For doctors: How to start using social media

How to start

My advice for doctors who are interested in using social media for professional purposes is simple:

- Start on Twitter, expand to a blog as natural progression.

- Input your blog posts automatically to a Facebook like/fan page.
- Listen to the leading physicians, nurses and patients' voices on Twitter, and reply.
- Comment on blogs.
- Do not be afraid to share your expertise.
- Comply with HIPAA and common sense.

I posted this on Twitter yesterday: Doctors, when you don't have time to write a blog post, record a video - the orthopedic surgeon @hjluks shows how it's done: http://goo.gl/jL73J


Howard J. Luks, MD

@Doctor_V (Bryan Vartabedian) said, "My blog is my home. Twitter and Facebook are outposts."

I actually disagree a bit. My use of Twitter goes beyond a simple outpost. It's my digital notebook and idea feedback system.

The circle of online information for me is as follows: Google Reader -> Share on Twitter -> Get feedback -> Write a blog post -> Share via RSS and Twitter -> Get feedback, go on.

Here is how to facilitate the Rise of the ePhysican who works hand in hand with the ePatient:

Substance over style

Going back to the video embedded above, I think that @hjluks is the current leader in creating original, honest, tell-it-like-it-is clinical content among physicians. This is an example to follow. The technical execution does not have to be perfect, as you will see from the discussion started on Twitter and summarized below. However, the content must be factually correct and professional.

@yayayarndiva (P. Mimi Poinsett MD) had a few comments about the technical aspects of the video such as "if you are going to do a video - make your background a tad less busy:)"

I actually liked the background - it's "authentic" and gives you something to look at during the 8-minute video.

@hjluks actually polled 100 patients on that. They like the laid back office view.

@yayayarndiva P. (Mimi Poinsett MD) thought that "authentically messy AND 8 min video with a head in bouncing chair - think I would rather read the transcript... I think docs like everyone else can sharpen their presentation skills with video... still good to continue. Video? A talking head doesn't confer authenticity- just a new toy:)... Or you could use Dragon software and dictate your post..."

@ePatientDave (Dave deBronkart) convinced @hjluks to do the transcripts, primarily for Google. "Otherwise, thy pearls of light are hidden under a YouTube bushel. I emphasize it's not just *marketing* SEO - it's for being findable for those in need", said @ePatientDave.

I agree. You need the transcript for SEO and quick info. SEO doesn't just apply to marketing - it's a way for people (real humans) to find you online.

Nothing beats video for authenticity though. I understand the concept of creating technically flawless presentations but if you wait to do a perfect video and you are a busy doctor, you may never do it. The same applies to blog posts - if you are going to write a blog post for 2 months, write a journal article instead.

I had some final encouragement for @hjluks: "You don't have to be pro with video. You are pro as orthopod - who uses video."

I think he liked that.

Do you need a social media policy for your medical practice?

Another good discussion point was brought up by an office manager of a pediatric group in Chicago: Do you need a social media policy for your medical practice? http://goo.gl/7APvI - I think you do.

John Sharp and I worked on a social media policy for Cleveland Clinic back in 2005 when all that was a big unknown in healthcare. It still is for many organizations - in terms of professional involvement and outreach. A social media policy provides some much needed guidance and boundaries.

The number one rule is very simple: comply with HIPAA and do not share any of the 18 identifiers: http://goo.gl/WR5MR

12-Word Social Media Policy by Mayo Clinic: "Don’t Lie, Don’t Pry, Don’t Cheat, Can’t Delete, Don’t Steal, Don’t Reveal" (http://goo.gl/1Jwdo).

Top Twitter Doctors

This is a list of the Top Twitter Doctors arranged by specialty in alphabetical order - feel free to add your own suggestions. The list is open to anybody to edit:

Comments from Twitter and Facebook:

Bryan Vartabedian: "When I present this stuff I recommend doctors find 2-3 role models in their specialty and follow them. Watch and study how they do things. Great place to start."

Related reading

What are the Downsides of Social Media for Doctors? Dr. Wes shares insights from 6 years of blogging

Chronic pancreatitis - The Lancet review

There are two forms of chronic pancreatitis

Chronic pancreatitis is a progressive fibroinflammatory disease that exists in 2 forms:

- large-duct forms (often with intraductal calculi)
- small-duct form

Causes of chronic pancreatitis

Chronic pancreatitis results from a complex mix of:

- environmental factors - alcohol, cigarettes, and occupational chemicals
- genetic factors - mutation in a trypsin-controlling gene or the cystic fibrosis transmembrane conductance regulator (CFTR)
- a few patients have hereditary or autoimmune disease

Management of pain

Pain is the main symptom that occurs in two forms:

- recurrent attacks of pancreatitis (representing paralysis of apical exocytosis in acinar cells)
- constant and disabling pain

Management of the pain is mainly empirical, involving:

- potent analgesics
- duct drainage by endoscopic or surgical means
- partial or total pancreatectomy
- steroids rapidly reduce symptoms in patients with autoimmune pancreatitis
- micronutrient therapy to correct electrophilic stress is emerging as a promising treatment

Steatorrhoea, diabetes, local complications, and psychosocial issues associated are additional therapeutic challenges.

References

Chronic pancreatitis. Dr Joan M Braganza DSc a , Stephen H Lee FRCR b, Rory F McCloy FRCS c, Prof Michael J McMahon FRCS d. The Lancet, Volume 377, Issue 9772, Pages 1184 - 1197, 2 April 2011.
Pancreatitis - JAMA Patient Page, 2012.

Image source: Wikipedia, public domain.

U-shaped link between Internet use and children health - beware of heavy use or very little/none

Study participants were categorized into 4 groups according to their intensity of Internet use:

- heavy Internet users (HIUs; >2 hours/day)

- regular Internet users (RIUs; several days per week and 2 hours/day)

- occasional users (1 hour/week)

- and non-Internet users (NIUs; no use in the previous month)

Health factors examined were:

- perceived health

- depression

- overweight

- headaches

- back pain

- insufficient sleep

U-shaped link

Heavy Internet users of both genders were more likely to report higher depressive scores.

Only male users were found at increased risk of overweight and female users at increased risk of insufficient sleep.

Non-Internet users (NIUs) and occasional users also were found at increased risk of higher depressive scores.

Back-pain complaints were found predominantly among male non-Internet users.

There was a U-shaped relationship between intensity of Internet use and poorer mental health of adolescents. Heavy Internet users were confirmed at increased risk for somatic health problems.

Regular Internet use (up to 2 hours per day) is OK

Health professionals should be on the alert when caring for adolescents who report either heavy Internet use or very little/none. Regular Internet use as a normative behavior without major health consequences.

Take home point

Whatever the intensity of your Internet use is (if you are reading this, my guess is that the "intensity" of you sedentary lifestyle is high), don't forget the benefits of regular exercise:


"Health Promotion" video: Benefits of exercise.

References:
A U-Shaped Association Between Intensity of Internet Use and Adolescent Health. PEDIATRICS Vol. 127 No. 2 February 2011, pp. e330-e335 (doi:10.1542/peds.2010-1235)

Image source: Wikipedia, public domain.

Your smartphone use predicts your social life, travel, risk of disease - even political views

The Really Smart Phone: Researchers are harvesting a wealth of intimate detail from cellphone data, uncovering the hidden patterns of social lives, travels, risk of disease - even political views.

Read more from WSJ.

Books that reference ClinicalCases.org and CasesBlog

Internet cool tools for physicians By Melissa L. Rethlefsen, David L. Rothman, Daniel Stéphane Mojon:

Some Blogs We Like: "Clinical Cases and Images – Blog (http:// casesblog.blogspot.com/) – This consistently interesting blog written by Dr. Ves Dimov features case histories, medical news, images, and useful practical technology tips."



Healthcare and the Effect of Technology: Developments, Challenges. Stefane M. Kabene - 2010:

"Giustini (2007) provided a summary of useful Web 2.0 applications in medicine (eg, Ves Dimov's Clinical Cases and Images Blog; Ask Dr. Wiki; Ganfyd."

New Directions in Intelligent Interactive Multimedia - Page 517 George A. Tsihrintzis, Maria Virvou, Robert J. Howlett - 2008.

Computational Intelligence in Healthcare 4: Advanced Methodologies - Page 319 Isabelle Bichindaritz, Lakhmi C. Jain, Sachin Vaidya - 2010.



Medical librarian 2.0: use of Web 2.0 technologies in reference. M. Sandra Wood - 2007.

Social Media Marketing All-in-One For Dummies - Page 76 Jan Zimmerman, Doug Shalin.

Ubiquitous Health and Medical Informatics: The Ubiquity 2.0 Trend and Beyond. Sabah Mohammed, Jinan Fiaidhi - 2010.

The Hospitalist Manual - Page 308 - Manish Mehta, Arun Thomas Mathews - 2009.

The high cost of healthcare in America (infographic)

The high cost of healthcare in America (infographic) - click on the image to see the larger-size file. The site hosting the infographic, MedicalBillingandCoding.org, is one of the URL-grabbing portals that redirects to other sites, so be careful what you click there once you go beyond the image.

Effect of 16-Hour Duty Periods on Patient Care and Resident Education

Dr. Amy Oxentenko details a study appearing in the March 2011 issue of Mayo Clinic Proceedings (available at: http://www.mayoclinicproceedings.com) that looked at the effects of 16-hour duty periods for residents, and the impact of reduced shift length on:

- patient care metrics

- education

- transitions of care

- work hours

- resident satisfaction

Effect of deployment on mental health of soldiers: common disorders and alcohol misuse more frequent than PTSD

This Lancet study examined the consequences of deployment to Iraq and Afghanistan on the mental health of UK armed forces from 2003 to 2009.

9990 (56%) participants completed the study questionnaire (roughly 8000 regulars, 1700 reservists).

The prevalence was:

- 19·7% for symptoms of common mental disorders

- 13% for alcohol misuse

- 4% for post-traumatic stress disorder (PTSD)

Deployment to Iraq or Afghanistan was significantly associated with alcohol misuse for regulars (odds ratio 1·22) and with post-traumatic stress disorder (PTSD) for reservists (2·83)

Symptoms of common mental disorders and alcohol misuse remain the most frequently reported mental disorders in UK armed forces personnel, whereas the prevalence of post-traumatic stress disorder (PTSD) was low.

References:

What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. The Lancet, Volume 375, Issue 9728, Pages 1783 - 1797, 22 May 2010.

What Happened to the Marlboro Marine?

Image source: The Los Angeles Times.

Statins slightly increase risk of cataracts, liver dysfunction, kidney failure and muscle weakness

Statins do NOT prevent a long list of diseases

Statins were not significantly associated with risk of Parkinson’s disease, rheumatoid arthritis, venous thromboembolism, dementia, osteoporotic fracture, gastric cancer, colon cancer, lung cancer, melanoma, renal cancer, breast cancer, or prostate cancer.

Statins may decrease risk of esophageal cancer

Statin use was associated with decreased risks of oesophageal cancer.

Statins slightly increase the risk of liver dysfunction, kidney failure, muscle weakness and cataracts

Statin use was associated with increased risks of moderate or serious liver dysfunction, acute renal failure, moderate or serious myopathy, and cataract.

Is the risk the same with all statins?

Adverse effects were similar across statin types for each outcome except liver dysfunction where risks were highest for fluvastatin.

A dose-response effect was apparent for acute renal failure and liver dysfunction. All increased risks persisted during treatment and were highest in the first year.

How long does the risk last?

After stopping treatment the risk of cataract returned to normal within a year in men and women. Risk of acute renal failure returned to normal within 1-3 years in men and women, and liver dysfunction within 1-3 years in women and from three years in men.

What was the NNT and NNH?

Based on the 20% threshold for cardiovascular risk, for women the NNT with any statin to prevent one case of cardiovascular disease over five years was 37 and for oesophageal cancer was 1266 and for men the respective values were 33 and 1082.

In women the NNH for an additional case of acute renal failure over five years was 434, of moderate or severe myopathy was 259, of moderate or severe liver dysfunction was 136, and of cataract was 33. Overall, the NNHs and NNTs for men were similar to those for women, except for myopathy where the NNH was 91.

Conclusion

Claims of unintended benefits of statins, except for oesophageal cancer, remain unsubstantiated, although potential adverse effects at population level were confirmed and quantified.

Interestingly, the BMJ abstract did not mention increased diabetes risk that was reported in a previous study published in The Lancet.

References:

Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database. BMJ 2010; 340:c2197 doi: 10.1136/bmj.c2197 (Published 20 May 2010).

Balancing the intended and unintended effects of statins. BMJ 2010; 340:c2240 doi: 10.1136/bmj.c2240 (Published 20 May 2010).

People on statins are 9% more likely to develop diabetes according to a meta-analysis
Cholesterol drug side effects need watching: study. Reuters.

Image source: Simvastatin. Wikipedia, public domain.

Selected videos from TEDxMaastricht "The Future of Health"

TEDxMaastricht is the European stage for bright ideas, bold thinkers and innovators in medicine and healthcare. The playlist embedded below includes 16 videos:



References:
TEDxMaastricht selected videos with comments. Laika's MedLibLog.

Aspirin 75 mg daily reduces incidence and mortality due to colorectal cancer

High-dose aspirin (≥500 mg daily) reduces long-term incidence of colorectal cancer, but adverse effects (bleeding) might limit its potential for long-term prevention. The long-term effectiveness of lower doses (75-300 mg daily) is unknown. This study in The Lancet assessed the effects of aspirin on incidence and mortality due to colorectal cancer over 20 years.

In the four trials of aspirin versus control (mean duration of treatment 6 years), 2·8% of 14,000 patients had colorectal cancer during a follow-up of 18 years.

Aspirin reduced the 20-year risk of colon cancer (incidence hazard ratio [HR] 0·76, but not rectal cancer (0·90).

Where subsite data were available, aspirin reduced risk of cancer of the proximal colon (0·45), but not the distal colon (1·10). Benefit increased with duration of treatment - aspirin taken for 5 years or longer reduced risk of proximal colon cancer by 70% and also reduced risk of rectal cancer (0·58).

There was no increase in benefit at doses of aspirin greater than 75 mg daily. However, risk of fatal colorectal cancer was higher on 30 mg versus 283 mg daily.

Aspirin taken for several years at doses of at least 75 mg daily reduced long-term incidence and mortality due to colorectal cancer. Benefit was greatest for cancers of the proximal colon, which are not otherwise prevented effectively by screening with sigmoidoscopy or colonoscopy.

References:
Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. The Lancet, Volume 376, Issue 9754, Pages 1741 - 1750, 20 November 2010.

Image source: Colon (anatomy), Wikipedia, public domain.

Decompression illness - Lancet review

Decompression illness is caused by intravascular or extravascular bubbles that are formed as a result of reduction in environmental pressure (decompression).

Types of decompression illness

The term decompression illness covers 2 entities:

- arterial gas embolism, in which alveolar gas or venous gas emboli (via cardiac shunts or via pulmonary vessels) are introduced into the arterial circulation

- decompression sickness, which is caused by in-situ bubble formation from dissolved inert gas

Both syndromes can occur in divers, compressed air workers, aviators, and astronauts, but arterial gas embolism also arises from iatrogenic causes unrelated to decompression.

Risk of decompression illness is affected by immersion, exercise, and heat or cold.

Clinical features of decompression illness

Manifestations of this condition include a wide range of symptoms and signs:

- itching and minor pain

- neurological symptoms

- cardiac collapse

- death

Treatment of decompression illness

First-aid treatment is 100% oxygen. Definitive treatment is recompression to increased pressure, breathing 100% oxygen.

Adjunctive treatments include fluid administration and prophylaxis against venous thromboembolism in paralysed patients.

Prognosis of decompression illness

Treatment is effective in most cases although residual deficits can remain in serious cases, even after several recompressions.

References:
Decompression illness. The Lancet, Volume 377, Issue 9760, Pages 153 - 164, 8 January 2011.
Image source: OpenClipArt.org, public domain.

Positive thinking: 1-minute video advice from a Cleveland Clinic psychologist

Positive thinking. Stop thinking bad thoughts. Scott Bea, Clinical Psychologist, offers a simple solution to negative thoughts. He discusses how mindfulness encourages positive thoughts. Uploaded by ClevelandClinic on Apr 4, 2011.

Gout update: New drugs for an old disease

Febuxostat is a non-purine-analogue inhibitor of xanthine oxidase that opened a new era in the treatment of gout.

Modified uricases

The use of modified uricases to rapidly reduce serum urate concentrations in patients with otherwise untreatable gout is progressing. Pegloticase, a pegylated uricase, is in development.

JAMA update, 08/2011: New Treatment Offers Hope for Patients With Severe Gout: pegloticase (Krystexxa) costs $2,500 per dose (http://goo.gl/gz9sO).

Drugs in development

Transport of uric acid in the renal proximal tubule and the inflammatory response to monosodium urate crystals (shown above) are targets for potential new treatments.

Several pipeline drugs for gout related to the targets above include:

- selective uricosuric drug RDEA594

- various interleukin-1 inhibitors. Canakinumab (trade name Ilaris) is a human monoclonal antibody targeted at interleukin-1 beta. It was rejected by the FDA panel in June 2011.

References:

Gout therapeutics: new drugs for an old disease. The Lancet, Volume 377, Issue 9760, Pages 165 - 177, 8 January 2011.
Diuretics, beta-blockers, ACEi, non-losartan ARBs associated with increased risk of gout vs. CCB lower risk. BMJ, 2012.

With FDA Approval, a Gout Drug Now Costs $5 Instead of Pennies - WSJ, 2011.

FDA Panel Rejects Gout Drug Canakinumab on Safety Concerns http://goo.gl/lO9uy
The strange story that links gout with the birth of the cocktail drinks. Lancet, 2012.

Image source: Spiked rods of uric acid (MSU) crystals from a synovial fluid sample photographed under a microscope with polarized light. Wikipedia, public domain.

10 Ways to Increase Your Physical Activity

Some helpful tips from one of the PLoS blogs, Obesity Panacea:

1. Take the stairs as often as possible.
2. Drink plenty of water.
3. Park as far from the front door as possible.
4. Clean your home regularly.
5. Gardening and yardwork.
6. Disconnect your cable for the summer.
7. Buy a pedometer.
8. Use active transportation and public transit.
9. Have “walk-meetings”.
10. Go for a family walk after dinner.

"Health Promotion" video: Benefits of exercise:

Telomeres are the chromosome tips which shorten each time a cell divides, making them a possible marker of aging. Exercise delays telomere shortening, and potentially slows the aging process in humans. A study of 2400 twins showed that physically active people had longer telomeres than sedentary people. According to the authors, this provides a powerful message that could be used by clinicians to promote the potentially antiaging effect of regular exercise.


Human chromosomes (grey) capped by telomeres (white). Image source: Wikipedia, public

domain.

References:

10 Simple Ways to Increase Your Physical Activity

Image source: OpenClipArt.org, public domain.

Headache? It could be that blade in skull (CNN video)

CNN: "I've got these stabbing pains" - Man complains about migraine, finds he has had a knife in his brain for 4 years.

Related reading:

Daily Mail