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1.  Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education 
Background
We have witnessed a rapid increase in the use of Web-based 'collaborationware' in recent years. These Web 2.0 applications, particularly wikis, blogs and podcasts, have been increasingly adopted by many online health-related professional and educational services. Because of their ease of use and rapidity of deployment, they offer the opportunity for powerful information sharing and ease of collaboration. Wikis are Web sites that can be edited by anyone who has access to them. The word 'blog' is a contraction of 'Web Log' – an online Web journal that can offer a resource rich multimedia environment. Podcasts are repositories of audio and video materials that can be "pushed" to subscribers, even without user intervention. These audio and video files can be downloaded to portable media players that can be taken anywhere, providing the potential for "anytime, anywhere" learning experiences (mobile learning).
Discussion
Wikis, blogs and podcasts are all relatively easy to use, which partly accounts for their proliferation. The fact that there are many free and Open Source versions of these tools may also be responsible for their explosive growth. Thus it would be relatively easy to implement any or all within a Health Professions' Educational Environment. Paradoxically, some of their disadvantages also relate to their openness and ease of use. With virtually anybody able to alter, edit or otherwise contribute to the collaborative Web pages, it can be problematic to gauge the reliability and accuracy of such resources. While arguably, the very process of collaboration leads to a Darwinian type 'survival of the fittest' content within a Web page, the veracity of these resources can be assured through careful monitoring, moderation, and operation of the collaborationware in a closed and secure digital environment. Empirical research is still needed to build our pedagogic evidence base about the different aspects of these tools in the context of medical/health education.
Summary and conclusion
If effectively deployed, wikis, blogs and podcasts could offer a way to enhance students', clinicians' and patients' learning experiences, and deepen levels of learners' engagement and collaboration within digital learning environments. Therefore, research should be conducted to determine the best ways to integrate these tools into existing e-Learning programmes for students, health professionals and patients, taking into account the different, but also overlapping, needs of these three audience classes and the opportunities of virtual collaboration between them. Of particular importance is research into novel integrative applications, to serve as the "glue" to bind the different forms of Web-based collaborationware synergistically in order to provide a coherent wholesome learning experience.
doi:10.1186/1472-6920-6-41
PMCID: PMC1564136  PMID: 16911779
2.  Exploring the Use of Social Media to Measure Journal Article Impact 
Science blogs, Twitter commentary, and comments on journal websites represent an immediate response to journal articles, and may help in identifying relevant publications. However, the use of these media for establishing paper impact is not well studied. Using Wikipedia as a proxy for other social media, we explore the correlation between inclusion of a journal article in Wikipedia, and article impact as measured by citation count. We start by cataloging features of PubMed articles cited in Wikipedia. We find that Wikipedia pages referencing the most journal articles are about disorders and diseases, while the most referenced articles in Wikipedia are about genomics. We note that journal articles in Wikipedia have significantly higher citation counts than an equivalent random article subset. We also observe that articles are included in Wikipedia soon after publication. Our data suggest that social media may represent a largely untapped post-publication review resource for assessing paper impact.
PMCID: PMC3243242  PMID: 22195090
3.  Online Professionalism and the Mirror of Social Media 
Journal of General Internal Medicine  2010;25(11):1227-1229.
The rise of social media—content created by Internet users and hosted by popular sites such as Facebook, Twitter, YouTube, and Wikipedia, and blogs—has brought several new hazards for medical professionalism. First, many physicians may find applying principles for medical professionalism to the online environment challenging in certain contexts. Second, physicians may not consider the potential impact of their online content on their patients and the public. Third, a momentary lapse in judgment by an individual physician to create unprofessional content online can reflect poorly on the entire profession. To overcome these challenges, we encourage individual physicians to realize that as they “tread” through the World Wide Web, they leave behind a “footprint” that may have unintended negative consequences for them and for the profession at large. We also recommend that institutions take a proactive approach to engage users of social media in setting consensus-based standards for “online professionalism.” Finally, given that professionalism encompasses more than the avoidance of negative behaviors, we conclude with examples of more positive applications for this technology. Much like a mirror, social media can reflect the best and worst aspects of the content placed before it for all to see.
doi:10.1007/s11606-010-1447-1
PMCID: PMC2947638  PMID: 20632121
professionalism; internet use; medical ethics; health policy
4.  Communicating the Experience of Chronic Pain and Illness Through Blogging 
Background
Although more individuals are sharing their experiences with chronic pain or illness through blogging (writing an Internet web log), research on the psychosocial effects and motivating factors for initiating and maintaining a blog is lacking.
Objective
The objective was to examine via online questionnaire the perceived psychosocial and health benefits of blogging among patients who use this media to communicate their experience of chronic pain or illness.
Methods
A 34-item online questionnaire was created, tested, and promoted through online health/disease forums. The survey employed convenience sampling and was open from May 5 to July 2, 2011. Respondents provided information regarding demographics, health condition, initiation and upkeep of blogs, and dynamics of online communication. Qualitative data regarding respondents’ blogging experiences, expectations for blogging, and the perceived effects from blogging on the blogger’s health, interpersonal relationships, and quality of life were collected in the form of written narrative.
Results
Out of 372 respondents who started the survey, 230 completed the entire questionnaire. Demographic data showed survey respondents to be predominantly female (81.8%) and highly educated (97.2% > high school education and 39.6% with graduate school or professional degrees). A wide spectrum of chronic pain and illness diagnoses and comorbidities were represented. Respondents reported that initiating and maintaining an illness blog resulted in increased connection with others, decreased isolation, and provided an opportunity to tell their illness story. Blogging promoted accountability (to self and others) and created opportunities for making meaning and gaining insights from the experience of illness, which nurtured a sense of purpose and furthered their understanding of their illness.
Conclusions
Results suggest that blogging about chronic pain and illness may decrease a sense of isolation through the establishment of online connections with others and increases a sense of purpose to help others in similar situations. Further study involving a larger sample size, a wider range of education levels, and respondents with different types and magnitudes of illnesses will be needed to better elucidate the mechanism of the observed associations in this understudied area.
doi:10.2196/jmir.2002
PMCID: PMC3510726  PMID: 23092747
Blogging; narrative medicine; disease management; Internet; pain; chronic illness; survey; psychosocial support systems; holistic health; selfcare
5.  HealthTrust: A Social Network Approach for Retrieving Online Health Videos 
Background
Social media are becoming mainstream in the health domain. Despite the large volume of accurate and trustworthy health information available on social media platforms, finding good-quality health information can be difficult. Misleading health information can often be popular (eg, antivaccination videos) and therefore highly rated by general search engines. We believe that community wisdom about the quality of health information can be harnessed to help create tools for retrieving good-quality social media content.
Objectives
To explore approaches for extracting metrics about authoritativeness in online health communities and how these metrics positively correlate with the quality of the content.
Methods
We designed a metric, called HealthTrust, that estimates the trustworthiness of social media content (eg, blog posts or videos) in a health community. The HealthTrust metric calculates reputation in an online health community based on link analysis. We used the metric to retrieve YouTube videos and channels about diabetes. In two different experiments, health consumers provided 427 ratings of 17 videos and professionals gave 162 ratings of 23 videos. In addition, two professionals reviewed 30 diabetes channels.
Results
HealthTrust may be used for retrieving online videos on diabetes, since it performed better than YouTube Search in most cases. Overall, of 20 potential channels, HealthTrust’s filtering allowed only 3 bad channels (15%) versus 8 (40%) on the YouTube list. Misleading and graphic videos (eg, featuring amputations) were more commonly found by YouTube Search than by searches based on HealthTrust. However, some videos from trusted sources had low HealthTrust scores, mostly from general health content providers, and therefore not highly connected in the diabetes community. When comparing video ratings from our reviewers, we found that HealthTrust achieved a positive and statistically significant correlation with professionals (Pearson r 10 = .65, P = .02) and a trend toward significance with health consumers (r 7 = .65, P = .06) with videos on hemoglobinA1 c, but it did not perform as well with diabetic foot videos.
Conclusions
The trust-based metric HealthTrust showed promising results when used to retrieve diabetes content from YouTube. Our research indicates that social network analysis may be used to identify trustworthy social media in health communities.
doi:10.2196/jmir.1985
PMCID: PMC3374533  PMID: 22356723
Medical informatics; information storage and retrieval; video; online systems; health communication; diabetes
6.  Social media policies at US medical schools 
Medical Education Online  2010;15:10.3402/meo.v15i0.5324.
Background/Purpose
Today's medical students are learning in a social media era in which patient confidentiality is at risk yet schools’ social media policies have not been elucidated. The purpose of this study is to describe the presence of medical schools on top social media sites and to identify whether student policies for these schools explicitly address social media use.
Method
Websites of all 132 accredited US medical schools were independently assessed by two investigators for their presence (as of March 31, 2010) on the most common social networking and microblogging sites (Facebook and Twitter) and their publicly available policies addressing online social networking. Key features from these policies are described.
Results
100% (n=132) of US medical schools had websites and 95.45% (126/132) had any Facebook presence. 25.76% (34/132) had official medical school pages, 71.21% (94/132) had student groups, and 54.55% (72/132) had alumni groups on Facebook. 10.6% of medical schools (14/132) had Twitter accounts. 128 of 132 medical schools (96.97%) had student guidelines or policies publicly available online. 13 of these 128 schools (10.16%) had guidelines/policies explicitly mentioning social media. 38.46% (5/13) of these guidelines included statements that defined what is forbidden, inappropriate, or impermissible under any circumstances, or mentioned strongly discouraged online behaviors. 53.85% (7/13) encouraged thoughtful and responsible social media use.
Conclusions
Medical schools and their students are using social media. Almost all US medical schools have a Facebook presence, yet most do not have policies addressing student online social networking behavior. While social media use rises, policy informing appropriate conduct in medical schools lags behind. Established policies at some medical schools can provide a blueprint for others to adopt and adapt.
doi:10.3402/meo.v15i0.5324
PMCID: PMC2941429  PMID: 20859533
online; internet; social networking; professionalism policies; Web 2.0
7.  Cancer patients on Twitter: a novel patient community on social media 
BMC Research Notes  2012;5:699.
Background
Patients increasingly turn to the Internet for information on medical conditions, including clinical news and treatment options. In recent years, an online patient community has arisen alongside the rapidly expanding world of social media, or “Web 2.0.” Twitter provides real-time dissemination of news, information, personal accounts and other details via a highly interactive form of social media, and has become an important online tool for patients. This medium is now considered to play an important role in the modern social community of online, “wired” cancer patients.
Results
Fifty-one highly influential “power accounts” belonging to cancer patients were extracted from a dataset of 731 Twitter accounts with cancer terminology in their profiles. In accordance with previously established methodology, “power accounts” were defined as those Twitter accounts with 500 or more followers. We extracted data on the cancer patient (female) with the most followers to study the specific relationships that existed between the user and her followers, and found that the majority of the examined tweets focused on greetings, treatment discussions, and other instances of psychological support. These findings went against our hypothesis that cancer patients’ tweets would be centered on the dissemination of medical information and similar “newsy” details.
Conclusions
At present, there exists a rapidly evolving network of cancer patients engaged in information exchange via Twitter. This network is valuable in the sharing of psychological support among the cancer community.
doi:10.1186/1756-0500-5-699
PMCID: PMC3599295  PMID: 23270426
Breast cancer; Breast neoplasms; Internet; Leukemia; Social media; Twitter messaging; Web 2.0
8.  Modeling the Adoption of Innovations in the Presence of Geographic and Media Influences 
PLoS ONE  2012;7(1):e29528.
While there is a large body of work examining the effects of social network structure on innovation adoption, models to date have lacked considerations of real geography or mass media. In this article, we show these features are crucial to making more accurate predictions of a social contagion and technology adoption at a city-to-city scale. Using data from the adoption of the popular micro-blogging platform, Twitter, we present a model of adoption on a network that places friendships in real geographic space and exposes individuals to mass media influence. We show that homophily both among individuals with similar propensities to adopt a technology and geographic location is critical to reproducing features of real spatiotemporal adoption. Furthermore, we estimate that mass media was responsible for increasing Twitter's user base two to four fold. To reflect this strength, we extend traditional contagion models to include an endogenous mass media agent that responds to those adopting an innovation as well as influencing agents to adopt themselves.
doi:10.1371/journal.pone.0029528
PMCID: PMC3261844  PMID: 22276119
9.  Social Features of Online Networks: The Strength of Intermediary Ties in Online Social Media 
PLoS ONE  2012;7(1):e29358.
An increasing fraction of today's social interactions occur using online social media as communication channels. Recent worldwide events, such as social movements in Spain or revolts in the Middle East, highlight their capacity to boost people's coordination. Online networks display in general a rich internal structure where users can choose among different types and intensity of interactions. Despite this, there are still open questions regarding the social value of online interactions. For example, the existence of users with millions of online friends sheds doubts on the relevance of these relations. In this work, we focus on Twitter, one of the most popular online social networks, and find that the network formed by the basic type of connections is organized in groups. The activity of the users conforms to the landscape determined by such groups. Furthermore, Twitter's distinction between different types of interactions allows us to establish a parallelism between online and offline social networks: personal interactions are more likely to occur on internal links to the groups (the weakness of strong ties); events transmitting new information go preferentially through links connecting different groups (the strength of weak ties) or even more through links connecting to users belonging to several groups that act as brokers (the strength of intermediary ties).
doi:10.1371/journal.pone.0029358
PMCID: PMC3256152  PMID: 22247773
10.  Online Social Networking: A Primer for Radiology 
Journal of Digital Imaging  2011;24(5):908-912.
Online social networking is an immature, but rapidly evolving industry of web-based technologies that allow individuals to develop online relationships. News stories populate the headlines about various websites which can facilitate patient and doctor interaction. There remain questions about protecting patient confidentiality and defining etiquette in order to preserve the doctor/patient relationship and protect physicians. How much social networking-based communication or other forms of E-communication is effective? What are the potential benefits and pitfalls of this form of communication? Physicians are exploring how social networking might provide a forum for interacting with their patients, and advance collaborative patient care. Several organizations and institutions have set forth policies to address these questions and more. Though still in its infancy, this form of media has the power to revolutionize the way physicians interact with their patients and fellow health care workers. In the end, physicians must ask what value is added by engaging patients or other health care providers in a social networking format. Social networks may flourish in health care as a means of distributing information to patients or serve mainly as support groups among patients. Physicians must tread a narrow path to bring value to interactions in these networks while limiting their exposure to unwanted liability.
doi:10.1007/s10278-011-9371-4
PMCID: PMC3180534  PMID: 21360214
E-communication; Doctor patient relationship; Facebook; Sermo
11.  Tweeting the Meeting: An In-Depth Analysis of Twitter Activity at Kidney Week 2011 
PLoS ONE  2012;7(7):e40253.
In recent years, the American Society of Nephrology (ASN) has increased its efforts to use its annual conference to inform and educate the public about kidney disease. Social media, including Twitter, has been one method used by the Society to accomplish this goal. Twitter is a popular microblogging service that serves as a potent tool for disseminating information. It allows for short messages (140 characters) to be composed by any author and distributes those messages globally and quickly. The dissemination of information is necessary if Twitter is to be considered a tool that can increase public awareness of kidney disease. We hypothesized that content, citation, and sentiment analyses of tweets generated from Kidney Week 2011 would reveal a large number of educational tweets that were disseminated to the public. An ideal tweet for accomplishing this goal would include three key features: 1) informative content, 2) internal citations, and 3) positive sentiment score. Informative content was found in 29% of messages, greater than that found in a similarly sized medical conference (2011 ADA Conference, 16%). Informative tweets were more likely to be internally, rather than externally, cited (38% versus 22%, p<0.0001), thereby amplifying the original information to an even larger audience. Informative tweets had more negative sentiment scores than uninformative tweets (means −0.162 versus 0.199 respectively, p<0.0001), therefore amplifying a tweet whose content had a negative tone. Our investigation highlights significant areas of promise and improvement in using Twitter to disseminate medical information in nephrology from a scientific conference. This goal is pertinent to many nephrology-focused conferences that wish to increase public awareness of kidney disease.
doi:10.1371/journal.pone.0040253
PMCID: PMC3390326  PMID: 22792254
12.  Blogging in an Online Health Information Technology Class 
In this article we introduce blogs, including their brief history, their current status, and motivations for blogging. We describe how we created a course blog in one online Health information management (HIM) baccalaureate course. We describe three pedagogical purposes (online discussion, digital drop box, and class project management tool) of the course blog. We report the results of our after-class survey on using the blog as a learning tool. Survey results illustrated that 55 percent of the students agree that the blog can be a tool for facilitating learning, 50 percent agree it can be used as a tool for student activities, 60 percent agree it can serve as a medium for reflective thinking and writing, and 60 percent want to see its application in other courses.
PMCID: PMC2047310  PMID: 18066374
13.  Twitter = Quitter? An Analysis of Twitter Quit Smoking Social Networks 
Tobacco Control  2011;21(4):447-449.
Objective
Twitter, a free social networking and micro-blogging service, offers potential for health promotion. Twitter may be a particularly appealing delivery channel for quit smoking programs given commonalities in the personality traits of heavy texters and smokers (e.g., high sensation seeking, impulsivity). This study examined the activity and popularity of Twitter quit smoking social network accounts.
Design
A cross-sectional analysis reviewed all Twitter accounts identified with the key words “quit or stop smoking” or “smoking cessation,” dating back to 2007, and examined recent account activity for the month of August 2010.
Results
A total of 153 activated Twitter quit smoking social network accounts were identified with a median of 155 followers and 82 total tweets per account; 49% of accounts had >100 tweets. Nearly half of the accounts (48%) linked to commercial sites for quitting smoking, 43% had tweets on e-cigarettes, and 26% posted automatic news alerts. Only 5% provided personal communications to support cessation and little content mapped onto clinical practice guidelines. In August 2010, 81 of the accounts (53%) were still active with a median of 23 tweets per account that month. Active accounts had more tweets overall and were more likely to have tweets on e-cigarettes compared to inactive accounts.
Conclusions
Study findings demonstrate interest in Twitter for building quit smoking social networks. However, many of the accounts are no longer active, and tweet content is largely inconsistent with clinical guidelines. Future research is needed to explore whether the popularity of Twitter can be leveraged for disseminating evidence-based tobacco treatment strategies on a national and global scale and to examine the effectiveness of this approach on smoking behavior.
doi:10.1136/tc.2010.042507
PMCID: PMC3310933  PMID: 21730101
Tobacco; Cigarettes; Smoking; Social Media; Blogging; Social Networking
14.  Modeling Users' Activity on Twitter Networks: Validation of Dunbar's Number 
PLoS ONE  2011;6(8):e22656.
Microblogging and mobile devices appear to augment human social capabilities, which raises the question whether they remove cognitive or biological constraints on human communication. In this paper we analyze a dataset of Twitter conversations collected across six months involving 1.7 million individuals and test the theoretical cognitive limit on the number of stable social relationships known as Dunbar's number. We find that the data are in agreement with Dunbar's result; users can entertain a maximum of 100–200 stable relationships. Thus, the ‘economy of attention’ is limited in the online world by cognitive and biological constraints as predicted by Dunbar's theory. We propose a simple model for users' behavior that includes finite priority queuing and time resources that reproduces the observed social behavior.
doi:10.1371/journal.pone.0022656
PMCID: PMC3149601  PMID: 21826200
15.  How the Scientific Community Reacts to Newly Submitted Preprints: Article Downloads, Twitter Mentions, and Citations 
PLoS ONE  2012;7(11):e47523.
We analyze the online response to the preprint publication of a cohort of 4,606 scientific articles submitted to the preprint database arXiv.org between October 2010 and May 2011. We study three forms of responses to these preprints: downloads on the arXiv.org site, mentions on the social media site Twitter, and early citations in the scholarly record. We perform two analyses. First, we analyze the delay and time span of article downloads and Twitter mentions following submission, to understand the temporal configuration of these reactions and whether one precedes or follows the other. Second, we run regression and correlation tests to investigate the relationship between Twitter mentions, arXiv downloads, and article citations. We find that Twitter mentions and arXiv downloads of scholarly articles follow two distinct temporal patterns of activity, with Twitter mentions having shorter delays and narrower time spans than arXiv downloads. We also find that the volume of Twitter mentions is statistically correlated with arXiv downloads and early citations just months after the publication of a preprint, with a possible bias that favors highly mentioned articles.
doi:10.1371/journal.pone.0047523
PMCID: PMC3486871  PMID: 23133597
16.  Use of Social Media by Pharmacy Preceptors 
Objective. To define current use patterns of Facebook and Twitter among pharmacy preceptors and assess perceptions regarding use of social media within professional practice.
Methods. An electronic survey instrument was sent to 315 pharmacists registered as advanced pharmacy practice experience (APPE) preceptors for Purdue University College of Pharmacy.
Results. Approximately 60% of the 155 respondents used a Facebook account and 9% used a Twitter account. Respondents were willing to complete continuing education (CE) credit (46%) using social media, and were interested in following professional organizations (39%) on social media; however, the majority were not interested in obtaining drug or disease-state information, identifying employment opportunities, or participating in clinical discussion forums via social media.
Conclusion. Despite the growing popularity of social media across multiple disciplines, the majority of pharmacy preceptors surveyed were not willing to use these venues in professional practice.
doi:10.5688/ajpe759176
PMCID: PMC3230337  PMID: 22171104
social networking; Facebook; Twitter; technology; advanced pharmacy practice experience
17.  Does Twitter Trigger Bursts in Signature Collections? 
PLoS ONE  2013;8(3):e58252.
Introduction
The quantification of social media impacts on societal and political events is a difficult undertaking. The Japanese Society of Oriental Medicine started a signature-collecting campaign to oppose a medical policy of the Government Revitalization Unit to exclude a traditional Japanese medicine, “Kampo,” from the public insurance system. The signature count showed a series of aberrant bursts from November 26 to 29, 2009. In the same interval, the number of messages on Twitter including the keywords “Signature” and “Kampo,” increased abruptly. Moreover, the number of messages on an Internet forum that discussed the policy and called for signatures showed a train of spikes.
Methods and Findings
In order to estimate the contributions of social media, we developed a statistical model with state-space modeling framework that distinguishes the contributions of multiple social media in time-series of collected public opinions. We applied the model to the time-series of signature counts of the campaign and quantified contributions of two social media, i.e., Twitter and an Internet forum, by the estimation. We found that a considerable portion (78%) of the signatures was affected from either of the social media throughout the campaign and the Twitter effect (26%) was smaller than the Forum effect (52%) in total, although Twitter probably triggered the initial two bursts of signatures. Comparisons of the estimated profiles of the both effects suggested distinctions between the social media in terms of sustainable impact of messages or tweets. Twitter shows messages on various topics on a time-line; newer messages push out older ones. Twitter may diminish the impact of messages that are tweeted intermittently.
Conclusions
The quantification of social media impacts is beneficial to better understand people’s tendency and may promote developing strategies to engage public opinions effectively. Our proposed method is a promising tool to explore information hidden in social phenomena.
doi:10.1371/journal.pone.0058252
PMCID: PMC3590117  PMID: 23484004
18.  Text and Structural Data Mining of Influenza Mentions in Web and Social Media 
Text and structural data mining of web and social media (WSM) provides a novel disease surveillance resource and can identify online communities for targeted public health communications (PHC) to assure wide dissemination of pertinent information. WSM that mention influenza are harvested over a 24-week period, 5 October 2008 to 21 March 2009. Link analysis reveals communities for targeted PHC. Text mining is shown to identify trends in flu posts that correlate to real-world influenza-like illness patient report data. We also bring to bear a graph-based data mining technique to detect anomalies among flu blogs connected by publisher type, links, and user-tags.
doi:10.3390/ijerph7020596
PMCID: PMC2872292  PMID: 20616993
disease surveillance; public health epidemiology; health informatics; graph-based data mining; web and social media; social network analysis
19.  Can Tweets Predict Citations? Metrics of Social Impact Based on Twitter and Correlation with Traditional Metrics of Scientific Impact 
Background
Citations in peer-reviewed articles and the impact factor are generally accepted measures of scientific impact. Web 2.0 tools such as Twitter, blogs or social bookmarking tools provide the possibility to construct innovative article-level or journal-level metrics to gauge impact and influence. However, the relationship of the these new metrics to traditional metrics such as citations is not known.
Objective
(1) To explore the feasibility of measuring social impact of and public attention to scholarly articles by analyzing buzz in social media, (2) to explore the dynamics, content, and timing of tweets relative to the publication of a scholarly article, and (3) to explore whether these metrics are sensitive and specific enough to predict highly cited articles.
Methods
Between July 2008 and November 2011, all tweets containing links to articles in the Journal of Medical Internet Research (JMIR) were mined. For a subset of 1573 tweets about 55 articles published between issues 3/2009 and 2/2010, different metrics of social media impact were calculated and compared against subsequent citation data from Scopus and Google Scholar 17 to 29 months later. A heuristic to predict the top-cited articles in each issue through tweet metrics was validated.
Results
A total of 4208 tweets cited 286 distinct JMIR articles. The distribution of tweets over the first 30 days after article publication followed a power law (Zipf, Bradford, or Pareto distribution), with most tweets sent on the day when an article was published (1458/3318, 43.94% of all tweets in a 60-day period) or on the following day (528/3318, 15.9%), followed by a rapid decay. The Pearson correlations between tweetations and citations were moderate and statistically significant, with correlation coefficients ranging from .42 to .72 for the log-transformed Google Scholar citations, but were less clear for Scopus citations and rank correlations. A linear multivariate model with time and tweets as significant predictors (P < .001) could explain 27% of the variation of citations. Highly tweeted articles were 11 times more likely to be highly cited than less-tweeted articles (9/12 or 75% of highly tweeted article were highly cited, while only 3/43 or 7% of less-tweeted articles were highly cited; rate ratio 0.75/0.07 = 10.75, 95% confidence interval, 3.4–33.6). Top-cited articles can be predicted from top-tweeted articles with 93% specificity and 75% sensitivity.
Conclusions
Tweets can predict highly cited articles within the first 3 days of article publication. Social media activity either increases citations or reflects the underlying qualities of the article that also predict citations, but the true use of these metrics is to measure the distinct concept of social impact. Social impact measures based on tweets are proposed to complement traditional citation metrics. The proposed twimpact factor may be a useful and timely metric to measure uptake of research findings and to filter research findings resonating with the public in real time.
doi:10.2196/jmir.2012
PMCID: PMC3278109  PMID: 22173204
bibliometrics; blogging; periodicals as topic; peer-review; publishing; social media analytics; scientometrics; infodemiology; infometrics; reproducibility of results; medicine 2.0; power law; Twitter
20.  Investigating biomedical research literature in the blogosphere: a case study of diabetes and glycated hemoglobin (HbA1c)*†‡ 
Objective:
The research investigated the relationship between biomedical literature and blogosphere discussions about diabetes in order to explore the role of Web 2.0 technologies in disseminating health information. Are blogs that cite biomedical literature perceived as more trustworthy in the blogosphere, as measured by their popularity and interconnections with other blogs?
Methods:
Web mining, social network analysis, and content analysis were used to analyze a large sample of blogs to determine how often biomedical literature is referenced in blogs on diabetes and how these blogs interconnect with others in the health blogosphere.
Results:
Approximately 10% of the 3,005 blogs analyzed cite at least 1 article from the dataset of 2,246 articles. The most influential blogs, as measured by in-links, are written by diabetes patients and tend not to cite biomedical literature. In general, blogs that do not cite biomedical literature tend not to link to blogs that do.
Conclusions:
There is a large communication gap between health professional and personal diabetes blogs. Personal blogs do not tend to link to blogs by health professionals. Diabetes patients may be turning to the blogosphere for reasons other than authoritative information. They may be seeking emotional support and exchange of personal stories.
doi:10.3163/1536-5050.100.1.007
PMCID: PMC3257491  PMID: 22272157
21.  Reviewing social media use by clinicians 
Adoption studies of social media use by clinicians were systematically reviewed, up to July 26th, 2011, to determine the extent of adoption and highlight trends in institutional responses. This search led to 370 articles, of which 50 were selected for review, including 15 adoption surveys. The definition of social media is evolving rapidly; the authors define it broadly to include social networks and group-curated reference sites such as Wikipedia. Facebook accounts are very common among health science students (64–96%) and less so for professional clinicians (13–47%). Adoption rates have increased sharply in the past 4 years. Wikipedia is widely used as a reference tool. Attempts at incorporating social media into clinical training have met with mixed success. Posting of unprofessional content and breaches of patient confidentiality, especially by students, are not uncommon and have prompted calls for social media guidelines.
doi:10.1136/amiajnl-2012-000990
PMCID: PMC3422846  PMID: 22759618
Facebook; machine learning; predictive modeling; social media; social networking; statistical learning; web 2.0
22.  Prevalence and Global Health Implications of Social Media in Direct-to-Consumer Drug Advertising 
Background
Direct-to-consumer advertising (DTCA), linked to inappropriate medication use and higher health care expenditures, is the fastest growing form of pharmaceutical marketing. DTCA is legal only in the United States and New Zealand. However, the advent of online interactive social media “Web 2.0” technologies—that is, eDTCA 2.0—may circumvent DTCA legal proscriptions.
Objective
The purpose of this study was to assess the prevalence of DTCA of leading pharmaceutical company presence and drug product marketing in online interactive social media technologies (eDTCA 2.0).
Methods
We conducted a descriptive study of the prevalence of eDTCA 2.0 marketing in the top 10 global pharmaceutical corporations and 10 highest grossing drugs of 2009.
Results
All pharmaceutical companies reviewed (10/10, 100%) have a presence in eDTCA 2.0 on Facebook, Twitter/Friendster, sponsored blogs, and really simple syndication (RSS) feeds. In addition, 80% (8/10) have dedicated YouTube channels, and 80% (8/10) developed health care communication-related mobile applications. For reviewed drugs, 90% (9/10) have dedicated websites, 70% (7/10) have dedicated Facebook pages, 90% (9/10) have health communications-related Twitter and Friendster traffic, and 80% (8/10) have DTCA television advertisements on YouTube. We also found 90% (9/10) of these drugs had a non-corporate eDTCA 2.0 marketing presence by illegal online drug sellers.
Conclusion
Pharmaceutical companies use eDTCA 2.0 to market themselves and their top-selling drugs. eDTCA 2.0 is also used by illicit online drug sellers. Regulators worldwide must take into account the current eDTCA 2.0 presence when attempting to reach policy and safety goals.
doi:10.2196/jmir.1775
PMCID: PMC3222189  PMID: 21880574
Illegal pharmacies; social media; pharmaceutical marketing; direct-to-consumer-advertising; internet pharmacies; global health; law; health policy
23.  Prefrontal social cognition network dysfunction underlying face encoding and social anxiety in fragile X syndrome 
NeuroImage  2008;43(3):592-604.
Individuals with fragile X syndrome (FXS) commonly display characteristics of social anxiety, including gaze aversion, increased time to initiate social interaction, and difficulty forming meaningful peer relationships. While neural correlates of face processing, an important component of social interaction, are altered in FXS, studies have not examined whether social anxiety in this population is related to higher cognitive processes, such as memory. This study aimed to determine whether the neural circuitry involved in face encoding was disrupted in individuals with FXS, and whether brain activity during face encoding was related to levels of social anxiety. A group of 11 individuals with FXS (5 M) and 11 age- and gender-matched control participants underwent fMRI scanning while performing a face encoding task with online eye-tracking. Results indicate that compared to the control group, individuals with FXS exhibited decreased activation of prefrontal regions associated with complex social cognition, including the medial and superior frontal cortex, during successful face encoding. Further, the FXS and control groups showed significantly different relationships between measures of social anxiety (including gaze-fixation) and brain activity during face encoding. These data indicate that social anxiety in FXS may be related to the inability to successfully recruit higher level social cognition regions during the initial phases of memory formation.
doi:10.1016/j.neuroimage.2008.08.009
PMCID: PMC2598775  PMID: 18778781
fragile X syndrome; social anxiety; face encoding; subsequent memory; brain function
24.  The iCritical Care Podcast: A Novel Medium for Critical Care Communication and Education 
Podcasting is a recent creation combining old and new technologies allowing rapid, inexpensive delivery of media content (primarily audio) to the end user, both via the desktop environment and personal media players. The authors’ group (the Society of Critical Care Medicine) saw the educational and communication potential for the podcasting concept, and have successfully designed and implemented the first podcast of a national medical society. As of this writing, there are an average of (mean ± SD) 664 ± 290 total downloads per podcast, and their podcast feed has been hit over 68,000 times in its first seven months. In this manuscript, the authors provide documentation of their successful endeavor, as well as a structured framework for other organizations to create similar products.
doi:10.1197/jamia.M2205
PMCID: PMC2215065  PMID: 17068348
25.  Legal and Ethical Issues Regarding Social Media and Pharmacy Education 
Widespread use of social media applications like Facebook, YouTube, and Twitter has introduced new complexities to the legal and ethical environment of higher education. Social communications have traditionally been considered private; however, now that much of this information is published online to the public, more insight is available to students' attitudes, opinions, and character. Pharmacy educators and administrators may struggle with the myriad of ethical and legal issues pertaining to social media communications and relationships with and among students. This article seeks to clarify some of these issues with a review of the legal facets and pertinent court cases related to social media. In addition, 5 core ethical issues are identified and discussed. The article concludes with recommendations for pharmacy educators with regard to preparing for and addressing potential legal issues pertaining to social media.
PMCID: PMC3058471  PMID: 21436925
social media; law; ethics; eprofessionalism; technology

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