The use and impact of Twitter at medical conferences: Best practices and Twitter etiquette

The use of social media, and in particular, Twitter, for professional use among healthcare providers is rapidly increasing across the world. One medical subspecialty that is leading the integration of this new platform for communication into daily practice and for information dissemination to the general public is the field of hematology/oncology. A growing amount of research in this area demonstrates that there is increasing interest among physicians to learn not only how to use social media for consumption of educational material, but also how to generate and contribute original content in one’s interest/expert areas. One aspect in which this phenomenon has been highlighted is at the time of maximum new information presentation: at a major medical conference. Hematologists/oncologists are engaging regularly in one of the most common forms of social media, Twitter, during major medical conferences, for purposes of debate, discussion, and real-time evaluation of the data being presented. As interest has grown in this area, this article aims to review the new norms, practices, and impact of using Twitter at the time of medical conferences, and also explores some of the barriers and pitfalls that users are encountering in this emerging field.     

Use of platelets and other transfusion products in patients with malignancy.

The need for blood components for oncology patients is small compared with the need for patients with hematologic malignancies. Appropriate use of blood components is necessary, not only medically, but also because of limited supply and availability. Agreement on when to use components is extremely important. In fact, at the time of this writing, the Transfusion Practices Committee of the AABB is conducting an extensive survey on the use of platelets in the oncology and hematology cancer patients (Questionnaire on Institutional Policy on Platelet Transfusion Practice for Hematology/Oncology Patients). The results will, it is hoped, provide a consensus on the proper times and counts that require prophylactic use of components for these patients. Since these patients use the vast majority of components (see Table 15), their proper use is imperative to maintaining an adequate platelet and frozen plasma supply. Transfusion support in cancer patients is vital for their survival. Platelets, in particular, are necessary to prevent serious bleeding. However, refractoriness to platelet transfusions can develop. It must be appreciated that refractoriness is not a general problem and need not require the expensiveness of a universal decision for handling all platelet transfusions in the same manner. Total refractoriness probably occurs in 15 to 20% of patients frequently transfused. In patients in whom frequent platelet transfusion is anticipated, that is, bone marrow transplantation, the development of platelet refractoriness may be reduced by using SDPC and administering them through leukocyte filters. Patients who become refractory to either random or SDPC can either be cross-matched for single-donor platelets that are compatible or can be given HLA-A,B matched platelets. Certainly, the success of platelet transfusion in leukemic patients cannot be denied, since only a small number of these patients now die because of bleeding due to platelet refractoriness. Most of the serious bleeding still seen is associated with sepsis. The risks from transfusion must always be considered. Fortunately, with increased monitoring of the blood supply, they have been reduced. As with any therapeutic regimen, these risks must be weighed against the benefit the patient may gain. Transfusion should always be used prudently.     

Statements on the interdependence between the oncologist and the geriatrician in geriatric oncology

Geriatric oncology is defined by the multidimensional and multidisciplinary approach of the elderly cancer patients. Autonomy, beneficence, non-maleficence and justice are the four fundamental principles on which are based the treatment objectives and practical management of these patients. The comprehensive geriatric assessment is the tool the most likely to detect the functional problems in these elderly patients. The standard oncologic managements of cancer are applicable to these patients. However treatment plan and geriatric interventions must be tailored to each individual patient characteristics. Thus a strong interdependence between oncologic and geriatric teams is warranted. This implies specific teaching programs during initial medical studies and in the setting of continuous medical education. Furthermore, such worldwide teaching programs may help to the implementation of geriatric oncology programs which is only based, to date, on personal experiences as described in this report.     

A Digital Ethnography of Medical Students who Use Twitter for Professional Development

BACKGROUND

While researchers have studied negative professional consequences of medical trainee social media use, little is known about how medical students informally use social media for education and career development. This knowledge may help future and current physicians succeed in the digital age.

OBJECTIVE

We aimed to explore how and why medical students use Twitter for professional development.

DESIGN

This was a digital ethnography.

PARTICIPANTS

Medical student “superusers” of Twitter participated in the study

APPROACH

The postings (“tweets”) of 31 medical student superusers were observed for 8 months (May–December 2013), and structured field notes recorded. Through purposive sampling, individual key informant interviews were conducted to explore Twitter use and values until thematic saturation was reached (ten students). Three faculty key informant interviews were also conducted. Ego network and subnetwork analysis of student key informants was performed. Qualitative analysis included inductive coding of field notes and interviews, triangulation of data, and analytic memos in an iterative process.

KEY RESULTS

Twitter served as a professional tool that supplemented the traditional medical school experience. Superusers approached their use of Twitter with purpose and were mindful of online professionalism as well as of being good Twitter citizens. Their tweets reflected a mix of personal and professional content. Student key informants had a high number of followers. The subnetwork of key informants was well-connected, showing evidence of a social network versus information network. Twitter provided value in two major domains: access and voice. Students gained access to information, to experts, to a variety of perspectives including patient and public perspectives, and to communities of support. They also gained a platform for advocacy, control of their digital footprint, and a sense of equalization within the medical hierarchy.

CONCLUSIONS

Twitter can serve as a professional tool that supplements traditional education. Students’ practices and guiding principles can serve as best practices for other students as well as faculty.

Electronic supplementary material

The online version of this article (doi:10.1007/s11606-015-3345-z) contains supplementary material, which is available to authorized users.KEY WORDS: social media, undergraduate medical education, internet, twitter, professional development     

The quality of medical evidence in hematology-oncology

PURPOSE: The purpose of this study was to evaluate the quality of the medical evidence available to the clinician in the practice of hematology/oncology. METHODS: We selected 14 neoplastic hematologic disorders and identified 154 clinically important patient management decision/interventions, ranging from initial treatment decisions to those made for the treatment of recurrent or refractory disease. We also performed a search of the scientific literature for the years 1966 through 1996 to identify all randomized controlled trials in hematology/oncology. RESULTS: We identified 783 randomized controlled trials (level 1 evidence) pertaining to 37 (24%) of the decision/interventions. An additional 32 (21%) of the decision/interventions were supported by evidence from single arm prospective studies (level 2 evidence). However, only retrospective or anecdotal evidence (level 3 evidence) was available to support 55% of the identified decision/interventions. In a retrospective review of the decision/interventions made in the management of 255 consecutive patients, 78% of the initial decision/interventions in the management of newly diagnosed hematologic/oncologic disorders could have been based on level 1 evidence. However, more than half (52%) of all the decision/interventions made in the management of these 255 patients were supported only by level 2 or 3 evidence. CONCLUSIONS: We conclude that level 1 evidence to support the development of practice guidelines is available primarily for initial decision/interventions of newly diagnosed diseases. Level 1 evidence to develop guidelines for the management of relapsed or refractory malignant diseases is currently lacking.     

Impact of social media for the hematologist/oncologist

In the era of modern communication, the physician and patient relationship has evolved to include an entirely new dimension—social media. This new dimension offers several opportunities for patient education, research and its dissemination, and professional development for health care providers; it can also serve as a platform for addressing important public health issues. However, these advantages come with challenges such as threats to patient and professional privacy. In this article, we dissect the benefits and drawbacks of this social evolution on the practicing hematologist-oncologist. We also perform a review of the current literature on the integration of social media in the practice of hematology/oncology; examine available guidelines for information exchange between health care professionals, industry, pharmaceutical companies, advocacy groups, and patients; and offer ways to create its seamless integration into clinical hematology-oncology practice.     

The European Hematology Association: strengthening hematology in Europe and beyond

European hematology is increasingly recognized as a medical speciality that contributes to public health through the development of new therapies for the management of malignant and nonmalignant blood diseases. The European Hematology Association (EHA) is a nonprofit scientific association that represents European medical professionals with an active interest in hematology. Our aim is to promote excellence in clinical practice, research and education in European hematology. An executive board and councillors elected by the members form the governmental body of EHA and are responsible for the strategy and organization of the association. Various EHA committees and units are assigned to the activities and programs of the EHA. The EHA has an important role to play by making education and training easily accessible in Europe and further afield. In order to best serve the European hematologist, the association has developed scientific programs and activities in a variety of areas. Besides focusing on European hematology, the EHA has also dedicated itself to outreach programs; an initiative to complement the needs of hematology education and to emphasize important topics of benefit to hematologists, not only in Europe, but also in other regions.     

Pharmacology of anticoagulants used in the treatment of venous thromboembolism

Anticoagulant drugs are the foundation of therapy for patients with VTE. While effective therapeutic agents, anticoagulants can also result in hemorrhage and other side effects. Thus, anticoagulant therapy selection should be guided by the risks, benefits and pharmacologic characteristics of each agent for each patient. Safe use of anticoagulants requires not only an in-depth knowledge of their pharmacologic properties but also a comprehensive approach to patient management and education. This paper will summarize the key pharmacologic properties of the anticoagulant agents used in the treatment of patients with VTE.     

Subspeciality training in hematology and oncology, 2003: results of a survey of training program directors conducted by the American Society of Hematology

A survey of directors of adult and pediatric hematology/oncology subspecialty training programs in the United States and Canada was conducted to assess the environment in which recruitment and training is conducted in these medical disciplines. A total of 107 program directors responded to the survey, representing 66% of internal medicine and 47% of pediatric subspecialty programs in hematology or hematology/oncology. Specific areas covered in the web-based questionnaire included the type and demographics of the training program, profile of the training program director, characteristics of the applicant pool and existing trainee recruits, characteristics of the training program environment and curricula, research productivity of trainees, and the career pathways taken by recent training program graduates (including dominant areas of clinical interest). The results of this survey show considerable heterogeneity in the recruiting practices and the environment in which subspecialty training occurs, leading the authors to recommend improvements in or a heightened attention to issues, including recruitment of minority trainees, flexibility to recruit international medical school graduates, timing of trainee acceptance, maintaining the financial support of Medicare graduation medical education (GME), training of physician scientists, organization of the continuity clinic experience, visibility of nonmalignant hematology as a career path, and level of training program director support.     

Isolated thrombocytopenia induced by thalidomide in a patient with multiple myeloma: case report and review of literature

Thalidomide is being increasingly used in hematology and oncology. Its use is associated with neuropathy, sedation, edema, fatigue, constipation, and deep venous thrombosis. Cytopenias are unusual, but there are case reports. However, there are no reports of isolated thrombocytopenia. We describe here a case of prolonged isolated thrombocytopenia most likely caused by thalidomide. The patient's in platelet count decreased promptly after an increase in the dose and improved after discontinuation of the drug. The relevant literature is reviewed.     

Patient adherence to oral anticancer drugs: an emerging issue in modern oncology

The steady increase in the use of oral anticancer drugs in modern oncology has created a paradigm shift, challenging traditional attitudes towards cancer care and requiring new concepts of organization of oncology services. Important issues are the prolonged treatment period, management of toxicity, treatment adherence, reimbursement conditions and patient and family education. Although most patients generally prefer oral therapy over intravenous treatment for reasons of convenience, the daily use of oral anticancer drugs can be a challenging commitment for many patients. Reports on adherence and persistence among patients with cancer show that adherence ranges from 16% to 100%, depending on the type of therapy and the measurement/definition of adherence. Apart from demographic, disease and therapy related factors, the determinants that mostly influence (non-)adherence are the satisfaction with care activities performed at the initiation of the drug treatment, and the perceived necessity of treatment. Therefore, patient education addressing these issues is considered the cornerstone of successful oral anticancer treatment. Studies examining the role of different health care providers in the pharmacotherapeutic care of patients with cancer, treated with oral anti-cancer drugs, support the need for a multidisciplinary approach to achieve a maximum benefit for the individual patient and consequently for the whole health system. Limiting adverse events and developing appropriate supportive care are only some aspects that need to be considered in this.     

Bacterial contamination of platelet components: potential solutions to prevent transfusion-related sepsis

Bacterial contamination of platelet components (PC) is the most prevalent risk for transfusion-transmitted infection. Based on the recent studies with optimal culture methods of expired PC, the prevalence of bacterial contamination is estimated to occur in approximately one in 750 to one in 1000 PC. Only within the last few years have the magnitude of the risks and the range of clinical outcomes associated with bacterial contamination been extensively characterized. Despite increased recognition of bacterial contamination of PC, transfusion-related sepsis is infrequently reported. This has largely been attributed to passive reporting systems, and low levels of clinical awareness for transfusion-related sepsis by primary care physicians. The risk for transfusion of contaminated PC has generally been characterized per component. Importantly, because patients require repeated transfusions of PC during a period of transfusion-dependent thrombocytopenia, it is appropriate to express the risk to receive a contaminated PC on a patient exposure basis. Assuming that the average hematology oncology patient may receive seven PC during a 28-day period of support, the risk of exposure to a contaminated PC is in the range of one in 150 per patient. This level of risk would not be acceptable for other intravenous medications. With increased appreciation of the risk of bacterial contamination, methods were developed to limit the risk of transfusion-transmitted bacteremia. This article focuses on those interventions that have been implemented in routine practice. The most important methods employed to mitigate the risk are improved skin disinfection, initial blood draw diversion, bacterial detection and pathogen inactivation/reduction. These technologies are now undergoing increased use in the clinical practice of transfusion medicine. With increased use, additional data are being generated to more fully characterize the effects of these interventions. Improved disinfection, blood diversion and bacterial detection have decreased, but not resolved the risk of bacterial contamination. Pathogen inactivation/reduction offers the potential for a further substantial decrease of the risk for transfusion of PC contaminated with bacteria.     

Survey of isolation practices at a tertiary care pediatric hospital

BACKGROUND: Although isolation precautions are an important aspect of hospital infection control, current rates of isolation in a pediatric hospital and rates of compliance with established precautions are unknown. We therefore initiated hospital-wide point prevalence studies to determine unit-specific rates of patient isolation and compliance with proper isolation requirements focusing on communication of isolation status and availability of personal protective equipment. In this report, we present data from the first 14 months of the study. METHODS: This was a prospective observational study. Twice monthly, between January 2004 and February 2005, infection control professionals reviewed the types and appropriateness of isolation of all hospitalized patients, except for those on the psychiatry unit. RESULTS: Seventeen percent of patients in the hospital during the study period were isolated, most frequently for community-acquired infections. Droplet isolation precautions were the most common form of isolation. Overall, only 74.6% of patients were isolated appropriately. The solid organ transplantation, hematology/oncology, and bone marrow transplantation units were those with the highest rates of inappropriate isolation. CONCLUSION: At our hospital, community-acquired infections, in particular respiratory infections, were the most common reasons for patient isolation. Monitoring of the appropriateness of isolation precautions offers the opportunity to reduce health care-related transmission of infection and identify specific target areas for improvement.     

Narrative research: a review of methodology and relevance to clinical practice

Using qualitative narrative research to explore how people proceed through cancer diagnosis and treatment may help clinicians render better care and consequently enhance the probability of optimal health outcomes. Narrative research can be defined as collecting and analyzing the accounts people tell to describe experiences and offer interpretation. Often, oncology clinicians use narrative methods to investigate issues such as clinical outcomes, coping, and quality of life. Narrative research provides an option to explore personal experiences beyond the boundaries of a questionnaire, providing insight into decisions involving treatment, screening or various health practices, which can help guide how health care services are developed and provided. The purpose of this article is to illustrate the use of narrative research methods to a clinical audience who may not be as familiar with narrative technique. Definitions of narrative research, examples of published research using narrative methods in healthcare, validity and data analysis will be addressed. A review of current literature from sociology, anthropology, nursing and psychology demonstrates that narrative methods are an effective research option that can lead to enhanced patient care.     

Evaluation of the Sysmex pocH-1001 haematology analyser in an outdoor oncology service

Since rapid blood count analysis as near patient testing is expanding, we evaluated the use of a Sysmex pocH-100i compact haematology analyser in an outdoor oncology setting according to the recently published International Council for Standardization in Haematology (ICSH) guidelines. In total, 838 blood samples from oncology patients were analysed by pocH-100i and re-analysed by a high-throughput haematology analyser for comparison (Abbott CD-4000 or Sysmex XE-2100) to evaluate in use imprecision, comparability and vote-outs. Imprecision was less than 5%, except for platelet enumeration in the low range (within-run imprecision 7%). Good comparability was found even for platelet enumeration in the low range (r2 = 0.82). Vote-outs were found in 10.6% of examined samples. In conclusion, the Sysmex pocH-100i demonstrates good imprecision conform with former publications, produces reliable results in normal and in lower ranges comparable to the results of high throughput haematology analysers. In a well controlled management plan the Sysmex pocH-100i is suitable for near patient testing in oncology.     

National Study of Internal Medicine Manpower. XVIII: Subspecialty fellowships with a special look at hematology and oncology, 1988-1989

OBJECTIVE: To determine the number and distribution of internists in subspecialty training and compare with data collected since 1976; to determine the distribution of activity of subspecialty fellows; and to focus on hematology and oncology. DESIGN: Repeated mail survey with telephone follow-up. PARTICIPANTS: All directors of subspecialty training programs in internal medicine in the United States. RESULTS: The 1988-1989 census identified 7530 fellows in training, 55 more than in 1987-1988. There are 24 more first-year fellows. Reports on the activities of subspecialty fellows show that, overall, 53% of fellows' time is spent in direct patient care, 20% on basic research, 15% on patient-related research, and 12% in teaching. CONCLUSIONS: The number of internists entering subspecialty training has risen at a considerably slower rate in the last 5 years compared with the 5 years before that. The length of subspecialty training has increased significantly since 1976. There has been a shift in subspecialty choice from hematology to oncology and toward joint programs offering both subspecialties.     

Drug-induced bone disorders

Medications that can induce, osteoporosis, osteomalacia, and osteonecrosis are discussed here. This article provides the mechanism of these adverse events and a brief summary of the most common offending agents. Evidence indicates a definitive association between glucocorticoids and decreased bone mineral density and increased fracture risk. Data are confounded by the inclusion of patients on glucocorticoids with other medical conditions that could also contribute to bone loss. Prevention and treatment strategies of glucocorticoidinduced osteoporosis are outlined, with studies supporting the idea that this adverse effect may be reversible. The clinical implications of these modalities and the management, of this drug-induced disease are patient-specific. Physicians must weigh the risks and benefits of pharmacotherapy with an agent that may cause bone loss. Regardless of the treatment option the patient receives, nonpharmacological measures must be carried out in order to successfully manage the patient. Patient and provider education is crucial for the discussion of the risks and benefits of treatment modalities. In addition, lifestyle modifications, such as smoking cessation, reducing alcohol intake and participating in weight-bearing exercise, is highly recommended. More research in the prevention and treatment modalities, of drug-induced osteoporosis is needed.     

Social Media,Text Messaging,and Email—Preferences of Asthma Patients between 12 and 40 Years Old

Background. Electronic media such as social media (Facebook, Twitter, MySpace), email, and text messaging could be useful in the management of asthma. However, patient use and preferences for electronic media in asthma management is currently unknown. Methods. A survey was sent to asthma patients between 12–40 years of age. The survey collected demographic information, use of electronic media, interest in using electronic media to receive asthma information, and interest in using electronic media to communicate with a health care provider about asthma. Free text entries were encouraged. Results. 145 completed surveys were returned. Text messaging, email, and Facebook were used at least weekly by a majority of respondents (82%, 77%, and 65%, respectively). Email was clearly the most preferred method to receive asthma information and to communicate with a physician. There was some interest in using Facebook or text messaging, whereas Myspace and Twitter had minimal interest. On logistic regression analysis, female and Black or Hispanic participants were more likely to have an interest in the use of electronic media for asthma care. Frequent users (>1X/week) of each electronic media type had greater enthusiasm for their incorporation into asthma care. Free text entries revealed that many participants felt social media sites were for connecting with friends rather than for health care, and privacy concerns were also raised. Conclusion. Electronic media offers a novel way to improve asthma care. Email was the most preferred method, though text messaging and social media sites like Facebook may be appropriate for certain patients.     

The Häma-COM laboratory data management system (LDS): tailor-made computerization of the individual working procedures arising in a hematology laboratory with a high throughput of pathologic samples

A laboratory data management system (Häma-COM) is presented that is individually adaptable to the different working procedures arising in a hematology laboratory. The Häma-COM can be easily integrated into a hospital and/or another laboratory computer system, providing the facilities of total electronic data transfer between the referring institutions and the laboratory. The system is based on a network of personal computers running Novell Network software and coordinates two hematology analyzers (NE-8000, R-1000) and several microscopic work stations. The entire information provided by the hematology analyzers including scatterplots and histograms is captured by the system, whereby automated results are validated and worklists for further sample workup are created. Corrections of and/or additions to automated analysis results might be directly entered into the system from the respective microscopic working places. The Häma-COM system minimizes the administrative workload without interfering with the individual laboratory organization.