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Dr Mark Newbold “Why Should Doctors Get Involved in Management – Understanding the Problems” - Birmingham Medical Leadership Society Lecture 3

The Birmingham Student’s Medical Leadership Society (MLS) held it’s third and final lecture of 2013 on Thursday December 5th. The final lecture was given by Dr Mark Newbold CEO of the Heart of England NHS Foundation Trust and was a particularly enlightening end to our autumn lecture series on why healthcare professionals should become involved in management and leadership. In contrast to the previous talk by Mr Tim Smart this lecture did not focus on why doctors would be suitable for management roles but rather on why clinical leadership is absolutely necessary to tackle the fundamental problems in our hospitals today. Once again, the Birmingham MLS heartily thanks Dr Newbold for giving up his valuable time to speak to us and we must also thank Michelle and Angie for video recording this event as well. Fingers crossed, the recordings of both of our last events should be available fairly shortly. The lecture began with a brief career history of why and how Dr Newbold became involved in hospital management, from front line doctor, to department lead and on to chief exec of a major NHS foundation trust. The second part of the lecture was a brief history of the recent NHS beginning with the Labour years. Between 1997 and 2010 NHS funding increased enormously, which was a good thing. Targets increased proportionally with the funding, not necessarily a good thing. Expectations to meet the targets at all costs and punishments for failure also increased, not a good thing. Focus became diverted from providing the best possible care to ensuring that the hospital didn’t go bankrupt from failing to hit it’s targets. The “budget culture” was an unintended consequence of overzealous central target setting. This system did have some major successes, such as overall reduced waiting times and new specialist urgent cancer referral pathways. However, these successes did not necessarily transform into better patient care or higher patient satisfaction. This came to ahead as well all know with the Mid-Staffs Enquiry, the Francis report and the Keogh review. The recent NHS reforms have tried to change the NHS management culture away from target driven accounting and more towards affordable, yet excellent patient care – a “quality culture”. The NHS structural reforms have been well meaning but messy and complicated. The NHS culture change has begun, but trying to change something as huge as the NHS is like trying to steer an oil tanker, it takes time for the tiniest change in direction to be noticed. Add to this list of changes, an ever ageing population, an ever growing population, an increasingly chronically ill, co-morbid population and a relative freeze in budget and you can start to see why NHS managers are having such a tough time at the moment. How can NHS managers adopt this culture? Put their priorities in order. Quality care + Patient satisfaction > Waiting lists > Budgets Engage with the public in a more meaningful way. Have a social media presence so that you, your hospital and its staff are more than just a faceless organisation. Have a twitter account and write blogs about your challenges and successes. This will increase patient satisfaction with your hospital. Ask for and listen to patient reviews regularly. Make sure these reviews are public and this will help ensure that any changes made are recognised. Better articulate why you are changing a service, e.g. you are not shutting a local A/E to save money but to save lives! Specialist centres have been shown to have better patient outcomes than smaller, less specialised centres. The London stroke service reforms are an excellent example of this principle. Realise that a budget is a constraint, not an aim! Create a dialogue with doctors about which targets are important and why they are important. If doctors don’t agree with the targets then they will not try to improve the measures. For example, the A/E 4 hour waiting time target annoys a lot of healthcare professionals, who see it as a criticism of their work. However, this target is in fact not a measure of A/E efficiency but actually a measure of FLOW through the entire hospital. If the 4h target is missed then there is a problem within the hospital system as a whole and the doctors needed to be aware that their service is reaching capacity and that this may affect their practice. They should also consider why the 4h target was missed and what can they do to increase the patient flow through the hospital – are they needed in an understaffed department? The essence of this part of the lecture can be summarised by saying that “poor hospital performance has consequences for that hospital and its staff, these consequences affect clinical care and therefore, healthcare professionals need to care about the bigger picture otherwise it will affect frontline care”. The next part of the talk went on to outline some of the recent problems that Dr Newbold has been made aware of and how this affects his hospitals performance. 35% of patients who present to the A/E department have at least 1 chronic condition. 12% of patients are re-admitted within 30 days. Did they receive suboptimal care the first time? Patients who are re-admitted have a far higher mortality rate than other patients. Once, a patient has been in hospital for longer than 5 days their mortality rate begins to rise drastically. Being in a hospital is bad for your health and patients are often not discharged as soon as they should be. A hospital of 1500 people needs to discharge over 200 patients a day just to maintain its flow of patients. If this discharge rate decreases then the pressure on the system increases and beds are no longer available, which starts to decrease the services a hospital can provide, such as elective operations. Hospitals tend to be managed on 4 layers of alert. When the hospital is on top alert i.e. the most under pressure, mortality rates can be up to 8% higher than when the hospital is at its least pressured. By not discharging patients promptly, doctors are increasing the pressure on the system as a whole with awful unintended consequences for the patients. By admitting patients to the wards, who do not necessarily require in-patient care, doctors are also increasing the pressure on the system. Bed blocking has consequences for the patients, not just the budgets. The list above demonstrates how unintended consequences of frontline staff decisions affect patient outcomes. That is why it is critical that frontline staff are involved with helping to improve some of these problems. Does that patient really need to be admitted to an already full hospital? Does that patient really need to stay on the ward until Friday? Did that man with an exacerbation of asthma get the best acute treatment and has a plan been made for his long term management that will decrease the chance of him re-admitting? Healthcare staff can help by adjusting their practice to the situation and by helping to change the systems overall, so that the above consequences are less likely to occur. This part of the lecture was really quite sobering. It spelled out some hard facts about how such a complex system as a hospital operates. But more importantly it helped clarify just what needs to be done in the future to make hospital care the best it can be. Dr Newbold quoted the RCP report “Hospitals are not the problem, they have a problem” to highlight his believe that in the future the health service needs to change to be less focussed on acute crises and more focussed on exacerbation prevention. Hospitals should be a last resort, not a first choice. Hospitals themselves need to change how they deliver care. NHS staff need to explore ways of providing their services in an ambulatory fashion, so that patients don’t need to stay on the wards for any pre-longed period of time but come and go as quickly as possible. This will involve a major shake up in how hospital trusts fund care. They will need to increase their funding for the provision of more services at home. They need to get their employs out of the hospital and into the community. They need to work more closely with GP’s and with local social services. As the previous Chief Medical Officer said “Good Health is about team work”. Only when GP’s, community staff, hospital staff and social services work as a team will patient care really improve. At the present The University of Birmingham Students Medical Leadership Society is in contact with the FMLM and other similar groups at the Universities of Bristol, Barts and Oxford. We are looking to get in contact with every other society in the country. If you are a new or old MLS then please do get in touch, we would love to hear from you and are happy to help your societies in any way we can – we would also love to attend your events so please do send us an invite. Email us at med.leadership.soc.uob@gmail.com Follow us on Twitter @UoBMedLeaders Find us on Facebook @ https://www.facebook.com/groups/676838225676202/ Come along to our up coming events… Wednesday 22nd January 2014 LT3 Medical School, 6pm ‘Has the NHS lost the ability to care?’ – responding to the Mid Staffs inquiry’ By Prof Jon Glasby, Director of the Health Services Management Centre , UoB Thursday 20th February LT3 Medical School, 6pm ‘Reforming the West Midlands Major Trauma Care” By Sir Prof Keith Porter, Professor of Traumatology, UHB Saturday 8th March WF15 Medical School, 1pm “Applying the Theory of Constraints to Healthcare” By Mr A Dinham and J Nieboer ,QFI Consulting  
jacob matthews
almost 8 years ago
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MedEd Technology: Twitter

Recently, I made a short video about where I see the use of technology in MedEd (take a look), and when asked to write for Meducation, I thought it would be great to get people thinking about technology and its uses in medical school. Social media – easy to use on smart phones, instant access to resources and thousands of likeminded people. Seems like a good place for medical education? Uses Now Students are often at the forefront of technology – we’ve grown up with it, and so many staff and lecturers within medical schools will be lagging. This makes it difficult to integrate technology into the curriculum, especially before technology has moved on. This is potentially why the use of twitter remains informal, and that may be its charm. By remaining informal, it means students can ask questions and get involved with hashtags without the constraints of marks and tests. Revision questions, mnemonics, diagrams and pictures are all over twitter, if you know where you’re looking. Here’s my current list of useful people in medical education to follow, and the hashtags I’m following: Advantages Easy and quick to set up an account Thousands of medics around the world – ask questions, network and share resources Can get involved as little or as much as you like Disadvantages Mixing social life and education – medicine can already take over your life, do we really want to be thinking about it in our spare time? And do you want your lecturer to follow you? Privacy – can only make full use of twitter with an open account Getting students involved – many students don’t want twitter, so if it was to be used formally in education, there would have to be incentives GMC advice on the use of social media can be found here. People to follow Hashtags to follow @knowmedge #quclms @meducation #twitfrig @twitfrg #FOAMed @MedEdNcl #MedEd @MedFinalsRev Content @patientuk Content I’ll update the list as it changes – leave a comment if you find anything good! Future Uses But can it be used in medical school? In my university, some lecturers put up a twitter feed, using the course name as a hashtag, where students ask questions without shouting out. The hashtag can be used after that, to ask questions and share relevant resources. I like this idea – but could it work in medical education? Maybe in early years it could be used in the same way, but once students are on placement it gets harder. While everyone is in different hospitals, it could be a good way to integrate learning, check students are meeting objectives and ask questions throughout to check understanding. Maybe its only use is announcements – “placement letters must be handed in by the 21st Jan”. The other question is, how long can twitter last for? We’re already seeing a gradual decline in Facebook, so it may not be worth medical schools investing time and money into social media. Are you on twitter? Do you keep it purely social or do you mix in medicine? Would you like to see your lecturers on board and tweeting you questions? At the moment, I’m not too sure – I keep my twitter for medicine, answering the questions from @knowmedge, saving the mnemonics from @medfinalsrev, but I’m not sure how much I would get involved if my medical school used it officially… Written by Anna Willis Anna is a Medical Student at Sheffield University and is a Resident Blogger for Meducation Follow Anna on Twitter: @AnnaPeerMedEd  
Anna W
over 7 years ago
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Imagine a world where procrastination became a productive pastime…

Imagine a world where procrastination became a productive pastime… Procrastination, as it stands, is a core feature of the ‘human condition’ and most would argue that it is here to stay. However, what if we could hijack the time we spend playing Candy Crush saga and trick ourselves into contributing towards something tangible. Today, I wish to explore this possibility with you. The phrase ‘gamification’ is not a new or made up word (I promise) although I agree it does sound jarring and I certainly wouldn’t recommend trying to use it in a game of scrabble (yet). The phrase itself refers to the process of applying game thinking and game mechanics to non-game contexts to engage users in solving problems. For our purposes and for the purposes of this blog ‘problems’ will equate to promoting healthy living for our patients and maintaining our own medical education. For one reason or another, most people show addictive behaviour towards games especially when they incorporate persistent elements of progression, achievement and competition with others. The underlying psychology won’t be discussed here; call it escapism, call it procrastination, call it whatever you will. What I want you to realise is that every day millions of people spend hours tending to virtual farms and cyber families whilst competing vigorously with ‘online’ friends. If we can take the addictive aspects of these popular games and incorporate them in to the non-game contexts I indicated to above, we could potentially trick ourselves, and even perhaps our patients, into a better way of life. The first time I heard the phrase ‘gamification’ was only last year. I was in Paris attending the Doctors 2.0 conference listening to talks on how cutting edge technologies and the Internet had been (or were going to be) incorporated into healthcare. One example that stood out to me was a gaming app that intended to engage people with diabetes to record their blood sugars more regularly and also compete with themselves to achieve better sugar control. People who have the condition of Diabetes Mellitus are continuously reminded of their diet and their blood sugar levels. I am not diabetic myself, but it is not hard to realise that diet and sugar control is going to be an absolute nightmare for people with diabetes both from a practical and psychological standpoint. Cue the mySugr Compainion, an FDA approved mobile application that was created to incorporate the achievement and progression aspects of game design to help encourage people with diabetes to achieve better sugar control. The app was a novel concept that struck a chord with me due to its potential to appeal to the part in everyone’s brain that makes them sit down and play ‘just one more level’ of their favorite game or app. There are several other apps on the market that are games designed to encourage self testing of blood sugar levels in people with diabetes. There is even a paediatric example titled; “Monster Manor,” which was launched by the popular Sanofi UK (who previously released the FDA / CE approved iBGStar iPhone blood glucose monitor). So applying aspects of game design into disease management apps has anecdotally been shown to benefit young people with Diabetes. However, disease management is just one area where game-health apps have emerged. We are taught throughout medical school and beyond that disease prevention is obviously beneficial to both our patients and the health economy. Unsurprisingly, one of the best ways to prevent disease is to maintain health (either through exercise and / or healthy eating). A prominent example of an app that helps to engage users in exercising is ‘RunKeeper,’ a mobile app that enables people to track and publish their latest jog-around-the-park. The elements of game design are a little more subtle in this example but the ability to track your own progress and compete with others via social media share buttons certainly reminds me of similar features seen in most of today’s online games. Other examples of ‘healthy living apps’ are rife amongst the respective ‘app stores,’ and there seems to be ample opportunity for the appliance of gamification in this field. An example might be to incorporate aspects of game design into a smoking cessation app or weight loss helper. Perhaps the addictive quality of a well designed game-app could overpower the urge for confectionary or that ‘last cigarette’… The last area where I think ‘gamification’ could have a huge benefit is in (medical) education. Learning and revising are particularly susceptible to the rot of procrastination, so it goes without saying that many educational vendors have already attempted to incorporate fresh ways in which they can engage their users to put down the TV remote and pick up some knowledge for the exams. Meducation itself already has an area on its website entitled ‘Exam Room,’ where you can test yourself, track your progress and provide feedback on the questions you are given. I have always found this a far more addictive way to revise than sitting down with pen and paper to revise from a book. However, I feel there could be a far greater incorporation of game design in the field of medical education. Perhaps the absolute dream for like-minded gamers out there would be a super-gritty medical simulator that exposes you to common medical emergencies from the comfort of your own computer screen. I mean, my shiny new gaming console lets me pretend to be an elite solider deep behind enemy lines so why not let me pretend and practice to be a doctor too? You could even have feedback functionality to indicate where your management might have deviated from the optimum. Perhaps more sensibly, the potential also exists to build on the existing banks of online medical questions to incorporate further aspects of social media interaction, achievement unlocks and inter-player competition (because in case you hadn’t noticed, medics are a competitive breed). I have given a couple of very basic examples on how aspects of game design have emerged in recent health-related apps. I feel this phenomenon is in its infancy. The technology exists for so much more than the above, we just need to use our imagination… and learn how to code.  
Dr. Luke Farmery
over 7 years ago
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Wikipedia - help or hindrance?

It’s quick, it’s easy and we’ve all done it. Don’t blush, whether it’s at our leisure or behind the consultant’s back we can confess to having used the world’s sixth most popular website. You might have seen it, sitting pride of place on the podium of practically any Google result page. Of course, it’s the tell tale sign of one of Web 2.0’s speediest and most successful offspring, Wikipedia. Now for fear of patronizing a generation who have sucked on the teat of this resource since its fledgling years, the formalities will remain delightfully short. Wikipedia is the free, multilingual, online encyclopedia, which harnesses the collective intelligence of the world’s internet users to produce a collaboratively written and openly modifiable body of knowledge. The technology it runs on is a highly flexible web application called wiki. It is open-source software; hence the explosion of wiki sites all united under the banner of combined authorship. Anyone with internet access can edit the content and do so with relative anonymity. It would be unthinkable that a source, which does not prioritize the fidelity of its content, could possibly play a role in medical education. How ironic it seems that medical students can waste hours pondering which textbook to swear their allegiance for the forthcoming rotation, yet not spare a second thought typing their next medical query into Wikipedia. Evidently it has carved itself a niche and not just among medical students, but healthcare professionals as well. According to a small qualitative study published in the International Journal of Medical Informatics, 70% of their sample, which comprised of graduates from London medical schools currently at FY2 and ST1 level, used Wikipedia in a given week for ‘clinical purposes’. These ranged from general background reading to double checking a differential and looking up medications. We are so ensnared by the allure of instantaneous enlightenment; it’s somewhat comparable to relieving an itch. "Just Google it..." is common parlance. We need that quick fix. When the consultant asks about his or her favourite eponymous syndrome or you’re a little short on ammunition before a tutorial, the breadth and ease-of-use offered by a service accessible from our phones is a clandestine escape. The concept of Wikipedia, the idea that its articles are in a way living bodies because of the continual editing process, is its strength. Conversely textbooks are to a degree outmoded by the time they reach their publication date. While I commend the contributors of Wikipedia for at least trying to bolster their pages with references to high impact journals, it does not soften the fact that the authorship is unverifiable. Visitors, lay people, registered members under some less than flattering pseudonyms such as Epicgenius and Mean as custard, don’t impart the sense of credibility students (or for that matter patients)expect from an encyclopedia. Since the prestige of direct authorship if off the cards, it does beg the question of what is their motivation and I’m afraid ‘the pursuit of knowledge and improving humanity’s lot' is the quaint response. There is a distinct lack of transparency. It has become a playground where a contributor can impress his/her particular theory regarding a controversial subject unchallenged. Considering there is no direct ownership of the article, who then has the authority to curate the multiple theories on offer and portray a balanced view? Does an edit war ensue? It is not unheard of for drug representatives to tailor articles detailing their product and erase the less pleasant side-effects. Obviously Wikipedia is not unguarded, defences are in place and there is such a thing as quality control. Recent changes will come under the scrutiny of more established editors, pages that are particularly prone to vandalism are vetted and there are a special breed of editors called administrators, who uphold a custodial post, blocking and banishing rebellious editors. A study featured in the First Monday journal put Wikipedia to the test by deliberately slipping minor errors into the entries of past philosophers. Within 48 hours half of these errors had been addressed. Evidently, the service has the potential to improve over time; provided there is a pool of committed and qualified editors. Wikiproject Medicine is such a group of trusted editors composed primarily of doctors, medical students, nurses, clinical scientists and patients. Since 2004, its two hundred or so participants have graded an excess of 25,000 health-related articles according to quality parameters not dissimilar to peer review. However, the vast majority of articles are in a state of intermediate quality, somewhere between a stub and featured article. Having some degree of professional input towards a service as far reaching as Wikipedia will no doubt have an impact on global health, particularly in developing countries where internet access is considered a luxury. March this year saw the medical pages of the English Wikipedia reach a lofty 249,386,264 hits. Its ubiquity is enviable; it maintains a commanding lead over competing medical websites. The accessibility of this information has catapulted Wikipedia far beyond its scope as a humble encyclopedia and into a medical resource. Patients arrive to clinics armed with the printouts. As future doctors we will have to be just that one step ahead, to recognise the limitations of a source that does not put a premium on provenance but is nevertheless the current public health tool of choice. Illustrator Edward Wong This blog post is a reproduction of an article published in the Medical Student Newspaper, November 2013 issue.  
James Wong
over 7 years ago
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Medical Blogging, an overview, pearl or peril

Medical blogging is blogging in the field of medicine. It is a relatively recent addition to the medical field. While its closest predecessor medical journalism; is about 300 years old, medical blogging is currently about a decade old. This blogpost aims at exploring the field of medical blogging and comparing it to related disciplines when relevant. It examines some opinions of bloggers, and reviews some medical blogs aiming to infer reasons for blogging, derive technique or outline of blog and hopefully arriving at a conclusion to the future prospects of medical blogging. Medicine is the practice of the art and science of healing 'ars medicina'. It is a branch of applied science, which started probably in the pre-historic era. The practice continued to flourish, specialise, sub-specialise and sub-sub-specialise. The word blog is most probably derived from the contraction of the words 'web log' which is a form of website that is more interactive, allowing comments, tagging,and is displayed in counter-chronological order from the most recent at the top of the page. The term 'blog' is currently used as a noun as well as a verb. The aggregation of blogs is named 'blogosphere', and the blog writer is named 'blogger'. There are single author blogs and multi-author blogs, they are as diverse in there content as the diversity of the bloggers, with regards to form they can be written text, images, videos, sounds or combination of more than one medium. The term 'blogroll' is referred to blogs followed by a person. Blogging is just more than a decade old now. However, the number of blogs have been increasing exponentially at times. The concept of blogging is considered as one of the components of the concept of web 2.0. Medical blogs refer to blogs that are primarily concerned with medical/health subjects. The name 'medical blog' is derived from content based taxonomic classification. Medical blogs can be classified by author, there are blogs by physicians, nurses, patients, medical institutions, medical journals, and anonymous blogs. They can be classified by target audience as either to other doctors, patients and carers, general public or a combination of more than one target. There are also medical blogs by patients or patient blogs that expresses their viewpoints. A study examined medical student blogs and concluded that they might be beneficial for students to reflect on their experience (Pinilla et al, 2013). The Nephrology Dialysis and Transplantation (NDT) made it own blog (El Nahas, 2012). The American Journal of Kidney Disorder (AJKD) made its own official blog (Desai et al, 2013). During the same year, the American Heart Association and American Stroke Association launched their official blog (Sanossian & Merino, 2013). Pereira discussed the blogs by neurosurgeons (Pereira et al, 2012). In the BMJ doc2doc blogs, they do not have to meet certain number of word count but will have to be reviewed prior to publication. KevinMD requires blog posts to be of maximum five hundred words, Medical-Reference require a minimum of one thousand words. Meducation requires a blog post to vary between 1500-3000 word. Independent blogs may show more variation in the number of words per blog post. Some blogs are predominantly in text format, other may combine multimedia or get linked to other medical blogs. The BMJ doc2doc tentatively recommends blog posting to be in the frequency of one to two blogs/month. Chrislyn Pepper, a medical blog writer, (2013) states that medical blogging can aim to be 'three blogs of 300+ words each week and three to four short blogs of less than a hundred words five days per week.' Medical bloggers seem to have various reasons to blog, some communicate clinical data to fellow doctors, in this case some blogs seem to resemble research or review articles in content and language which can contain medical jargon. There are diagnosis blogs that were studied by Miller and Pole (2010). The comparison between the electronic predecessors of blogging including Electronic Bulletin Board, USENET, and emailing in addition to the why of blogging in general has been discussed by Mongkolwat (Mongkolwat et al, 2005). Some put their hypotheses forward, others share clinical experience or discuss a clinical matter. Some bloggers direct their attention to the general public providing information about medical topics. Some discuss issues which can be difficult to be put in research topics. Dr Rob discussed that importance of medical blogging as an equivalent to the concept of democracy in an online world. Doctor Blogger website offers 10 reasons for medical blogging including public education, correction of misconceptions and establishing a name. For the medical blogger's direct benefit Medical Rant blog offers an overview of personal benefits from medical blogging including stimulation of thought and stimulation of academic writing. Dr Wible seems to use her medical blog to promote a standard of care that seems to be a mix between the medical model and the befriending model of care. Another study examined the young adults blogging and concluded that powerlessness, loneliness, alienation, and lack of connection with others, where the primary outcomes of young adults as a result of mental health concerns (Eysenbach et al, 2012). Wolinsky (2011) enquires whether scientists should stick to popularizing science or more. Medical blogs are essentially online activity which renders them immediately accessible to any area with internet connection, they are paperless by definition which makes them more environment friendly. The medical blogs are open access by default which adds to the accessibility, and they are decentralised which decreases control over the control and seems to accentuate diversity. As compared to peer reviewed journals, medical blogs seem to be less referenced, are hardly ever taken as academic writing, the process of peer reviewed medical blogs is minimal if any, and they do not get reflected on resume or be considered as publication, though the term 'blogfolio' started to become a watch word. It seems hard to base clinical decisions on medical blogs. However, medical blogs can offer more diversity into research and non-research medical topics. They are published online with no delay or review time, they can comment on the most recent advances in the medical field or most contemporary issues instantaneously. Very recently, citing blogs seems to become a bit accepted. BMJ Journals have their dedicated blogs Some online resources give a comprehensive outline on blogging in general and medical blogging in particular including video interview with a medical blogger Michelle Guilemard in her blog makes a valid point of how medical blogging can enhance career. Medical Squid also highlighted medical blogging as a career Kovic et al (2008) conducted a research on the medical blogosphere an concluded that 'Medical bloggers are highly educated and devoted blog writers, faithful to their sources and readers'. Miller & Pole (2010) concluded that 'Blogs are an integral part of this next stage in the development '. Stanwell-Smith (2013) discussed the aspect as an important tool to communicate with patients. The blur between academia and blogging was discussed in research blogs. (Sheema et al, 2012). During the same another study discussed the impact of blogging on research (Fausto et al, 2012). While Baerlocher & Detsky (2008) warn in an article against the hazards of medical blogging due to potential breach of confidentiality. After an exhaustive study of the content of weblog written by health professional, Lagu reached the concern of breaching of confidentiality (Lagu et al, 2007). Rebecca Golden (2007) cites the perils of medical blogging she concludes her article saying 'Science has a peer-review process for a reason'. Brendan Koerner (2007) in wired magazines posted an article about the problems of giving medical advice via blogging. Dr Val Jones makes a point by concluding that social media provide the 'allure of influence'. Thomas Robey (2008) offers arguments for and against medical blogging, including confidentiality, and ruining personal reputation on the negative side, while enhancing democratization of conversation and having a creative outlet on the positive side. Brendel offers an intriguing discussion to whether it would be ethical or not to monitor patients' blog to determine their health status. (Brendel, 2012). O'Reilly voiced in 2007 the need for blogging code of conduct. The GMC published guidance on the use of social media by doctors and it included blogging as a form of social media. The Royal College of General Practitioners also published the social media high way code to offer guidance on social media including medical blogging. There is also the medblog oath online. Flaherty (2013) argues that blogging is under attack by micro-blogging, and that it is in its deathbed. Mike Myatt in his article Is Blogging Dead, discusses various views about blogging in an era of micro-blogging The Royal College of Psychiatrists recently introduced a number of blogs including the president's blog, overseas blogs and other blogs. The medical blogging seems to occupy a middle space between the quick micro-blogging and the thoughtful research article. Its diversity and freedom are its strongest tools and can have the potential to be its worst enemies. One wonders whether the emergence of guidelines for medical blogging – given the seriousness of the content – would save medical blogging and elevate it to the next level or change the essence of it. After all, the question is how much the medical field which is a top-down hierarchy accept grass-root movement. Freedom of expression is probably at the heart of blogging. It would be logistically impossible to impose rules on it. However, guidelines and code of honour may help delineating the quality of medical blogs from each other. This post is previously posted on doc2doc blogs. Bibliography & Blogiography Brendel, D. Monitoring Blogs: A New Dilemma for Psychiatrists Journal of Ethics, American Medical Association, 2012, Vol. 14(6), pp. 441-444 Desai, T., S.M.A.N.V.S.K.T.J.K.C.K.B.E.J.K.D. The State of the Blog: The First Year of eAJKD Am J Kidney Dis., 2013, Vol. 61(1), pp. 1-2 El Nahas, M. An NDT blog Nephrol Dial Transplant (2012) 27: 3377–3378, 2012, Vol. 27, pp. 3377-3378 Eysenbach, G., B.K.M.M. What Are Young Adults Saying About Mental Health? An Analysis of Internet Blogs Journal of Medical Internet Research, 2012, Vol. 14(1) Fausto, S. Machado, F.B.L.I.A.N.T.M.D. Research Blogging: Indexing and Registering the Change in Science 2.0 PLoS one, 2012, Vol. 7(12), pp. 1-10 Lagu, T, K.E.J.D.A.A.A.K. Content of Weblogs Written by Health Professionals J Gen Intern Med, 2008, Vol. 23(10), pp. 1642–6 Miller, EA., P.A. Diagnosis Blog: Checking Up on Health Blogs in the Blogosphere American Journal of Public Health, 2010, Vol. 8, pp. 1514-1518 Mongkolwat, P. Kogan, A.K.J.C.D. Blogging Your PACS Journal of Digital Imaging, 2005, Vol. 18(4), pp. 326-332 Pereira, JLB., K.P. d.A.L. d.C.G. d.S.A. Blogs for neurosurgeons Surgical Neurology International, 2012, Vol. 3:62 Pinilla, S. Weckbach, L.A.S.B.H.N.D.S.K.T.S. Blogging Medical Students: A Qualitative Analysis  
Dr Emad Sidhom
over 7 years ago
Foo20151013 2023 1x8tym4?1444774283
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Apple iOS 8 - A step towards omnipotent healthcare informatics.

Introduction The use of smartphones amongst health care professionals is now estimated to be in excess of 85%, with Apple's iPhone currently being the most popular platform. There is a wealth of information (from popular blogs, to formal journals) that demonstrate the potential of smartphone apps (and technology in general) to improve healthcare. However, despite widespread use of smartphones, proper application of the software at our disposal has been arguably poor. The latest mobile Apple operating system 'iOS 8', may be the start of a long-awaited overhaul of the current health apps available. The App Store - as it stands The Apple app store boasts many hundreds of what it describes as 'medical' apps. A review of the 'Top 200' medical apps conducted in 2012 by this author revealed that 49% were in fact general health or lifestyle applications aimed at the general public. The same process was repeated this year (2014) and demonstrated that this percentage has increased to 54%. This increase in apps aimed at the general public suggests that Apple do not differentiate between 'medical apps' and 'health and lifestyle' apps. This could negatively affect health care professionals' perception of the otherwise high-quality medical apps that are available. In addition, of the remaining percentage of apps aimed at healthcare professionals, only 5.56% were deemed to be of clinical benefit (an increased from 3% in 2012). The overwhelming majority of 'medical' apps aimed at medical professionals are actually educational in content and usually focus on the learning of anatomy. Current health apps Much like the 'medical' apps, only a limited selection of the health apps that are aimed at the public/patient are deemed to be high-quality. Prominent examples include the blood glucose monitors that record data in to a smartphone and similarly, the blood pressure and pain diaries. These examples focus on people with medical conditions, but it is important to note the potential of apps in preventative medicine too (i.e. promoting general health). Typical high-quality apps in this category include RunKeeper and Map My Ride. These apps allow everyone to become their own personal trainer and keep an accurate record of their physical activity. Smartphones will even send reminders to the user that a workout is due, and the option is present to share your stats and 'compete' with friends/family via social media. These features highlight the absolute vanguard of what could potentially come in terms of technology influencing healthy living. A current criticism of health apps is that most (if not all) are individual enterprises with very little information shared between them. The metaphor of 'silos' is used to represent these large vessels of information that sit adjacent to one another whilst never benefiting from the contents of one another. The iOS 8 operating system hopes to ameliorate this current issue with its new Health app and HealthKit, which will enable developers and their apps to pull data from several health related apps into one streamlined app. It is envisaged that this app will be able to feed (with the appropriate permissions of course) health related information to your family physician for health monitoring purposes. This could have impressive effects in community blood pressure management and blood glucose management (just to name the obvious ones). Problems Ahead There are scattered anecdotal reports of users being wary of centralised health information and as always Data Protection is a major concern (whether it is warranted or not). In addition, whilst a large percentage of the population may have a smartphone many may still opt not to use health related apps. Poor uptake will obviously limit the perception of this medium as a method of health monitoring. Summary Smartphone usage is high and many healthcare related apps are already available either to serve as medical tools to healthcare professionals or health monitoring devices for the public. Currently, Apple does not seem to differentiate between medical and lifestyle apps on its app store and many lower quality apps seem to appear in 'medical' searches. Also, Current apps do not share information. However, with iOS 8 it seems that Apple seems to be addressing several key issues surrounding the use of the iPhone as a health monitoring device. For the moment it seems that healthcare professionals will have to harness this patient-held approach. Perhaps direct improvements to the medical aspect of the Apple app store and the quality and originality of apps aimed at doctors is still a little way off.  
Dr. Luke Farmery
over 7 years ago
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#StudentLedChange NHS Change Day Campaign - Do you want to make your voice heard?

Are you a student, junior doctor, trainee or other healthcare professional? Do you want to make a difference to patient care? If you anwsered "yes" to both of those questions, then please do contact the #StudentLedChange team. We want to invite you all to join the campaign and put all of our enthusiasm together to make a real difference to patient care. To contact us: Search Twitter or Facebook for #StudentLedChange @QuID_UK or email quid.editor@gmail.com http://changeday.nhs.uk/campaigns/studentledchange/ https://www.facebook.com/groups/1588447701402451/ http://www.quid.org.uk/all-ongoing-projects/on-going-projects/item/52-using-projectmatch-org-to-develop-better-regional-project-banks-for-students-and-trainees-studentledchange http://www.projectmatch.org/ Our main aims are: 1) To harness the enthusiasm of juniors to improve patient care 2) To reduce the barriers to research and quality improvement projects that juniors often run into - such as not knowing any enthusiastic supervisors - via www.projectmatch.org 3) To increase the sharing of small scale projects and new ideas - via www.quid.org.uk 4) To build a vibrant community of like minded individuals via social media - please joint he discussions today 5) Our last aim is rather ambitious, we want to encourage all of the organisations involved in patient care improvement to work more closely together. We want there to be more collaborative projects that students can get involved in and we want to make it easier for students to know who to contact and where to start. We also want to help other students achieve their aims by collaborating together. If you would like to help with any of the above then please do get in contact... Originally posted on: http://doc2doc.bmj.com/forums/open-clinical_quality-safety_studentledchange-nhs-change-day-campaign-want-involved  
jacob matthews
over 6 years ago
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The reason we can't resist puppy dog eyes explained

Exclusive music news, big interviews, entertainment, social media trends and video from the news people at BBC Radio 1 and 1Xtra.  
bbc.co.uk
over 6 years ago
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3

How to crowdsource the world for emergency medicine

Two new studies, published online in Annals of Emergency Medicine, illustrate the power of social media and the Internet to promote scholarly dialogue around the world and the importance...  
medicalnewstoday.com
over 6 years ago
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8

Social motivation for exercise proven with trial Facebook app

A collaborative approach between health scientists, designers and social media experts has produced a health app that actually works to get normal people to be more active.  
medicalnewstoday.com
over 6 years ago
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23

Medical professionalism online

In this new era of social media, medical schools must do more to ensure that online medical professionalism among trainees is understood, discussed and practiced, argues an editorial in...  
medicalnewstoday.com
over 6 years ago
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5 Insights on Depression From Someone Who Suffers

Don't do it. Don't go on Facebook if you're feeling depressed. The worst thing about social media is the illusion it creates that everyone else is happy ...  
huffingtonpost.com
over 6 years ago
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SGEM#101: Puke – Antiemetics in Adult Emergency Department Patients

Guest Skeptics: Eve Purdy. She is a 4th year medical student from Queen’s University. Eve is interested in all things medicine but especially emergency medicine, rural medicine, medical education and social media. She is the creative force behind the excellent medical student blog Manu et Corde (Hand and Heart). She is also an editor for BoringEM. When not learning to be a doctor, Eve is usually running, playing guitar or planning an outdoor adventure.  
thesgem.com
over 6 years ago