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Diabetes‐related foot disease is a serious and common complication for people with diabetes mellitus. The gold standard care for a person with diabetes‐related foot disease is the involvement of a multidisciplinary foot team engaged in evidence‐based care. To date, there are seven International Working Group on the Diabetic Foot (IWGDF) guidelines published to assist healthcare providers in managing diabetes‐related foot disease around the world. This review discusses the acute management of diabetes‐related foot infection with insights from experts of various specialities (internal medicine, infectious disease, vascular surgery, radiology) with a discussion on the implementation of IWGDF guidelines in real life practice and the challenges that healthcare providers may face. [ABSTRACT FROM AUTHOR]

Clinical leadership is necessary to improve the performance of large public hospitals. Trainee medical officers (TMOs) are important stakeholders in organisation-wide initiatives that affect the medical workforce and support clinician engagement. This case study describes the development of a representative body known as the ‘TMO Forum’ within the Central Adelaide Local Health Network as a mechanism to promote engagement between medical trainees and the hospital executive to facilitate escalation and discussion of system-based issues. Over the past 8 years, this group has evolved into a community of practice with steady and sustained growth since inception. Trainees have fostered relationships with the executive, and have engaged in leadership and quality improvement initiatives. Here we explore the evolution, value and barriers to success of the TMO Forum. Our discussion is supplemented with findings from anonymous online evaluation surveys of both the TMO and executive stakeholder groups. We propose that initiatives such as the described may offer reciprocal benefits to both constituent groups regarding communication, and that the development of a dedicated community of practice will enhance engagement of TMOs in health service improvement initiatives and advocacy. However, there are obstacles to overcome in order to attract a greater number of trainees and maximise the benefits from this initiative. [ABSTRACT FROM AUTHOR]

Background: Frailty predicts adverse perioperative outcomes and increased mortality in patients having vascular surgery. Frailty assessment is a potential tool to inform resource allocation, and shared decision‐making about vascular surgery in the resource constrained COVID‐19 pandemic environment. This cohort study describes the prevalence of frailty in patients having vascular surgery and the association between frailty, mortality and perioperative outcomes. Methods: The COVID‐19 Vascular Service in Australia (COVER‐AU) prospective cohort study evaluates 30‐day and six‐month outcomes for consecutive patients having vascular surgery in 11 Australian vascular units, March–July 2020. The primary outcome was mortality, with secondary outcomes procedure‐related outcomes and hospital utilization. Frailty was assessed using the nine‐point visual Clinical Frailty Score, scores of 5 or more considered frail. Results: Of the 917 patients enrolled, 203 were frail (22.1%). The 30 day and 6 month mortality was 2.0% (n = 20) and 5.9% (n = 35) respectively with no significant difference between frail and non‐frail patients (OR 1.68, 95%CI 0.79–3.54). However, frail patients stayed longer in hospital, had more perioperative complications, and were more likely to be readmitted or have a reoperation when compared to non‐frail patients. At 6 months, frail patients had twice the odds of major amputation compared to non‐frail patients, after adjustment (OR 2.01; 95% CI 1.17–3.78), driven by a high rate of amputation during the period of reduced surgical activity. Conclusion: Our findings highlight that older, frail patients, experience potentially preventable adverse outcomes and there is a need for targeted interventions to optimize care, especially in times of healthcare stress. [ABSTRACT FROM AUTHOR]

Background: Tunneled central venous catheters (TCVCs) and peripherally inserted central catheters (PICC) are often used for the provision of home parenteral nutrition (HPN). There is no formal comparison being made to study the rate of catheter-related bloodstream infection (CRBSI) between TCVCs and PICC in HPN to recommend the use of 1 over the other.Methods: An online MEDLINE, PubMed, and Scopus search was conducted. Studies reporting the rate of CRBSI in HPN patients were included. DerSimonian and Laird random effects meta-analyses were used to analyze comparative studies, whereas Begg and Pilote's random effects meta-analysis was used to pool and analyze single-arm studies.Results: Seventeen studies (12 single-arm studies and 5 comparative studies) were included for analysis. Meta-analysis of comparative studies showed that PICC use was associated with a significantly lower rate of CRBSI (relative risk (RR) 0.40, 95% CI 0.19-0.83), whereas meta-analysis of single-arm studies revealed that the relative risk for CRBSI was not statistically significantly different from unity.Conclusion: TCVC is more commonly used in long-term HPN. Our analysis of comparative studies showed a lower rate of CRBSI in HPN patients using PICC compared with TCVC; however, analysis of single-arm studies showed that the rate of CRBSI was comparable in PICC and TCVC use. The decision to which type of catheter is most suited for HPN patients should hence be based on the duration of treatment, level of care, patients' dexterity, as well patients' underlying comorbidities that may potentially contribute to other catheter-related complications. [ABSTRACT FROM AUTHOR]

Studies the intramolecular metal-to-metal interaction in heterobimetallic complexes. Use of X-ray analysis, spectral absorption and emission spectroscopy; Strength of emissions at excited states; Reaction with alkyl halides through an electron-transfer mechanism.

Investigates the spectroscopic and luminescent properties of heterobimetallic Pt(II)-Rh(II), Au(I)-Rh(I) and Ag(I)-Rh(I) complexes. Synthesis; Instrumentation; Molecular orbital calculations.

2D Ti3C2Tx MXene is a desirable electrode material for advanced lithium‐ion batteries (LIBs) in the pursuit of high energy and power densities, owing to its extensive reactive area and surface‐induced pseudo‐capacitance. Here, a novel synergistic strategy for fortifying lithium storage capability is first proposed, by in‐situ anchoring BaTiO3 ferroelectric nanoparticles on few‐layered Ti3C2Tx nanosheets (BT/f‐Ti3C2Tx) using a hydrothermal method. The uniform BaTiO3 nanoparticles effectively prevent the restacking of Ti3C2Tx nanosheets, successfully deplete metastable Ti atoms, and intriguingly form a thin and well‐adhered solid electrolyte interface layer, enhancing the aggregation‐resistant, oxidation‐resistant, and electrochemical properties of Ti3C2Tx. Simultaneously, the internal electric fields, originating from the spontaneous polarization of BaTiO3 ferroelectric nanoparticles, can augment the adsorption of Li+, boosting the lithium storage capacity and reaction kinetics. The resulting composite electrode displays a remarkable charge capacity of 84 mAh g−1 at 10 A g−1, almost five times that of pristine Ti3C2Tx electrode. The excellent rate performance and cyclability make BT/f‐Ti3C2Tx composites highly attractive for LIBs. Furthermore, this synthetic approach presented here is scalable and can be extended to other Ti‐based materials. This strategy is expected to underscore the considerable potential of ferroelectric composites for integration into high‐performance LIBs. [ABSTRACT FROM AUTHOR]

Background: Catheter-related bloodstream infections (CRBSIs) are life-threatening complications for home parenteral nutrition (HPN) patients. This review clarifies Candida CRBSI rates by species, risk factors, outcomes, and management to improve effectiveness of HPN programs., Methods: A review of Candida CRBSIs in HPN patients was conducted around the following questions: 1. How often do adult and paediatric HPN patients contract Candida CRBSIs? 2. What is the proportion of different Candida species? 3. What are the risk factors? 4. How are outcomes in Candida versus other CRBSIs? 5. What are current guidelines to manage Candida CRBSIs? Specifically, should catheters be removed? What antimicrobial therapy is indicated? Are catheter lock techniques effective?, Results: 20 studies were included - six paediatric and 14 adult. Candida represented 9.8% of paediatric CRBSIs and 11.7% of adult CRBSIs. Paediatric candidal CRBSIs featured these species: C. albicans (46.2%), C. parapsilosis (34.6%), Candida guilliermondii (11.5%), Candida tropicalis (3.8%), and mixed or other types of Candida (3.8%). Adult candidal CRBSIs featured these species: C. albicans (37.3%), C. glabrata (33.3%), C. parapsilosis (22.4%), mixed or other types of Candida (5.7%), and C. tropicalis (1.3%). Risk factors for paediatric HPN CRBSIs include underlying haematological disease and previous fungaemia. Candida infection is associated with mortality rates around 30%. In Candida CRBSIs, major guidelines advocate catheter removal prior to systemic antifungal treatment (fluconazole, amphotericin B, echinocandins), ideally until 14 days after the first negative blood culture; some studies suggest the possibility of systemic therapy while catheters remain in-situ to preserve crucial line access. Various catheter lock solutions are effective as treatment and prophylaxis, but are not yet firmly established., Conclusions: Candida CRBSI is a significant danger to HPN patients causing high mortality; gold standard treatment is catheter removal and antifungal treatment, although treatments with catheters in-situ and catheter locks as prophylaxis appear to be gaining traction., (Copyright © 2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)