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Intro: Necrotising soft tissue infection (NSTI) is associated with high mortality and morbidity. Factors shown to reduce mortality and morbidity include early disease recognition, appropriate antibiotic therapy and prompt surgical intervention. Studies examining epidemiology and management of NSTI globally are sparse due to a lack of centralised database. Methods: This retrospective study was conducted by accessing electronic medical records at a single large health network (Central Adelaide Local Health Network, Adelaide South Australia). Pertinent information relating to patient factors, microbiological data and clinical outcomes were collected. Findings: A total of 167 cases of NSTI were identified with an overall mortality of 12%. Median length of hospitalization was 22 days. Overall, 149 patients (80.2%) underwent early surgery with a mortality of 10% compared to 28% of those had delayed surgery irrespective of antibiotic choice (p=0.03). The majority of NSTI (86.8%) involved a single anatomical site. Most infections were polymicrobial (55%) with nearly half of these infections involving the perineal or perianal region (46%). Monomicrobial infections accounted for 38% of NSTIs, of which S. pyogenes and S. aureus were the two most common pathogens isolated. Appropriate empiric antibiotic treatment was used in 59% of NSTI patients. Discussion: NSTI related mortality is reducible by up to 50% with broad- spectrum antibiotics and early surgery. Within our cohort, NSTI remains a condition with high morbidity demonstrated by a median length of hospitalization exceeding three weeks and a mortality up to 12%. From our study, treatment at a minimum either with broad-spectrum antimicrobials or early surgical intervention may be protective but utilizing both shows the highest mortality benefit and should remain standard of care. Conclusion: NSTIs are associated with significant morbidity and mortality, though improved through early surgical intervention in combination with broad spectrum antimicrobial therapy.

Background: Ward rounds (WRs) are a daily organisational process in hospitals. Studies have found variation however in the definition and objectives of WRs, where they take place, who partakes in them and how they impact patient care. Objectives: This study was undertaken as part of a longitudinal improvement project in relation to WRs taking a socio-technical systems approach. The objective of this study was to explore junior doctors understanding of the goals, process sequence, social relations particularly understanding of roles and responsibilities, and information and knowledge in relation to WRs. We also wished to hear junior doctors’ perceptions of how WRs may be improved. Methods: Our study took place in a large 1000 bed acute teaching hospital. A survey was developed by the improvement project team and administered to junior doctors at the hospital (n=148). Results: A response rate of 30.4% was achieved (n=45 completing the survey). Junior doctors perceive the primary goals of WRs to be reviewing patient history and current status (39%) and progressing care plans (38%). They believe their main role on WRs to be writing notes (46.5%). 75% of participants reported that they fully understood their responsibilities on WR, while 67% fully understood the responsibilities of others. 80% reported learning on WRs lower than all other forms of learning. Conclusions: The findings of this study will help inform our current ‘AS IS’ understanding of WR practice and co-design of improvements. We would argue that further systems level research is needed to examine the impact of lack of agreed goals; clarity in relation to roles and responsibilities; involvement of nursing and health and social care professionals in the WR, and perceived educational value of WRs on staff and patient outcomes.

Abstract Epidermolysis Bullosa (EB) is a group of rare genetic disorders resulting in skin fragility and other symptoms. Commissioned by DEBRA International and funded by DEBRA Norway, this evidence-bases guideline provides recommendations to optimise psychosocial wellbeing in EB. An international multidisciplinary panel of social and health care professionals (HCP) and people living with EB was formed. A systematic international literature review was conducted by the panel following the Scottish Intercollegiate Guidelines Network (SIGN) methodology. The resulting papers underwent systematic selection and critique processes. Included papers were allocated to 6 different outcome groups to allow data synthesis and exploration: quality of life, coping, family, wellbeing, access to HCP and pain. Based on the evidence in those papers, recommendations were made for individuals living with EB, family and caregivers and HCP working in the field. Few studies have investigated interventions and which factors lead to better outcomes, but general recommendations can be made. EB is a complex disease impacting enormously on every aspect of psychosocial life. People and families living with EB need access to multidisciplinary support, including psychological guidance, in order to improve quality of life and psychosocial wellbeing. Interventions should stimulate social participation to prevent isolation. People with EB and their families should be able to access a supportive network. HCP should be well supported and educated about the complexity of EB. They should work collaboratively with those around the individual with EB (e.g. schools, employers etc.) to provide psychosocial opportunity and care. Attention should be paid to the psychosocial impact of EB as well as physical needs. Directions for research are indicated.

We utilized femtosecond time-resolved resonant inelastic X-ray scattering and ab initio theory to study the transient electronic structure and the photoinduced molecular dynamics of a model metal carbonyl photocatalyst Fe(CO)5 in ethanol solution. We propose mechanistic explanation for the parallel ultrafast intra-molecular spin crossover and ligation of the Fe(CO)4 which are observed following a charge transfer photoexcitation of Fe(CO)5 as reported in our previous study [Wernet et al., Nature 520, 78 (2015)]. We find that branching of the reaction pathway likely happens in the 1A1 state of Fe(CO)4. A sub-picosecond time constant of the spin crossover from 1B2 to 3B2 is rationalized by the proposed 1B2 → 1A1 → 3B2 mechanism. Ultrafast ligation of the 1B2 Fe(CO)4 state is significantly faster than the spin-forbidden and diffusion limited ligation process occurring from the 3B2 Fe(CO)4 ground state that has been observed in the previous studies. We propose that the ultrafast ligation occurs via 1B2 → 1A1 → 1A′ Fe(CO)4EtOH pathway and the time scale of the 1A1 Fe(CO)4 state ligation is governed by the solute-solvent collision frequency. Our study emphasizes the importance of understanding the interaction of molecular excited states with the surrounding environment to explain the relaxation pathways of photoexcited metal carbonyls in solution.

A pseudoaneurysm is a haematoma which is surrounded by connective tissue and communicates with the lumen of a ruptured blood vessel. It has no true defined capsule. We describe a case of tuberculous pseudoaneurysm. This is a rare complication of tuberculosis. The clinical presentation of these lesions is highly variable. Definitive diagnosis should consist of contrast-enhanced CT and arteriography. Treatment should include repair of the arterial wall by surgery, endovascular stent-graft insertion, or embolization followed by a full course of antituberculous chemotherapy. Our case is highly unusual in that the pseudoaneurysm arose from the subclavian vasculature in a patient with extrapulmonary tuberculosis only.

The demand for evidence syntheses to inform urgent decision-making surged during the pandemic. The challenging circumstances of the pandemic created significant hurdles for both those requesting and creating evidence syntheses, leading to the refinement and adjustment of evidence synthesis practices. This research sought to capture and explore how the field of evidence synthesis evolved and adapted during the pandemic from the perspective of those who produced evidence syntheses in Canada. In this qualitative study, semi-structured interviews were carried out between October 2022 to January 2023. Twenty-two participants from 19 different organizations across seven provinces and one territory were interviewed. This included producers of evidence syntheses from academic institutions, not-for-profit organizations, and provincial and federal government. Data analysis was conducted thematically using a phenomenological approach. Results indicated the evidence synthesis landscape drastically changed during the pandemic including short timelines to produce syntheses and changes in the volume, types, and quality of literature included in them. Due to the changing landscape and different needs of requestors, evidence synthesis methodologies evolved, synthesis products were tailored, and quality assessment tools were adapted. In addition, the use of artificial intelligence, processes for engaging subject matter experts and patient-citizen partners, and the coordination of the evidence synthesis community changed. The findings of this study contribute to the ongoing dialogue surrounding evidence synthesis to inform decision-making, and highlights the importance of flexibility and necessity of continuously evolving methodologies to meet the demands of frequently changing landscapes. The lessons learned from this study can help inform future strategies for improving evidence synthesis practices not only in the face of public health emergencies, but also in everyday practice.