Nicole M. Paradise Black

The Intersection of Online Social Networking with Medical Professionalism

AimTo measure the frequency and content of online social networking among medical students and residents.MethodsUsing the online network Facebook, we evaluated online profiles of all medical students (n = 501) and residents (n = 312) at the University of Florida, Gainesville. Objective measures included the existence of a profile, whether it was made private, and any personally identifiable information. Subjective outcomes included photographic content, affiliated social groups, and personal information not generally disclosed in a doctor–patient encounter.ResultsSocial networking with Facebook is common among medical trainees, with 44.5% having an account. Medical students used it frequently (64.3%) and residents less frequently (12.8%, p < .0001). The majority of accounts (83.3%) listed at least 1 form of personally identifiable information, only a third (37.5%) were made private, and some accounts displayed potentially unprofessional material. There was a significant decline in utilization of Facebook as trainees approached medical or residency graduation (first year as referent, years 3 and 4, p < .05).DiscussionWhile social networking in medical trainees is common in the current culture of emerging professionals, a majority of users allow anyone to view their profile. With a significant proportion having subjectively inappropriate content, ACGME competencies in professionalism must include instruction on the intersection of personal and professional identities.

Ankyloglossia, Exclusive Breastfeeding, and Failure to Thrive

A 6-month-old term boy was hospitalized to evaluate the cause of his failure to thrive, mandated as part of an investigation by the Department of Children and Families after an allegation of medical neglect was made. On admission the patient was below birth weight, and a medical workup for failure to thrive was pursued; however, he was noted to have severe ankyloglossia and was an exclusively breastfed infant. The only interventions during his hospitalization were frenotomy and assistance to the mother to increase her milk supply. The infant immediately experienced weight gain and has continued to show slow, but steady, weight gain as an outpatient. We illustrate here many of the controversies concerning ankyloglossia.

Online social network use by health care providers in a high traffic patient care environment.

Background The majority of workers, regardless of age or occupational status, report engaging in personal Internet use in the workplace. There is little understanding of the impact that personal Internet use may have on patient care in acute clinical settings. Objective The objective of this study was to investigate the volume of one form of personal Internet use—online social networking (Facebook)—generated by workstations in the emergency department (ED) in contrast to measures of clinical volume and severity. Methods The research team analyzed anonymous network utilization records for 68 workstations located in the emergency medicine department within one academic medical center for 15 consecutive days (12/29/2009 to 1/12/2010). This data was compared to ED work index (EDWIN) data derived by the hospital information systems. Results Health care workers spent an accumulated 4349 minutes (72.5 hours) browsing Facebook, staff cumulatively visited Facebook 9369 times and spent, on average, 12.0 minutes per hour browsing Facebook. There was a statistically significant difference in the time spent on Facebook according to time of day (19.8 minutes per hour versus 4.3 minutes per hour, P<.001). There was a significant, positive correlation between EDWIN scores and time spent on Facebook (r=.266, P<.001). Conclusions Facebook use constituted a substantive percentage of staff time during the 15-day observation period. Facebook use increased with increased patient volume and severity within the ED.

Pediatrics After-Hours: A Twenty-Year Academic-Community Partnership for Acute Care Delivery

A ccess to extended primary care hours in a nonemergency setting is essential to any health care system serving children. In many communities, after-hours care of sick children is performed by physicians in group practices, is shared among practitioners of different groups, or is handled by nonemergent visits to emergency departments. Some practices use centralized call centers to manage and triage after-hours calls from patients of multiple providers. Thereafter, patients requiring after-hours evaluation by a physician may also be referred to local emergency rooms, where they may, or may not, be seen by pediatricians. This after-hours care model is labor intensive, does not afford continuity of care, and does not ensure that all children are evaluated by pediatricians. To address these shortcomings, the University of Florida (UF) Pediatric After-Hours (PAH) program was established in 1993. PAH provided benefit to both the community pediatricians and the pediatric resident education curriculum. The pediatricians benefitted by decreasing the frequency of on-call nights from every 3 nights on average to 2-3 times per month. Under the tutelage of experienced pediatricians, the residents learned how to deal with after-hours medical issues and to determine who needed to be seen, what could be dealt with over the phone, and who required additional laboratory and imaging studies. This program offers an after-hours medical home for all pediatric patients in the community who are seen by a community pediatrician or a university-based general pediatrician, and the program involves all pediatricians in the local area. It also is an important educational opportunity and teaches this model of care to pediatric trainees.

Two Cases of a Neonatal Interlabial Mass Presenting Within 30 Hours of Each Other: Coincidence or Underdiagnosed and Underreported Finding?

A 40-week gestational age girl was born via spontaneous vaginal delivery to a 34 year-old prima gravida, with blood type AB negative and prenatal testing negative for syphilis, HIV, Hepatitis B, gonorrhea, chlamydia, and group B Streptococcus. The mother had a history of uterine fibroids. The patient’s APGAR scores were 9 and 9 at 1 and 5 minutes, respectively, and she was appropriate for gestational age (AGA) for height, weight, and head circumference. Her physical exam was normal, with the exception of the genitourinary exam, which demonstrated a spherical mass that was 1 cm in diameter. The mass appeared marblelike, yellowish in color, shiny with surface vascularity, and mildly balladable to touch. The patient’s urethra and vaginal opening were obscured by the mass. The patient urinated within the first 24 hours of life; however, the urine stream was not visualized. Pediatric surgery was consulted, and the teams agreed that the mass appeared to be consistent with a paraurethral cyst. Given the large size of the mass and the parents’ anxiety, the team decided to carry out exploration under anesthesia on the second day of life. The mass was to the left of the urethra between a normal clitoris and vaginal introitus. A 5 French feeding tube was used to catheterize the urethra and good urine flow was observed. The vagina was examined using a Storz cytoscope and was found to be normal as well. A 25-gauge needle was used to drain 5 to 6 mL of milky colored fluid from the mass, which completely decompressed. The patient tolerated the procedure well with no evidence of any abnormality postsurgery. She was discharged home the following day. Postoperative follow-up 4 weeks later revealed no recurrence of the cyst.