Background We created a 3-month webinar series, entitled Broadening Horizons , which explored plastic surgery principles from each subspeciality according to the Intercollegiate Surgical Curriculum Programme (ISCP) for plastic surgery. This article reports on our experience of producing a teaching programme, its impact on our delegates, and provides a useful guide to creating future webinar series in plastic surgery and other specialities. Methods Pre- and post-course questionnaires were used to perform a needs analysis, collect feedback and assess our delegates’ career interests and perceptions of plastic surgery. Delegates rated their responses on 5-point Likert scales. Delegates also undertook a 60-question pre- and post-course exam to test their knowledge. Results One thousand eight attendances were recorded for the entire 16-part webinar series. Sixty-three (53–73) delegates, including undergraduate, postgraduate and international students, attended each lecture on average. Seventy-five percent of delegates felt they had previously received inadequate plastic surgery teaching. Ninety-six percent were satisfied or very satisfied with Broadening Horizons . Confidence in their knowledge of plastic surgery increased significantly from 2 (1–3) (not very confident) to 3 (2–5) (somewhat confident) ( p = 0.01). Post-course exam scores increased significantly from 49% (32–67) to 56% (23–85) ( p = 0.05). Career interest and positive perceptions were maintained. Conclusions This is the first webinar series to provide undergraduates and postgraduates plastic surgery teaching based on ISCP learning objectives. The series increased delegates’ knowledge and confidence in their understanding of plastic surgery. This article describes the 5-E-Z step guide to developing future teaching programmes similar to Broadening Horizons . Level of evidence Not ratable

BackgroundGiven the expansion of remote digital dermatology services from the National Health Service, particularly during the COVID-19 pandemic, there is a need for methods that identify patients at risk of digital exclusion to guide equitable representation in service co-design processes and tailor remote services to the needs of their patient population. ObjectiveThis quality improvement project aims to inform the redesign of remote services to optimally support the ongoing needs of patients with chronic skin diseases, ensuring that the services are tailored to patients’ digital health literacy requirements. MethodsWe profiled the digital health literacy of 123 people with chronic skin conditions who require long-term surveillance in 2 specialist clinics (London, United Kingdom) using the Multidimensional Readiness and Enablement Index for Health Technology (READHY) questionnaire alongside the Optimizing Health Literacy and Access (Ophelia) process for hierarchical cluster analysis. ResultsThe cluster analysis of READHY dimensions in responding participants (n=116) revealed 7 groups with distinct digital and health literacy characteristics. High READHY scores in groups 1 (n=22, 19%) and 2 (n=20, 17.2%) represent those who are confident with managing their health and using technology, whereas the lower-scoring groups, 6 (n=4, 3.4%) and 7 (n=12, 10.3%), depended on traditional services. Groups 3 (n=27, 23.3%), 4 (n=23, 19.8%), and 5 (n=8, 6.9%) had varying digital skills, access, and engagement, highlighting a population that may benefit from a co-designed dermatology service. ConclusionsBy identifying patient groups with distinguishable patterns of digital access and health literacy, our method demonstrates that 63.8% (n=74) of people attending specialist clinics in our center require support in order to optimize remote follow-up or need an alternative approach. Future efforts should streamline the READHY question profile to improve its practicality and use focus groups to elicit strategies for engaging patients with digital services.

Despite global synchronous teledermatology (SynTD) use during the pandemic, existing studies have not reviewed patient perceptions of SynTD or compared these to face-to-face consultation (FTFC) perceptions. We aim to evaluate and compare the forenamed perceptions alongside assessing patients preferred consultation modality. We searched four public databases for studies on SynTD patient perceptions. Twelve studies were eligible, all demonstrating SynTD satisfaction. Those comparing TC (n=3) and VC (n=4) to FTFC revealed lower and similar satisfaction, respectively, however, overall, there was no preferred modality. Patients favoured SynTD's convenience but valued FTFC's in-person examinations and privacy. Most (80.0%, n=4) of the five studies querying future preferences demonstrated patient interest in prospective SynTD. Despite patient interest in general SynTD, FTFC results in higher satisfaction than TC and similar satisfaction to VC. Future research areas include, comparing TC and VC perceptions and developing a TD satisfaction measure.

Background: Glioblastoma multiforme is the most common and aggressive primary adult brain neoplasm. The current standard of care is maximal safe surgical resection, radiotherapy with concomitant temozolomide, followed by adjuvant temozolomide according to the Stupp protocol. Although the protocol is well adopted in high-income countries (HICs), little is known about its adoption in low- and middle-income countries (LMICs). The aim of this study is to describe a protocol design for a systematic review of published studies outlining the differences in GBM management between HICs and LMICs. Methods: A systematic review will be conducted. MedLine via Ovid, Embase and Global Index Medicus will be searched from inception to date in order to identify the relevant studies. Adult patients (>18 years) with histologically confirmed primary unifocal GBM will be included. Surgical and chemoradiation management of GBM tumours will be considered. Commentaries, original research, non-peer reviewed pieces, opinion pieces, editorials and case reports will be included. Results: Primary outcomes will include rates of complications, disability-adjusted life years (DALYs), prognosis, progression-free survival (PFS), overall survival (OS) as well as rate of care abandonment and delay. Secondary outcomes will include the presence of neuro-oncology subspecialty training programs. Discussion: This systematic review will be the first to compare the current landscape of GBM management in HICs and LMICs, highlighting pertinent themes that may be used to optimise treatment in both financial brackets. Systematic Review Registration: The protocol has been registered on the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020215843). Highlights Glioblastoma multiforme (GBM) remains the most common primary adult cerebral neoplasm, with an age-adjusted incidence rate of 3.22 per 100,000 population and a 5-year survival rate of 6.8% Despite the well-evidenced efficacy of Stupp protocol, the implementation of this approach bears an institutional and individual financial burden that is particularly notable in low- and middle-income countries (LMICs) This systematic review will be the first to compare the current landscape of GBM management in HICs and LMICs, highlighting pertinent themes that may be used to optimise treatment in both financial brackets.

It is unclear what non-pharmacological interventions to prevent cognitive decline should comprise. We systematically reviewed lifestyle and psychosocial interventions that aimed to reduce cognitive decline in healthy people aged 50+, and people of any age with Subjective Cognitive Decline or Mild Cognitive Impairment. We narratively synthesised evidence, prioritising results from studies rated as at lower Risk of Bias (ROB) and assigning Centre for Evidence Based Medicine grades. We included 64 papers, describing: psychosocial (n = 12), multi-domain (n = 10), exercise (n = 36), and dietary (n = 6) interventions. We found Grade A evidence that over 4+ months: aerobic exercise twice weekly had a moderate effect on global cognition in people with/ without MCI; and interventions that integrate cognitive and motor challenges (e.g. dance, dumb bell training) had small to moderate effects on memory or global cognition in people with MCI. We found Grade B evidence that 4+ months of creative art or story-telling groups in people with MCI; 6 months of resistance training in people with MCI and a two-year, dietary, exercise, cognitive training and social intervention in people with or without MCI had small, positive effects on global cognition. Effects for some intervention remained up to a year beyond facilitated sessions.