Background: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+. Conclusion: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.
Als na afloop van een brandincident een stoffelijk overschot wordt aangetroffen, is het van belang dat de causaliteit tussen de brand en het overlijden wordt onderzocht. Brand is zeer destructief voor het menselijk lichaam. Dit bemoeilijkt de interpretatie van onderzoeksbevindingen aan een lichaam. Er zijn diverse verschijnselen die tot op zekere hoogte duiden op vitaliteit (de betrokkene was levend) ten tijde van de brand. In dit artikel worden deze verschijnselen tegen het licht gehouden. Op basis van de huidige wetenschappelijke theorieën bestaan er geen verschijnselen die leiden tot de eenduidige conclusie over al dan niet vitale blootstelling. Wel kunnen verschijnselen een vermoeden van vitale blootstelling tot op zekere hoogte ondersteunen. Ontbreken de verschijnselen, dan is het niet mogelijk om een conclusie te trekken; de afwezigheid is geen bewijs van overlijden vóór het ontstaan van de brand. Om in de rechtszaal een uitspraak te kunnen doen over de causaliteit tussen brand en overlijden, wordt het noodzakelijk geacht om de waarde voor de aannemelijkheid van vitale blootstelling per verschijnsel te motiveren.
MULTIFILE
Abstract: Aureobasidium is omnipresent and can be isolated from air, water bodies, soil, wood, and other plant materials, as well as inorganic materials such as rocks and marble. A total of 32 species of this fungal genus have been identified at the level of DNA, of which Aureobasidium pullulans is best known. Aureobasidium is of interest for a sustainable economy because it can be used to produce a wide variety of compounds, including enzymes, polysaccharides, and biosurfactants. Moreover, it can be used to promote plant growth and protect wood and crops. To this end, Aureobasidium cells adhere to wood or plants by producing extracellular polysaccharides, thereby forming a biofilm. This biofilm provides a sustainable alternative to petrol-based coatings and toxic chemicals. This and the fact that Aureobasidium biofilms have the potential of self-repair make them a potential engineered living material avant la lettre. Key points: •Aureobasidium produces products of interest to the industry •Aureobasidium can stimulate plant growth and protect crops •Biofinish of A. pullulans is a sustainable alternative to petrol-based coatings •Aureobasidium biofilms have the potential to function as engineered living materials.
