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Introduction Breast cancer is the leading cause of death in Singaporean women, with advanced stage rendering a poorer prognosis. This study aims to explore the barriers to early presentation, information needs and sources in patients with locally advanced breast cancer (LABC). Materials & methods A convenience sample of patients who presented with locally advanced breast cancer to the Department of General Surgery in a teaching tertiary hospital were recruited for the study. We conducted semi-structured interviews face to face with the recruited patients. We recorded the interviews, transcribed them verbatim and analysed using thematic content analysis. Results Twenty-three participants were recruited of which 12 were Chinese and 11 were Malay women. Mean age was 60 years (± 13 SD). The most common knowledge barrier resulting in delay was the misconception that a breast lump must be painful to be malignant. Other knowledge barriers include the lack of knowledge and misinformation from the internet or other social media platforms. Some perceived barriers include fear of diagnosis, fear of treatment and fear of imposing financial burden on family members. A significant proportion of participants were also not aware of a national breast screening programme. Conclusions Our study has found that barriers to early presentation of women with locally advanced breast cancer remain similar and have persisted over the years despite targeted efforts. There is a need for a rethink of existing strategies and to develop new innovative ways to reach out to this group of patients.

Background The COVID-19 pandemic has disrupted medical education, shifting learning online. Social media platforms, including messaging apps, are well integrated into medical education. However, Telegram’s role in medical education remains relatively unexplored. Objective This study aims to explore the perceptions of medical students regarding the role of messaging apps in medical education and their experience of using Telegram for surgical education. Methods A Telegram channel “Telegram Education for Surgery Learning and Application (TESLA)” was created to supplement medical students’ learning. We invited 13 medical students who joined the TESLA channel for at least a month to participate in individual semistructured interviews. Interviews were conducted via videoconferencing using an interview guide and were then transcribed and analyzed by 2 researchers using inductive thematic content analysis. Results Two themes were identified: (1) learning as a medical student and (2) the role of mobile learning (mLearning) in medical education. Students shared that pandemic-related safety measures, such as reduced clinic allocations and the inability to cross between wards, led to a decrease in clinical exposure. Mobile apps, which included proprietary study apps and messaging apps, were increasingly used by students to aid their learning. Students favored Telegram over other messaging apps and reported the development of TESLA as beneficial, particularly for revision and increasing knowledge. Conclusions The use of apps for medical education increased during the COVID-19 pandemic. Medical students commonly used apps to consolidate their learning and revise examination topics. They found TESLA useful, relevant, and trustworthy.

BACKGROUND The COVID-19 pandemic disrupted medical education, shifting a huge portion of learning online. Social media platforms have long been well-integrated into medical education. However, Telegram’s role in medical education remains relatively unexplored. A Telegram channel titled “Telegram Education for Surgery Learning and Application (TESLA)” focusing on General Surgery education was created to supplement medical students’ learning. It encompassed weekly multiple-choice questions and resources such as illustrations and journal articles. OBJECTIVE This study explored students’ experience of TESLA and their views on the role of messaging apps in medical education. METHODS We invited thirteen medical students from Lee Kong Chian School of Medicine, Singapore who were in the TESLA channel for at least a month to participate in individual semi-structured interviews. The interviews were conducted via video conference using an interview guide. Interviews were transcribed and analysed by two researchers using inductive thematic content analysis. RESULTS Three themes were identified: (1) Learning as a medical student, (2) The role of mobile learning in medical education and (3) TESLA for surgical education. Students shared that pandemic-related safety measures such as reduced clinic allocations and the inability to cross between wards led to a decrease in clinical exposure. Students used a variety of messaging and study apps to aid their medical education. Telegram was preferred over other messaging apps. Concerning the use of TESLA, students felt that the questions were clinically relevant and of appropriate difficulty. Students offered suggestions for improvement relating to the organization, content and format of TESLA. CONCLUSIONS Medical students found TESLA useful as a supplementary learning instrument in surgical education. They were supportive of integrating TESLA into formal undergraduate education and using Telegram as an educational tool in other areas of medicine. In line with our findings, we outlined recommendations for the use of Telegram in medical education.

Background Early laparoscopic cholecystectomy (ELC) within 72 h of symptom onset is preferred for management of acute cholecystitis (AC). Beyond 72 h, acute‐on‐chronic fibrosis sets in rendering surgery challenging. This study aims to compare the outcomes of ELC for AC within and beyond 72 h of symptom onset by a dedicated acute surgical unit. Methods This is a single‐centre retrospective study of 217 patients with AC who underwent ELC by an acute surgical unit from January 2017 to August 2018. Outcomes collected include post‐operative morbidity, length of hospitalization and operation duration. A subgroup analysis for the same outcomes was performed for elderly patients. Results Of the 217 patients, 88 were operated within 72 h of symptom onset while 129 were operated beyond 72 h. Twenty‐six patients received ELC after 7 days. There was no occurrence of bile duct injury. There was no statistical difference in conversion rates, wound infections and post‐operative collections. Patients receiving ELC beyond 72 h had longer duration of operation (125.4 versus 116 min, P = 0.035) and length of hospitalization (4.59 versus 3.09 days, P = 0.001) without increase in morbidity. Patients older than 75 years had a higher incidence of post‐operative collection (P < 0.001). Conclusion Patients with AC undergoing ELC by a dedicated acute surgical unit can have good outcomes even beyond 72 h of symptom onset. Meticulous haemostasis should be performed for the elderly subgroup of patients.