criteria of knee osteoarthritis (OA) on persisting knee complaints and increase of disability in adult patients with knee pain in general practice after 1-year follow-up. METHODS: Patients (aged >35 years) consulting for non-traumatic knee complaints in general practice were enrolled in the study. At baseline and 1-year follow-up knee complaints and function were assessed by questionnaires and a physical examination was performed. The prognostic value of fulfilling the clinical ACR criteria of knee OA at baseline on the outcomes persisting knee complaints and increase of disability was determined. RESULTS: 549 patients were included in the study of which 480 (87.4%) were available for follow-up. The studied population consisted of 236 (49.2%) women with mean age 53.6 [standard deviation (sd) 11.3], mean body mass index (BMI) 27.1 (sd 4.2), 288 (60.0%) patients had payed employment, and 292 (60.8%) patients fulfilled the clinical ACR criteria of knee OA. After 1-year follow-up, 236 (49.2%) patients reported persisting knee complaints, and 84 (17.5%) reported an increase of disability. There was no association of fulfilling the clinical ACR criteria of knee OA at baseline with persisting knee complaints [odds ratio (OR) 1.15; 95% Confidence Interval (CI) 0.80; 1.67] or increase of disability (OR 1.05; 95% CI 0.43; 2.58) at follow-up. CONCLUSION: The clinical ACR classification criteria of knee OA have no prognostic value for predicting persisting knee complaints or an increase of disability at 1-year of follow-up in adult patients with non-traumatic knee complaints in GP.

Multicaloric effect in a multiferroic composite of Gd5(Si,Ge)4 microparticles embedded into a ferroelectric PVDF matrix.

The coupling between electric, magnetic and elastic features in multiferroic materials is an emerging field in materials science, with important applications on alternative solid-state cooling technologies, energy harvesting and sensors/actuators. In this direction, we developed a thorough investigation of a multiferroic composite, comprising magnetocaloric/magnetostrictive Gd[Formula: see text]Si[Formula: see text]Ge[Formula: see text] microparticles blended into a piezo- and pyroelectric poly(vinylidene) fluoride (PVDF) matrix. Using a simple solvent casting technique, the formation and stabilization of PVDF electroactive phases are improved when the filler content increases from 2 to 12 weight fraction (wt.%). This effect greatly contributes to the magnetoelectric (ME) coupling, with the ME coefficient [Formula: see text] increasing from 0.3 V/cm.Oe to 2.2 V/cm.Oe, by increasing the amount of magnetic material. In addition, magnetic measurements revealed that the ME-coupling has influenced the magnetocaloric effect via a contribution from the electroactive polymer and hence leading to a multicaloric effect. These results contribute to the development of multifunctional systems for novel technologies.

Testing of the ITER plasma position reflectometry high-field side in-vessel antenna assembly prototype.

The ITER plasma position reflectometry diagnostic aims to provide measurements of the edge plasma to correct or supplement the magnetics for plasma position control. It consists of five reflectometers, two of which have components installed inside the vessel. One of these systems probes the plasma from the high-field side using a bistatic array of small pyramidal horns located in the gap between two blankets. Electromagnetic simulations have shown that the blankets shape the radiation pattern and need to be considered as part of the antenna. Full-wave plasma simulations have confirmed these results and have also shown that the first-wall geometry may induce measurement errors above the required margin. To further address these issues, we manufactured a prototype of the high-field side antenna, which includes a mock-up of the blanket modules. Here, we present the results of the prototype tests, with and without the blankets, using a metallic mirror as a target. The signals reflected from the mirror are used to derive the mirror distance and assess the precision of the measurements under different arrangements. The sensitivity to the blankets' installation tolerances is also assessed by changing the antennas' position with respect to the blankets' surfaces and cut-outs.

Primary chemotherapy with sequential docetaxel followed by docetaxel and epirubicin in large operable breast cancer.

UNLABELLED: Primary chemotherapy is increasingly used in patients with large operable breast cancer. Docetaxel and epirubicin are the most active agents in breast cancer treatment. PURPOSE: To evaluate clinical response rate, breast conserving surgery and pathological response rate in patients with large operable breast cancer treated with docetaxel followed by docetaxel and epirubicin as primary chemotherapy. PATIENTS AND METHODS: Patients with operable breast cancer more than 3 cm in the longest diameter with T2N0, T2N1 and T3N0 disease were enrolled. Patients were treated with three cycles of docetaxel 100 mg/m2 followed by three cycles of docetaxel 75 mg/m2 and epirubicin 90 mg/m2 prior to surgery. RESULTS: Sixty-five patients were enrolled between 09/2002 and 12/2005. The median age was 48.9 years and 72.3% were premenopausal. Median tumour size was 4.26 cm, 10.8% were T3 tumours and 38.5% had clinical positive lymph nodes. Of the tumours 58.5% were grade 1/2, 33.9% ER positive and 21.5% c-erb negative. All six cycles were administered to 62 patients; six cycles were delayed and five had dose reductions. Complete clinical response occurred in 41.5% of patients and partial response in 49.2%. Breast conserving surgery was performed in 30% of patients however it was feasible in 57%. Complete pathological response occurred in both primary tumour and nodes in 28%, and in 34% just in the primary tumour. Nine percent of cases had neutropenia and 7.7% febrile neutropenia, and two cases had a hypersensitivity reaction to docetaxel. One associated treatment death occurred. CONCLUSION: Docetaxel followed by epirubicin and docetaxel as primary chemotherapy results in a high clinical and pathological response rate. The majority of adverse events were predictable and manageable.

[The practice guideline 'pelvic inflammatory disease' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice]. / De standaard 'Pelvic inflammatory disease' (eerste herziening) van het Nederlands Huisartsen Genootschap; reactie vanuit de huisartsgeneeskunde.

In the revised guideline of the Dutch College of General Practitioners on pelvic inflammatory disease (PID), 5 criteria must be met to establish the diagnosis: (a) non-acute lower abdominal pain; (b) pain on upward movement or adnexal tenderness during vaginal touch; (c) painful or swollen adnexae; (d) ESR > or = 15 mm in the 1st hour or a temperature > 38 degrees C, and (e) no indications for other diseases, such as appendicitis or an extra-uterine pregnancy. Treatment is started when all criteria are met. In case ofuncertainty, the patient should be referred to a gynaecologist. In quite a few patients, however, the accumulated certainty obtained by a general practitioner from the 5 criteria still leaves room for doubt about the right moment for referral. Another potential weak point in this otherwise very practicable guideline is that the start of treatment in young women of childbearing age, in whom this disease is most prevalent, could well have been recommended at an earlier stage.

Performance assessment of the antenna setup for the ITER plasma position reflectometry in-vessel systems.

The design of the in-vessel antennas for the ITER plasma position reflectometry diagnostic is very challenging due to the need to cope both with the space restrictions inside the vacuum vessel and with the high mechanical and thermal loads during ITER operation. Here, we present the work carried out to assess and optimise the design of the antenna. We show that the blanket modules surrounding the antenna strongly modify its characteristics and need to be considered from the early phases of the design. We also show that it is possible to optimise the antenna performance, within the design restrictions.

Primary structure of the nuclear-encoded 10.5 kDa subunit of complex I from Neurospora crassa.

We have isolated a cDNA clone for the nuclear encoded 10.5 kDa subunit of complex I from N. crassa. DNA sequencing revealed an open reading frame corresponding to a polypeptide with 94 amino acids and a calculated molecular mass of 10531 Da. The protein is synthesized without a cleavable mitochondrial targeting sequence. The N. crassa polypeptide is the fungal equivalent of subunit B8 of bovine complex I.

Complementary DNA sequences of the 24 kDa and 21 kDa subunits of complex I from Neurospora.

We have cloned and sequenced cDNAs coding for two subunits of the peripheral arm of Neurospora crassa complex I. The two polypeptides are synthesized as precursor proteins which are processed to mature forms with predicted molecular masses of 24331 and 20982 Da.

The prechordal midline of the chondrocranium is defective in Goosecoid-1 mouse mutants.

Gsc-1 expression marks cells with Spemann organizer, or axis-inducing, activity in the vertebrate gastrula. Gsc-1 knockouts, however, did not display phenotypes related to the early phase of expression. In this paper, additional phenotypes for the Gsc-1 mouse mutant are presented. Examination of the base of the cranium in the dorsal view revealed fusions and deletions in the midline of the prechordal chondrocranium. These defects were correlated with the sites of expression of Gsc-1 in the prechordal plate/foregut endoderm in the day 7.5/8.5 embryo. Gsc-1 expression in proximal limb buds was correlated with malformations of the shoulder and hip articulations. In addition, ribs in the seventh cervical vertebra were observed with low penetrance. The role of Gsc-1 during gastrulation and axial development is discussed in relation to possible compensatory interactions with other genes such as HNF-3beta and the recently identified Gsc-2 and Gsc-3 genes.

Cerberus-like is a secreted factor with neutralizing activity expressed in the anterior primitive endoderm of the mouse gastrula.

We report the isolation of mouse cerberus-like (cer-l), a gene encoding a novel secreted protein that is specifically expressed in the anterior visceral endoderm during early gastrulation. Expression in the primitive endoderm starts before the appearance of the primitive streak and lasts until the head-fold stage. In later stages, a second region of expression is found in newly formed somites. Mouse cer-l shares some sequence similarity with Xenopus cerberus (Xcer). In Xenopus assays cer-l, like Xcer, mRNA acts as a potent neuralizing factor that induces forebrain markers and endoderm, but is unable to induce ectopic head-like structures as Xcer does. In addition to cer-l, anterior visceral endoderm was found to express the transcription factors Lim1, goosecoid and HNF-3beta that are also present in trunk organizer cells. A model of how head and trunk development might be regulated is discussed. Given its neuralizing activity, the secreted protein Cer-l is a candidate for mediating inductive activities of anterior visceral endoderm.

The BMP antagonists cerberus-like and noggin do not interact during mouse forebrain development.

Mouse cerberus-like encodes for a secreted factor of the Cerberus/Dan family. This molecule has neural inducing capabilities and can bind to BMP-4 and nodal molecules in the extracellular space. When cerberus-like is inactivated, its function may be compensated for another molecule, since no abnormalities can be observed in the mouse mutant. Compensation mechanisms have been shown to occur between the BMP antagonists chordin and noggin. Here we report the generation of cerberus-like-/-; noggin-/- double mutants to uncover a possible compensation by noggin in cer-l-/- mutant. Double mutants were obtained and failed to show any further detectable defects beside the ones presented by the noggin-/- single mutant. Contrarily to chordin and noggin, mouse cerberus-like and noggin cannot compensate for each other during mouse embryogenesis.

Prognostic factors in adults with knee pain in general practice.

OBJECTIVE: To predict the 1-year outcome of incident nontraumatic knee symptoms in adults presenting in general practice. METHODS: Adults age >35 years with nontraumatic knee symptoms (n = 480) were followed for 1 year. At baseline, data on knee symptoms and demographics were collected and a physical examination performed. Knee symptoms were assessed by self-report questionnaires at 3-month intervals. After 1 year the physical examination was repeated. Multivariate prognostic regression models of patient characteristics, symptom characteristics, and physical examination were used to predict persisting knee symptoms after 1 year. Areas under receiving operating characteristic curves (AUCs) were used to determine the predictive value of the model. To assess the added predictive value of symptom characteristics and physical examination, these models were added to the model of patient characteristics. The improvement was expressed as the difference between the 2 AUCs. RESULTS: In the multivariate prognostic model of patient characteristics, age >60 years, educational level, kinesophobia, and comorbidity of the skeletal system were associated with persistent knee symptoms after 1 year (AUC 0.67). Of the symptom characteristics, history of nontraumatic knee symptoms, bilateral symptoms, and duration of symptoms >3 months were associated (AUC 0.73). For determinants of physical examination, crepitus of passive extension was associated (AUC 0.55). The added value of the symptom characteristics model to the patient characteristics model was 0.09 (AUC 0.76). Physical examination added no further value. CONCLUSION: Symptom characteristics are the strongest predictors of persisting knee symptoms at 1-year followup. Physical examination has no added value in predicting persistent knee symptoms in general practice.

Longitudinal and cross-sectional validity of the DynaPort Knee Test in adults with nontraumatic knee complaints in general practice.

OBJECTIVE: The aim of the study was to determine the cross-sectional and longitudinal validity of a performance-based assessment of knee function, DynaPort KneeTest (DPKT), in first-time consulters with nontraumatic knee complaints in general practice. METHODS: Patients consulting for nontraumatic knee pain in general practice aged >18 years were enrolled in the study. At baseline and 6-months follow-up knee function was assessed by questionnaires and the DPKT; a physical examination was also performed at baseline. Hypothesis testing assessed the cross-sectional and longitudinal validity of the DPKT. RESULTS: Eighty-seven patients were included for the DPKT, 86 were available for analysis. The studied population included 44 women (51.2%), the median age was 54 (range 18-81) years. At follow up, 77 patients (89.5%) were available for the DPKT. Only 3 out of 11 (27%) predetermined hypotheses concerning the cross-sectional and longitudinal validity were confirmed. Comparison of the general practice and secondary care population showed a major difference in baseline characteristics, DynaPort Knee Score, internal consistency, and hypotheses confirmation concerning the construct validity. CONCLUSION: The validity of the DPKT could not be demonstrated for first-time consulters with nontraumatic knee complaints in general practice. Measurement instruments developed and validated in secondary care are therefore not automatically also valid in primary care setting.

Prognostic factors of progression of osteoarthritis of the knee: a systematic review of observational studies.

OBJECTIVE: To provide an overview of prognostic factors of knee osteoarthritis (OA) progression. METHODS: We searched Medline and Embase up to December 2003 according to a specified search strategy (keywords for disease, location, and study design). Studies that fulfilled predefined criteria were assessed for methodologic quality. Study characteristics and associations were extracted and the results were summarized according to a best evidence synthesis. RESULTS: Of the 1,004 studies found, 37 met the inclusion criteria. Methodologic quality was assessed and only high-quality studies were included (n = 36). The best evidence synthesis yielded strong evidence that hyaluronic acid serum levels and generalized OA are predictive for progression of knee OA. Sex, knee pain, radiologic severity, knee injury, quadriceps strength, and regular sport activities were not predictive. Conflicting evidence for associations was found for several factors including body mass index and age. Limited evidence for an association with progression of knee OA was found for several factors, including the alignment (varus/valgus) of the joint. Limited evidence for no association with progression of OA was also found for several factors, including meniscectomy, several markers of bone or cartilage turnover, and the clinical diagnosis of localized OA. CONCLUSION: Generalized OA and level of hyaluronic acid seem to be associated with the radiologic progression of knee OA. Knee pain, radiologic severity at baseline, sex, quadriceps strength, knee injury, and regular sport activities seem not to be related. For other factors, the evidence was limited or conflicting.

Body mass index associated with onset and progression of osteoarthritis of the knee but not of the hip: the Rotterdam Study.

OBJECTIVE: To investigate the relationship between body mass index (BMI) and the incidence and progression of radiological knee as well as of radiological hip osteoarthritis. DESIGN: Cohort study. SETTING: Population based. PARTICIPANTS: 3585 people aged > or =55 years were selected from the Rotterdam Study, on the basis of the availability of radiographs of baseline and follow-up. MAIN OUTCOME MEASURES: Incidence of knee or hip osteoarthritis was defined as minimally grade 2 at follow-up and grade 0 or 1 at baseline. The progression of osteoarthritis was defined as a decrease in joint space width. METHODS: x Rays of the knee and hip at baseline and follow-up (mean follow-up of 6.6 years) were evaluated. BMI was measured at baseline. RESULTS: A high BMI (>27 kg/m(2)) at baseline was associated with incident knee osteoarthritis (odds ratio (OR) 3.3), but not with incident hip osteoarthritis. A high BMI was also associated with progression of knee osteoarthritis (OR 3.2). For the hip, a significant association between progression of osteoarthritis and BMI was not found. CONCLUSION: On the basis of these results, we conclude that BMI is associated with the incidence and progression of knee osteoarthritis. Furthermore, it seems that BMI is not associated with the incidence and progression of hip osteoarthritis.