Objective evaluation of burn and post-surgical scars and the accuracy of subjective scar type judgment

Background The true proliferation degree of burn and operation scars during their maturation was poorly defined. The objective of this study was to provide a quantitative evaluation of the proliferation degree of deep-partial thickness burn and surgical suture wound scars after wound healing and the accuracy of subjective judgment of scar types. Methods A total of 423 patients in the burn group and 667 patients in the suture wound group were enrolled in this study. Objective scar measurement （by negative-positive moulage） was carried out at 3, 6 and 12 months after wound healing in 1090 patients from different regions in China. The Kruskal-Wallis H test and chi-square test were used in the statistical analysis. Results The median degrees of scar proliferation were 0.03 cm at 3 months, 0.03 cm at 6 months and 0 cm at 12 months in the burn group and 0.05 cm, 0.04 cm and 0.04 cm respectively in the suture wound group. At 3 and 6 months post wound healing, there was no significant difference in scar proliferation between the groups （P 〉0.01）. After 1 year, burn scars displayed evidence of atrophy （P 〈0.01）. Although the degree of scar proliferation differed among the four scar types （P 〈0.01）, the ranges of scar height in the four scar types largely overlapped when judged in a subjective manner, especially in proliferation and superficial scars. Conclusions Scar atrophy occurs after one year in burns, but not in the surgical suture wound group. It is important to take anti-scar therapy for surgical wounds as well as burn wounds. The various scar types could not be judged precisely in a subjective manner.     

Presumed consent for transplantation: a dead issue after Alder Hey?

In the wake of scandals about the unauthorised retention of organs following postmortem examination, the issue of valid consent (or the lack of it) has returned to the forefront. Emphasis is put on obtaining explicit authorisation from the patient or family prior to any medical intervention, including those involving the dead. Although the controversies in the UK arose from the retention of human material for education or research rather than therapy, concern has been expressed that public mistrust could also adversely affect organ donation for transplantation. At the same time, however, the British Medical Association (BMA) continues to call for a shift to a system of presumed consent for organ transplantation. This apparent inconsistency can be justified because valid distinctions exist between the reasons requiring explicit consent for retention and the acceptability of presumed consent for transplantation. This paper argues for introducing a system of presumed consent for organ donation, given the overwhelming expressions of public support for transplantation. Ongoing legislative review in the UK provides an ideal chance to alter the default position to one where potential donors can simply acquiesce or opt out of donation. Combined with consultation with their relatives, this could be a much better method of realising individuals' wishes. It would also achieve a better balance between the duties owed to the deceased and those owed to people awaiting a transplant.     

Helicobacter pylori infection in Indigenous Australians: a serious health issue?

If Indigenous Australians are at high risk of H. pylori infection, the associated risks of peptic ulceration and gastric cancer may make screening and treatment necessary.     

Can the Delta stop singing the blues?

This article was written to describe a collaborative effort between the University of Mississippi Medical Center and the Delta Health Alliance to increase primary care providers in the 18 counties designated as the Mississippi Delta. Journals compiled by trainees were analyzed to reveal issues significant to practicing in a rural area from the perspective of medical students and residents who participated in the program. Patient noncompliance, provider sensitivity to cost, continuity of care, and quality of the doctor-patient relationship were all identified as significant issues by the trainees.     

Who's killing the autopsy?

A new tool for assessing the causes of falling autopsy rates.     

Is the pill safe?

A brief review of India's population figures and recent studies of oral contraceptives concludes that most side effects are not due to the medication, but are symptoms normally present in the population or are of psychogenic origin. The problems of the lack of cooperation of patients on oral contraceptives in conducting research is discussed.