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.

Necrotising fasciitis due to an infected sebaceous cyst.

The current case presents a patient who was admitted to our hospital with the diagnosis of cellulitis of the right groin. In the following days, the patient's condition deteriorated and developed a septic shock. Exploration in the operating room showed a necrotising fasciitis of the adductor muscles, with an infected sebaceous cyst in the inguinal crest as port d'entrée. After extensive surgical debridement, antibiotic therapy, haemodynamic and respiratory support, the patient recovered. Necrotising fasciitis is a rare but very lethal condition, which necessitates aggressive surgical therapy and antibiotic support. The current case report is the first report to show a necrotising fasciitis due to an infected sebaceous cyst.

Distributed crack analysis of ceramic inlays.

In all-ceramic restorations, crack formation and propagation phenomena are of major concern, since they may result in intra-oral fracture. The objective of this study was calculation of damage in porcelain MOD inlays by utilization of a finite-element (FE) implementation of the distributed crack theory. "Damage" is defined as the parameter that describes the local decrease of stiffness caused by microdefects. In the simulated MOD ceramic inlay, the crack initiation starts at the internal occlusal surface near the pulpo-axial line angle. This initiation is invisible from the external surface and cannot be detected by the clinician. The crack initiation at the internal surface started as soon as 55-60% of the loading needed for complete fracture was reached. The use of FE techniques for calculation of the fracture in loaded ceramic inlays offers prospects for further detailed study of the crack behavior, including three-dimensional modeling and cyclic loading situations.

Mechanical performance of a dental composite: probabilistic failure prediction.

In clinical situations, the mechanical performances of dental structures--for example, composite restorations--depend on many factors. Most of them have a probabilistic character. Because composites are brittle materials, their strength should also be considered as a probabilistic quantity. For successful prediction of mechanical failure of structures consisting of these materials, a probabilistic approach is indispensable, and a suitable definition of equivalent stress must be introduced. An equivalent stress facilitates the transfer of strength data of laboratory specimens to situations where the stress state is much more complicated. The tensile and compressive strengths of composites differ considerably. Of two equivalent stress definitions that potentially describe this experimental fact (the Drücker-Prager and the Modified von Mises equivalent stress), the predictive capacity was investigated for a microfine composite. In a probabilistic approach to failure, use of the Drücker-Prager equivalent stress appeared to be superior, because the average failure load of notched beams was predicted with an error smaller than 8%.