Healing after dermal injury is a complex but imperfect process that results in a wide range of visible scars. The degree of disfigurement is not the sole determinant of a scar's effect on patient well-being, with a number of other factors being critical to outcome. These include cosmetic appearance, symptoms such as itch and pain, functional loss, psychological or social problems, and quality of life. An accurate assessment of these domains can help clinicians measure outcomes, develop, and evaluate treatment strategies. A PubMed literature search was performed up to 31st March 2020. Ten objective scar measurements, four Clinician-Reported Outcome Measures (CROMs), six Patient-Reported Outcome Measures (PROMs), and one combined measure were evaluated for their reliability, clinical relevance, responsiveness to clinical change, and feasibility. Many quantitative tools were limited in their clinical relevance and feasibility, whereas few qualitative CROMs and PROMs have undergone rigorous assessment. This review examines currently available assessment tools, focusing primarily on subjective scar measurements (CROMs, PROMs), and offers a perspective on future directions in the field.

There has been a paradigm shift in health service delivery to a more holistic approach, which considers Quality of Life (QoL) and overall functioning. Health-Related Quality of Life (HRQoL) is a multidimensional construct that encompasses physical functioning as well as psychosocial aspects of emotional and social functioning. This study explored factors related to HRQoL in Asian pediatric patients with leukemia in Singapore. The available variables included: age, treatment duration, household income, gender, ethnicity, religion, diagnosis, and phase of treatment. It is hypothesized that the relationships will be significant. In the current study, there were 60 patients (60% males) with leukemia; their ages ranged from 1 to 21 years (Mean = 8.03, Standard Deviation = 4.55). The hypothesis was partially supported. Age had a significant positive relationship with physical functioning, r(60) = 0.28, p < 0.05, physical health, r(60) = 0.28, p < 0.05, and the total HRQoL score, r(60) = 0.29, p < 0.05. Treatment duration had a positive relationship with school functioning, r(60) = 0.28, p < 0.05. All other correlations were statistically non-significant. The effects of the available psychosocial variables of gender, ethnicity, and religion were examined on scores from the Pediatric Quality of Life Inventory (PedsQL). Ethnicity had a significant effect on social functioning, U = 292.00, p < 0.05, r = 0.3 (medium effect size). Specifically, Chinese (Median = 85.00, n = 33) had significantly higher scores on social functioning than others (Median = 70.00, n = 27). The remaining comparisons were statistically non-significant. The current findings added to QoL research, and provided an impetus for more research in the area of HRQoL for children with leukemia in Singapore.

HighlightsAn “augmentation-therapeutic mastopexy” for invasive tubular carcinoma is described.It is a rare technique to optimise symmetry of prosthetic reconstruction.It enlarges and reshapes the breast while adequately treating ipsilateral cancer.

Introduction The General Medical Council (GMC) stipulates that medical graduates should obtain competency in basic wound care. In a national review, only 24.7% of UK medical schools provided suturing training. Newly qualified doctors may be less prepared in performing basic surgical skills independently. Hence, Cambridge University Surgical Society initiated a weekly teaching programme, Surgical Skills Club (SSC). Method SSC covered instrument handling, knot-tying and various suturing techniques (interrupted, continuous, mattress and subcuticular), with 32 student participants. Trainees led these sessions, with tutor:student ratios at 1:5. SSC was designed to be cost-effective (£8/student); both reusable suturing pads and animal tissue were used. Glass jars were repurposed into knot-tying trainers. Participants completed questionnaires pre- and post-programme, rating confidence in skills on Likert scales; 1 (not confident) to 5 (very confident), alongside qualitative feedback. Results SSC was well-subscribed; most participants (88%) would highly-recommend it to peers. Receiving individualised feedback was highly valued. Students were more confident (scores 4 or 5) in skills post-programme compared to pre-programme (instrument handling: 21.9% vs 92.0%; basic knot-tying: 28.1% vs 88.0%; interrupted suturing: 50.0% vs 100%). Conclusions We demonstrated the effectiveness of a regular skills-teaching programme, where learning is consolidated through spaced repetition. This sustainable and accessible format can be widely adapted and implemented

questionnaire. Data on all patients undergoing TNE was collected prospectively and retrospectively analysed from the hospital computer records. Results Since its introduction, 113 patients have been assessed as suitable for TNE. 67 females and 46 males (median age 62, IQR 52.5-70 years) underwent TNE. The first 17 patients were part of the pilot study. Of 96 subsequent patients, 66 were direct to test referrals on the cancer pathway, 10 other referrals on the cancer pathway, 13 routine, 3 planned surveillance, 1 urgent and 3 urgent inpatients. The most common indications were dysphagia (55 patients) and dyspepsia (36 patients). Endoscopy was completed trans-nasally in 92 patients (81.4%), trans-orally in 16 patients (14.1%) and failed in 5 patients (4.4%). Reasons for performing trans-orally were narrow nasal passages in 7 patients, 2 patients on warfarin with high INR, 2 patient choice and 7 didn't tolerate scope in nose. Duodenal intubation was successful in 107/113 (94.7%). There were no abnormal findings in 57 patients, inflammation was seen in 36 patients and 8 cancers of the oesophagus/oesophago-gastric junction were found. Biopsies were taken in 63 procedures and all were adequate for histology. Procedures were tolerated well with no immediate complications. Median (range) VAS was 9 (5-10) and of those who had had previous OGD, 71% expressed a preference for TNE and 29% preferred neither. Conclusions TNE delivered in an outpatient clinic setting with immediate access to endoscopy unit is a safe and effective method of investigating upper gastrointestinal tract symptoms. This innovative service delivery has the potential to reduce traditional diagnostic gastroscopy and increase capacity.