Grant Cumming

Increased Use of Twitter at a Medical Conference: A Report and a Review of the Educational Opportunities

Background Most consider Twitter as a tool purely for social networking. However, it has been used extensively as a tool for online discussion at nonmedical and medical conferences, and the academic benefits of this tool have been reported. Most anesthetists still have yet to adopt this new educational tool. There is only one previously published report of the use of Twitter by anesthetists at an anesthetic conference. This paper extends that work. Objective We report the uptake and growth in the use of Twitter, a microblogging tool, at an anesthetic conference and review the potential use of Twitter as an educational tool for anesthetists. Methods A unique Twitter hashtag (#WSM12) was created and promoted by the organizers of the Winter Scientific Meeting held by The Association of Anaesthetists of Great Britain and Ireland (AAGBI) in London in January 2012. Twitter activity was compared with Twitter activity previously reported for the AAGBI Annual Conference (September 2011 in Edinburgh). All tweets posted were categorized according to the person making the tweet and the purpose for which they were being used. The categories were determined from a literature review. Results A total of 227 tweets were posted under the #WSM12 hashtag representing a 530% increase over the previously reported anesthetic conference. Sixteen people joined the Twitter stream by using this hashtag (300% increase). Excellent agreement (κ = 0.924) was seen in the classification of tweets across the 11 categories. Delegates primarily tweeted to create and disseminate notes and learning points (55%), describe which session was attended, undertake discussions, encourage speakers, and for social reasons. In addition, the conference organizers, trade exhibitors, speakers, and anesthetists who did not attend the conference all contributed to the Twitter stream. The combined total number of followers of those who actively tweeted represented a potential audience of 3603 people. Conclusions This report demonstrates an increase in uptake and growth in the use of Twitter at an anesthetic conference and the review illustrates the opportunities and benefits for medical education in the future.

The emergent discipline of health web science

The transformative power of the Internet on all aspects of daily life, including health care, has been widely recognized both in the scientific literature and in public discourse. Viewed through the various lenses of diverse academic disciplines, these transformations reveal opportunities realized, the promise of future advances, and even potential problems created by the penetration of the World Wide Web for both individuals and for society at large. Discussions about the clinical and health research implications of the widespread adoption of information technologies, including the Internet, have been subsumed under the disciplinary label of Medicine 2.0. More recently, however, multi-disciplinary research has emerged that is focused on the achievement and promise of the Web itself, as it relates to healthcare issues. In this paper, we explore and interrogate the contributions of the burgeoning field of Web Science in relation to health maintenance, health care, and health policy. From this, we introduce Health Web Science as a subdiscipline of Web Science, distinct from but overlapping with Medicine 2.0. This paper builds on the presentations and subsequent interdisciplinary dialogue that developed among Web-oriented investigators present at the 2012 Medicine 2.0 Conference in Boston, Massachusetts.

A 5-year observational study of cancellations in the operating room: Does the introduction of preoperative preparation have an impact?

Background: Preoperative preparation (assessment) of patients reduces cancellations on the day of surgery. A Center for Reviews and Dissemination review (2007) concluded “the evidence was weak and it was uncertain that preassessment reduced cancellations.” The aim of this study was to observe the impact of a preoperative preparation clinic on cancellations of operating room cases on the day of surgery, and in particular on those causes of cancellation on the day of surgery which were expected to be affected by preoperative preparation. Materials and Methods: Observational study conducted in a 194 bed District General Hospital in the United Kingdom from April 1, 2006 to March 31, 2011. 42,082 operating room cases were scheduled for operation during this period. Surgical sessions which did not require anesthetic input were excluded. Contemporaneous data were collected and analyzed on a monthly basis, and also grouped by year over a 5-year period. The cancellations on the day of surgery were divided into two groups: Those considered to be affected by preoperative preparation and those which were not. Comparisons were made between these two groups and between individual reasons for cancellation. Results: A total of 28,928 cases met the inclusion criteria. The clinic introduction reduced cancellations considered to be affected by preoperative preparation from 462 to 177 (78% and 42% total cancellations, respectively) (P < 0.001). There was a decrease in cancellations due to patients who did not arrive (P < 0.001) and medical reasons (P < 0.001), but an increase in the number of cancellations by the patients themselves (P = 0.002). Cancellations due to lack of beds and “other” reasons both increased (P < 0.001) across the study period. Conclusions: This study suggests that the introduction of preoperative preparation clinics for patients reduces cancellations on the day of surgery.

Searching for pelvic floor muscle exercises on YouTube: what individuals may find and where this might fit with health service programmes to promote continence.

Objective. This paper describes the investigation, categorization/characterization and viewing of pelvic floor muscle exercises (PFME) on YouTube from the perspective of the ‘wisdom of the crowd’. The aim of the research was to increase awareness of the type of clips that individuals are likely to come across when searching YouTube and to describe trends and popularity. This awareness will be useful for the design of continence promotion services, especially for hard-to-reach individuals. Study design. Web-based videos relating to PFE were identified by searching YouTube using the snowball technique. Main outcome measures. Number of views; the approach taken (health, fitness, sexual and pregnancy); product promotion; and the use of music, visual cues and elements designed to encourage exercise. The number of views of each video was recorded at three points over a seven-month period. Results. Twenty-two videos were identified. Overall these videos had been viewed over 430,000 times during the study period. One video was viewed over 100,000 times and overall the median increase in views was 59.4%. Conclusions. YouTube is increasingly used to access information about pelvic floor exercises. Different approaches are used to communicate PFME information but there are no formal structures for quality control. Further research is required to identify which elements of the video clips are effective in communicating information and in motivating exercise and to establish appropriate protocols. Kitemarking is recommended in order that women obtain correct advice.

The need to do better – Are we still letting our patients down and at what cost?

Objective To survey women’s views on HRT and alternative therapies and make comparisons with 2007 data. Study design A questionnaire on a UK patient-tailored independent clinician-led website with anonymous responses analysed using descriptive statistics. Main outcome measures Answers to survey questions in 2007 and 2014. Results A total of 1476 responses from 33 countries were obtained. Almost 70% of respondents had used/would consider using HRT. Over the last 5 years, 27.7% felt that their views had changed for the better. Most obtained information from health professionals or the Internet. About 51.1% felt that their family doctor did not recognise the importance of the menopause with one-third feeling resistance to being offered HRT. Compared to 2007, significantly more women were aware of the different risks associated with different types of HRT. More women were able to respond positively to the question asking whether or not they felt able to make an informed choice regarding HRT/alternative therapies. Conclusions There has been negativity and confusion regarding HRT management since the beginning of the millennium. Our findings suggest that we, as health professionals, continue to let our patients down with poor provision of information, inaccurate or wrong information, or access to the right care. The cost of this is women living with preventable sequelae associated with the menopausal transition with a consequent adverse impact on health and the health economy. The importance of the menopause consultation as part of a life course approach is highlighted as well as the emerging discipline of Health Web Science.

Health Web Science

The transformative power of the Internet on all aspects of daily life, including health care, has been widely recognized. These transformations reveal opportunities realized, the promise of future advances, and the problems created by the penetration of the World Wide Web for both individuals and for society at large. Health Web Science explores the role of the Web as it drives discussions, technologies, policies, and solutions related to health. We also examine the impact of the Webs health-related uses on the design, structure and evolution of the Web itself. The orientation of Health Web Science, compared to related research domains, motivates innovation in Web technology and better utilization of the Web for communication, collaboration, information access and sharing, remote sensing, and even remote treatment.

Web-based survey ‘Contraception and attitudes to sexual behaviour’ completed by women accessing a UK menopause website

Background and methodology. Sociodemographic trends mean increasing numbers of new relationships in later life. These trends may not only have health consequences for women and health services but also impact on the targeting of sexual health messages. This study aimed to examine attitudes and knowledge surrounding contraception, sexual health and unwanted pregnancy among those accessing the website www.menopausematters.co.uk. A voluntary online survey was completed. Results. Survey was completed by 550 respondents. Three hundred and sixty-six women, 94% of whom self-classified as pre- or perimenopausal, had been sexually active with a male partner in the previous four weeks. Commonest contraceptive methods used by perimenopausal and postmenopausal women were condoms, combined oral contraceptive pill (COCP) and male sterilization. Up to 42% of women surveyed were unhappy with their contraception. A total of 27% premenopausal, 32% perimenopausal women and 40% postmenopausal used no contraception. One-third of women were unhappy about this and 19 unplanned pregnancies had occurred. The majority of women were informed regarding COCP use over 35 years, hormone replacement therapy, emergency contraception and ceasing contraception. The majority of women were unaware that more terminations of pregnancy are performed in women over 40 than any other age group per total pregnancies.Almost a third of women were unaware that chlamydia incidence is increasing in older women. Most would use condoms in new relationship. Discussion and conclusions. Women accessing www.menopausematters.co.uk are well informed about contraception and sexual health. The majority of those accessing the site are sexually active, but many use no contraception, or are unhappy with their chosen method, leaving them vulnerable to unwanted pregnancy or sexually transmitted infection.

The future of post-reproductive health – The role of the Internet, the Web, information provision and access

The World Wide Web celebrated its 25th birthday in 2014. In those 25 years, the Web has evolved from static websites (Web 1.0) to a highly complex dynamic system (Web 3.0) with health information processing one of the primary uses. Until now, the western biomedical paradigm has been effective in delivering healthcare, but this model is not positioned to tackle the complex challenges facing healthcare today. These challenges have arisen by increasing healthcare demands across the world, exacerbated by an ageing population, increased lifespan and chronic conditions. To meet these needs, a ‘biopsychosocial’ shift from reactive to proactive health is necessary with a patient-centric emphasis (personalised, preventative, participatory and predictive) that includes ‘gender-specific medicine’. The management of the menopause, part of post-reproductive health, requires a life-course approach as it provides a framework for achieving a women’s preferred health outcome. Surveys from www.menopausematters.co.uk have consistently shown that women do not feel informed enough to make decisions regarding Hormone Replacement Therapy and alternative therapies. Health professionals must meet this challenge. The recently published National Institute for Health and Care Excellence guidance on the diagnosis and management of the menopause highlights the need for tailored information provision. The Internet underpinned by the academic disciplines of Health Web Science and Medicine 2.0 has potential to facilitate this shift to biopsychosocial medicine and tailored information within a life-course framework. The concept of Health Web Observatories and their potential benefit to a life-course approach using tools such as www.managemymenopause.co.uk is discussed.

Health web science: application of web science to the area of health education and health care

In the western world, the characteristic age of the patient population who require the most medical support for longer durations is increasing. The current model for supporting health care is not sustainable for this greater need. Given that the web has emerged as a daily part of life for much of the western world, it may be one route to finding solutions that improve this situation. Commerce, education, entertainment and individuals have embraced the potential of the World Wide Web and seen revolutionary benefits in the way they operate. Indeed the users of the web have influenced the development of the web, co-creating it into the form that it exists today. This leads to the question of whether health provision and education, which have already started to move into the area of the web, create an environment in which individuals and communities become more responsible for their own health and treatment? With an been increased interest internationally in E-Health, Health 2.0, Medicine 2.0 and the recent birth of the discipline of Web Science, this workshop aimed to investigate the application of Web Science to health education and health care. This paper reports on the first Health Web Science Workshop which took place on June 15, 2011, at the WebSCi11 conference in Koblenz, Germany. The workshop aimed to lead a discussion about the application of Web Science to Health education and provision. This paper describes the papers presented, the arising discussion and the identified next steps.

Formulating ehealth utilizing an ecological understanding

Current evaluation and impact of health care on health outcomes via the Internet is limited in its scope in terms of feedback and interaction between the Web, health-care providers, and patients.