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1.  Enabling Community Through Social Media 
Social network analysis provides a perspective and method for inquiring into the structures that comprise online groups and communities. Traces from interaction via social media provide the opportunity for understanding how a community is formed and maintained online.
The paper aims to demonstrate how social network analysis provides a vocabulary and set of techniques for examining interaction patterns via social media. Using the case of the #hcsmca online discussion forum, this paper highlights what has been and can be gained by approaching online community from a social network perspective, as well as providing an inside look at the structure of the #hcsmca community.
Social network analysis was used to examine structures in a 1-month sample of Twitter messages with the hashtag #hcsmca (3871 tweets, 486 unique posters), which is the tag associated with the social media–supported group Health Care Social Media Canada. Network connections were considered present if the individual was mentioned, replied to, or had a post retweeted.
Network analyses revealed patterns of interaction that characterized the community as comprising one component, with a set of core participants prominent in the network due to their connections with others. Analysis showed the social media health content providers were the most influential group based on in-degree centrality. However, there was no preferential attachment among people in the same professional group, indicating that the formation of connections among community members was not constrained by professional status.
Network analysis and visualizations provide techniques and a vocabulary for understanding online interaction, as well as insights that can help in understanding what, and who, comprises and sustains a network, and whether community emerges from a network of online interactions.
PMCID: PMC3842435  PMID: 24176835
online community; online social networks; information and communication technology; social media; Twitter
2.  Communicating the Experience of Chronic Pain and Illness Through Blogging 
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.
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.
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.
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.
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.
PMCID: PMC3510726  PMID: 23092747
Blogging; narrative medicine; disease management; Internet; pain; chronic illness; survey; psychosocial support systems; holistic health; selfcare
3.  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
4.  Open Source Health Intelligence (OSHINT) for Foodborne Illness Event Characterization 
We propose a cloud-based Open Source Health Intelligence (OS-HINT) system that uses open source media outlets, such as Twitter and RSS feeds, to automatically characterize foodborne illness events in real-time. OSHINT also forecasts response requirements, through predictive models, to allow more efficient use of resources, personnel, and countermeasures in biological event response.
An increasing amount of global discourse reporting has migrated to the online space, in the form of publicly accessible social media outlets, blogs, wikis, and news feeds. Social media also presents publicly available and highly accessible information about individual, real-time activity that can be leveraged to detect, monitor, and more efficiently respond to biological events.
Salmonella and Escherichia Coli (E. coli) events were selected based on the magnitude and number of reported outbreaks to the Centers for Disease Control (CDC) in the last ten years (1). These events affect multiple states and were large enough to ensure appropriate confidence levels when developing response metrics obtained from our prediction models. We collected social media data between 2006 – 2012 due to the emergence of Twitter, Facebook, and other social media utilization during this time period.
Characterization is defined as the process of identifying specific event features that inform overall situational awareness. The number hospitalized, dead, or injured, in addition to patient demographics and symptoms were determined to be useful for our characterization and forecast event metrics. Analytical methods, such as term-frequency-inverse document frequency (TF-IDF), natural language processing (NLP), and information extraction, were used to characterize events according to our metrics. Lexicon development, during NLP implementation, was generated from online news articles used to describe the events. Lastly, forecasting algorithms were developed to predict the potential response based on similar historical events that were initially characterized by our information extraction algorithms.
The OSHINT system was developed in Amazon Web Services and includes real-time social media collection for event characterization (see Figure 1). OSHINT currently characterizes number of victims ill, hospitalized, and dead due to foodborne illness events.
OSHINT was used to characterize the recent national 2012 Salmonella event related to cantaloupes, during which OSHINT characterized social media posts related to the event, as news articles and Twitter tweets streamed into the system (Figure 2). On August 17, 2012 the OSHINT system identified a large increase in Twitter tweets mentioning salmonella. Social media data found absent (victims missing work or school day), death, hospital, and sick events to involve 2, 4, 17, 283 media mentions, respectively. Our TF-IDF algorithm characterized the salmonella event impact as two dead and 150 sickened by salmonella-tainted cantaloupe. Retrospective analysis of CDC reported data on August 30, 2012 indicated the salmonella event involved two deaths in 204 cases (2).
The OSHINT team is continually developing and refining characterization and forecasting algorithms used in the system. Upon completion, OSHINT will characterize symptoms, geography, and demographics for E. coli and Salmonella events. The system will also forecast number sick, dead, and hospitalized for an effective and quick response. We will refine our algorithms and evaluate the system against past and future events to provide confidence in our results.
PMCID: PMC3692774
Open Source; Forecasting; Social Media; Response; Food Safety
5.  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.
PMCID: PMC2947638  PMID: 20632121
professionalism; internet use; medical ethics; health policy
6.  Aging 2.0: Health Information about Dementia on Twitter 
PLoS ONE  2013;8(7):e69861.
Online social media is widespread, easily accessible and attracts a global audience with a widening demographic. As a large proportion of adults now seek health information online and through social media applications, communication about health has become increasingly interactive and dynamic. Online health information has the potential to significantly impact public health, especially as the population gets older and the prevalence of dementia increases. However, little is known about how information pertaining to age-associated diseases is disseminated on popular social media platforms. To fill this knowledge gap, we examined empirically: (i) who is using social media to share information about dementia, (ii) what sources of information about dementia are promoted, and (iii) which dementia themes dominate the discussion. We data-mined the microblogging platform Twitter for content containing dementia-related keywords for a period of 24 hours and retrieved over 9,200 tweets. A coding guide was developed and content analysis conducted on a random sample (10%), and on a subsample from top users’ tweets to assess impact. We found that a majority of tweets contained a link to a third party site rather than personal information, and these links redirected mainly to news sites and health information sites. As well, a large number of tweets discussed recent research findings related to the prediction and risk management of Alzheimer’s disease. The results highlight the need for the dementia research community to harness the reach of this medium and its potential as a tool for multidirectional engagement.
PMCID: PMC3724927  PMID: 23922827
7.  Methodology of an International Study of People with Multiple Sclerosis Recruited through Web 2.0 Platforms: Demographics, Lifestyle, and Disease Characteristics 
Background. Despite evidence of the potential importance of the role of health and lifestyle behaviours in multiple sclerosis (MS) outcomes, there has not been a significant focus on this area of research. Aim. We aimed to recruit an international sample of people with MS at baseline and over a five-year timeframe, examine their health and lifestyle behaviours, and determine the relationship of these behaviours to self-reported disability, disease activity, and quality of life. Methods. People with MS were recruited through web 2.0 platforms including interactive websites, social media, blogs, and forums and completed a comprehensive, multifaceted online questionnaire incorporating validated and researcher-derived tools. Results. 2519 participants met inclusion criteria for this study. This paper describes the study methodology in detail and provides an overview of baseline participant demographics, clinical characteristics, summary outcome variables, and health and lifestyle behaviours. The sample described is unique due to the nature of recruitment through online media and due to the engagement of the group, which appears to be well informed and proactive in lifestyle modification. Conclusion. This sample provides a sound platform to undertake novel exploratory analyses of the association between a variety of lifestyle factors and MS outcomes.
PMCID: PMC3649686  PMID: 23691313
8.  Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education 
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).
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.
PMCID: PMC1564136  PMID: 16911779
9.  Jointly They Edit: Examining the Impact of Community Identification on Political Interaction in Wikipedia 
PLoS ONE  2013;8(4):e60584.
In their 2005 study, Adamic and Glance coined the memorable phrase ‘divided they blog’, referring to a trend of cyberbalkanization in the political blogosphere, with liberal and conservative blogs tending to link to other blogs with a similar political slant, and not to one another. As political discussion and activity increasingly moves online, the power of framing political discourses is shifting from mass media to social media.
Methodology/Principal Findings
Continued examination of political interactions online is critical, and we extend this line of research by examining the activities of political users within the Wikipedia community. First, we examined how users in Wikipedia choose to display their political affiliation. Next, we analyzed the patterns of cross-party interaction and community participation among those users proclaiming a political affiliation. In contrast to previous analyses of other social media, we did not find strong trends indicating a preference to interact with members of the same political party within the Wikipedia community.
Our results indicate that users who proclaim their political affiliation within the community tend to proclaim their identity as a ‘Wikipedian’ even more loudly. It seems that the shared identity of ‘being Wikipedian’ may be strong enough to triumph over other potentially divisive facets of personal identity, such as political affiliation.
PMCID: PMC3616028  PMID: 23573269
10.  The use of microblog-based case studies in a pharmacotherapy introduction class in China 
BMC Medical Education  2013;13:120.
Microblog is a Web 2.0 technology that provides an online social networking platform for communicating and sharing information among web users. Pharmacy educators have previously used microblog to promote active engagement of students. However, there is very little research to demonstrate how to use microblogging effectively to enhance pedagogy in a blended or face-to-face classroom environment. We used the most popular microblog website in China to create a “space” within the classroom to evaluate an interactive microblogging forum for the integration of pharmacotherapy case studies. This study is aimed to determine students’ attitudes toward microblog-based case studies (MBC) in a pharmacotherapy class.
We created a group on Sina Weibo, the most popular microblog website in China, to explore the possibilities of using microblog-based case discussions in pharmacy education to promote and motivate student learning. The class teaching activities began in November 2011; individual group assignments to a single case study were administered to 21 groups with a total of 126 participating pharmacy students. Each group was required to share a discussion care plan on the microblogging platform. Individual students were expected to participate in an online discussion related to at least two other group cases by posting their comments on the microblog platform. All postings were tracked and analyzed, and then a post MBC survey was administered anonymously to determine students’ opinions towards MBC.
A total of 126 students posted 592 messages and 112 students (89%) completed the survey. More than 80% of students agreed that MBC improved communication; nearly 70% agreed that MBC increased the amount of interaction, and over 50% found value in reading other students’ messages. However, 25% students believed the collaborative learning was not effective and 22% indicated the quality of interaction was low.
MBC appears to be well-accepted learning method to students in this study. Educators who wish to use MBC for pharmacy courses should balance the potential advantages, such as improving communication and the amount of interaction, with potential disadvantages, such as inefficient collaborative learning and the low quality of interaction.
PMCID: PMC3846686  PMID: 24010945
11.  Mind the Gap: Social Media Engagement by Public Health Researchers 
The traditional vertical system of sharing information from sources of scientific authority passed down to the public through local health authorities and clinicians risks being made obsolete by emerging technologies that facilitate rapid horizontal information sharing. The rise of Public Health 2.0 requires professional acknowledgment that a new and substantive forum of public discourse about public health exists on social media, such as forums, blogs, Facebook, and Twitter.
Some public health professionals have used social media in innovative ways: to surveil populations, gauge public opinion, disseminate health information, and promote mutually beneficial interactions between public health professionals and the lay public. Although innovation is on the rise, most in the public health establishment remain skeptical of this rapidly evolving landscape or are unclear about how it could be used. We sought to evaluate the extent to which public health professionals are engaged in these spaces.
We conducted a survey of professorial- and scientist-track faculty at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, USA. We asked all available faculty via email to complete a 30-question survey about respondent characteristics, beliefs about social media, and usage of specific technologies, including blogs, Facebook, Twitter, and YouTube.
A total of 181 (19.8%) of 912 professor- and scientist-track faculty provided usable responses. The majority of respondents rarely used major social media platforms. Of these 181 respondents, 97 (53.6%) had used YouTube, 84 (46.4%) had used Facebook, 55 (30.4%) had read blogs, and 12 (6.6%) had used Twitter in the prior month. More recent degree completion was the best predictor of higher usage of social media. In all, 122 (67.4%) agreed that social media is important for disseminating information, whereas only 55 (30.4%) agreed that social media is useful for their research. In all, 43 (23.8%) said social media was helpful for professional career advancement, whereas 72 (39.8%) said it was not. Only 43 (23.8%) faculty said they would employ a full- or part-time social media consultant, and 30 (16.6%) currently employed one.
Despite near-universal appreciation of the potential for social media to serve as a component of public health strategy, a small minority are actually engaged in this space professionally, whereas most are either disinterested or actively opposed to professional engagement. Social media is seen by most as more useful for spreading information than obtaining it. As public discourse on a number of critical health topics continues to be influenced and sometimes shaped by discussions online from Twitter to Facebook, it would seem that greater discourse is needed about when and how public health professionals should engage in these media, and also how personal, institutional, and professional barriers to greater use of social media may be overcome.
PMCID: PMC3906700  PMID: 24425670
Internet; social media; public health; blogging
12.  Global Reach of Direct-to-Consumer Advertising Using Social Media for Illicit Online Drug Sales 
Illicit or rogue Internet pharmacies are a recognized global public health threat that have been identified as utilizing various forms of online marketing and promotion, including social media.
To assess the accessibility of creating illicit no prescription direct-to-consumer advertising (DTCA) online pharmacy social media marketing (eDTCA2.0) and evaluate its potential global reach.
We identified the top 4 social media platforms allowing eDTCA2.0. After determining applicable platforms (ie, Facebook, Twitter, Google+, and MySpace), we created a fictitious advertisement advertising no prescription drugs online and posted it to the identified social media platforms. Each advertisement linked to a unique website URL that consisted of a site error page. Employing Web search analytics, we tracked the number of users visiting these sites and their location. We used commercially available Internet tools and services, including website hosting, domain registration, and website analytic services.
Illicit online pharmacy social media content for Facebook, Twitter, and MySpace remained accessible despite highly questionable and potentially illegal content. Fictitious advertisements promoting illicit sale of drugs generated aggregate unique user traffic of 2795 visits over a 10-month period. Further, traffic to our websites originated from a number of countries, including high-income and middle-income countries, and emerging markets.
Our results indicate there are few barriers to entry for social media–based illicit online drug marketing. Further, illicit eDTCA2.0 has globalized outside US borders to other countries through unregulated Internet marketing.
PMCID: PMC3668613  PMID: 23718965
health policy; pharmacies; social media; Internet; social marketing; marketing of health services; online pharmaceutical services
13.  Cancer patients on Twitter: a novel patient community on social media 
BMC Research Notes  2012;5:699.
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.
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.
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.
PMCID: PMC3599295  PMID: 23270426
Breast cancer; Breast neoplasms; Internet; Leukemia; Social media; Twitter messaging; Web 2.0
14.  Physicians, Social Media, and Conflict of Interest 
Physicians and patients increasingly use social media technologies, such as Facebook, Twitter, and weblogs (blogs), both professionally and personally. Amidst recent reports of physician misbehavior online, as well as concerns about social media’s potential negative effect on trust in the medical profession, several national-level physician organizations have created professional guidelines on social media use by physicians. Missing from these guidelines is adequate attention to conflict of interest. Some guidelines do not explicitly mention conflict of interest; others recommend only disclosure. Recommending disclosure fails to appreciate the unique features of social media that make adequate disclosure difficult to accomplish. Moreover, in emphasizing disclosure alone, current guidelines are inconsistent with medicine’s general trend toward management or elimination, not just disclosure, of potential conflicts. Because social media sites typically rely on physicians’ voluntary compliance with professional norms, physicians necessarily play a major role in shaping these norms’ content and scope. To achieve the benefits of social media and ensure the veracity of social media content while preserving trust in the profession, physicians must reaffirm their commitment to disclose potential conflicts; advocate for better electronic disclosure mechanisms; and develop concrete management strategies—including, where necessary, the elimination of conflicts altogether.
PMCID: PMC3614128  PMID: 23129160
professionalism; ethics; internet; conflict of interest; blogging; social media
15.  Social media use among patients and caregivers: a scoping review 
BMJ Open  2013;3(5):e002819.
To map the state of the existing literature evaluating the use of social media in patient and caregiver populations.
Scoping review.
Data sources
Medline, CENTRAL, ERIC, PubMed, CINAHL Plus Full Text, Academic Search Complete, Alt Health Watch, Health Source, Communication and Mass Media Complete, Web of Knowledge and ProQuest (2000–2012).
Study selection
Studies reporting primary research on the use of social media (collaborative projects, blogs/microblogs, content communities, social networking sites, virtual worlds) by patients or caregivers.
Data extraction
Two reviewers screened studies for eligibility; one reviewer extracted data from relevant studies and a second performed verification for accuracy and completeness on a 10% sample. Data were analysed to describe which social media tools are being used, by whom, for what purpose and how they are being evaluated.
Two hundred eighty-four studies were included. Discussion forums were highly prevalent and constitute 66.6% of the sample. Social networking sites (14.8%) and blogs/microblogs (14.1%) were the next most commonly used tools. The intended purpose of the tool was to facilitate self-care in 77.1% of studies. While there were clusters of studies that focused on similar conditions (eg, lifestyle/weight loss (12.7%), cancer (11.3%)), there were no patterns in the objectives or tools used. A large proportion of the studies were descriptive (42.3%); however, there were also 48 (16.9%) randomised controlled trials (RCTs). Among the RCTs, 35.4% reported statistically significant results favouring the social media intervention being evaluated; however, 72.9% presented positive conclusions regarding the use of social media.
There is an extensive body of literature examining the use of social media in patient and caregiver populations. Much of this work is descriptive; however, with such widespread use, evaluations of effectiveness are required. In studies that have examined effectiveness, positive conclusions are often reported, despite non-significant findings.
PMCID: PMC3651969  PMID: 23667163
social media; scoping review
16.  The value and use of social media as communication tool in the plant sciences 
Plant Methods  2013;9:26.
Social media now complements many parts of our lives. Facebook, Twitter, YouTube and many other social networking sites allow users to share and interact with online content and to connect with like-minded people. Its strengths – rapid dissemination and amplification of content and the ability to lead informal conversations – make it a powerful tool to use in a professional context. This commentary explains the overall concept of social media and offers suggestions on usage and possible types of scientific content. It advises researchers on the potential benefits and how to take a strategic approach towards building a social media presence. It also presents examples of effective social media use within the plant science community. Common reasons for scientists to not engage with social media include the fear of appearing unprofessional, posting something wrong or being misunderstood, or a lack of confidence in their computer skills. With the rapid changes in academic publishing, dissemination and science communication, as well as the rise of ‘altmetrics’ to track online engagement with scientific content, digital literacy will become an essential skill in a scientist’s tool kit.
PMCID: PMC3716900  PMID: 23845168
Social media; Social networking; Hashtag; Blogging; Science communication
17.  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.
PMCID: PMC3180534  PMID: 21360214
E-communication; Doctor patient relationship; Facebook; Sermo
18.  Social Media and Physicians’ Online Identity Crisis 
Physicians are increasingly counted among Face-book’s 1 billion users and Twitter’s 500 million members. Beyond these social media platforms, other innovative social media tools are being used in medical practice, including for online consultation,1 in the conduct of clinical research,2 and in medical school curricula.3 Social media content is brief, characterized as “many-to-many” communication, and able to spread rapidly across the Internet beyond a person’s control. These and other features of social media create new dimensions to traditional ethical issues, particularly around maintaining appropriate boundaries between physicians and patients.
PMCID: PMC3954788  PMID: 23942675
19.  Social media policies at US medical schools 
Medical Education Online  2010;15:10.3402/meo.v15i0.5324.
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.
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.
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.
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.
PMCID: PMC2941429  PMID: 20859533
online; internet; social networking; professionalism policies; Web 2.0
20.  An Exploration of Social Circles and Prescription Drug Abuse Through Twitter 
Prescription drug abuse has become a major public health problem. Relationships and social context are important contributing factors. Social media provides online channels for people to build relationships that may influence attitudes and behaviors.
To determine whether people who show signs of prescription drug abuse connect online with others who reinforce this behavior, and to observe the conversation and engagement of these networks with regard to prescription drug abuse.
Twitter statuses mentioning prescription drugs were collected from November 2011 to November 2012. From this set, 25 Twitter users were selected who discussed topics indicative of prescription drug abuse. Social circles of 100 people were discovered around each of these Twitter users; the tweets of the Twitter users in these networks were collected and analyzed according to prescription drug abuse discussion and interaction with other users about the topic.
From November 2011 to November 2012, 3,389,771 mentions of prescription drug terms were observed. For the 25 social circles (n=100 for each circle), on average 53.96% (SD 24.3) of the Twitter users used prescription drug terms at least once in their posts, and 37.76% (SD 20.8) mentioned another Twitter user by name in a post with a prescription drug term. Strong correlation was found between the kinds of drugs mentioned by the index user and his or her network (mean r=0.73), and between the amount of interaction about prescription drugs and a level of abusiveness shown by the network (r=0.85, P<.001).
Twitter users who discuss prescription drug abuse online are surrounded by others who also discuss it—potentially reinforcing a negative behavior and social norm.
PMCID: PMC3785991  PMID: 24014109
prescription drug abuse; social media; social circles; Twitter
21.  HealthTrust: A Social Network Approach for Retrieving Online Health Videos 
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.
To explore approaches for extracting metrics about authoritativeness in online health communities and how these metrics positively correlate with the quality of the content.
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.
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.
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.
PMCID: PMC3374533  PMID: 22356723
Medical informatics; information storage and retrieval; video; online systems; health communication; diabetes
22.  Public hospital quality report awareness: evidence from National and Californian Internet searches and social media mentions, 2012 
BMJ Open  2014;4(3):e004417.
Publicly available hospital quality reports seek to inform consumers of important healthcare quality and affordability attributes, and may inform consumer decision-making. To understand how much consumers search for such information online on one Internet search engine, whether they mention such information in social media and how positively they view this information.
Setting and design
A leading Internet search engine (Google) was the main focus of the study. Google Trends and Google Adwords keyword analyses were performed for national and Californian searches between 1 August 2012 and 31 July 2013 for keywords related to ‘top hospital’, best hospital’, and ‘hospital quality’, as well as for six specific hospital quality reports. Separately, a proprietary social media monitoring tool was used to investigate blog, forum, social media and traditional media mentions of, and sentiment towards, major public reports of hospital quality in California in 2012.
Primary outcome measures
(1) Counts of searches for keywords performed on Google; (2) counts of and (3) sentiment of mentions of public reports on social media.
National Google search volume for 75 hospital quality-related terms averaged 610 700 searches per month with strong variation by keyword and by state. A commercial report (Healthgrades) was more commonly searched for nationally on Google than the federal government's Hospital Compare, which otherwise dominated quality-related search terms. Social media references in California to quality reports were generally few, and commercially produced hospital quality reports were more widely mentioned than state (Office of Statewide Healthcare Planning and Development (OSHPD)), or non-profit (CalHospitalCompare) reports.
Consumers are somewhat aware of hospital quality based on Internet search activity and social media disclosures. Public stakeholders may be able to broaden their quality dissemination initiatives by advertising on Google or Twitter and using social media interactively with consumers looking for relevant information.
PMCID: PMC3963102  PMID: 24618223
Public Health; Health Services Administration & Management
23.  Social Media Release Increases Dissemination of Original Articles in the Clinical Pain Sciences 
PLoS ONE  2013;8(7):e68914.
A barrier to dissemination of research is that it depends on the end-user searching for or ‘pulling’ relevant knowledge from the literature base. Social media instead ‘pushes’ relevant knowledge straight to the end-user, via blogs and sites such as Facebook and Twitter. That social media is very effective at improving dissemination seems well accepted, but, remarkably, there is no evidence to support this claim. We aimed to quantify the impact of social media release on views and downloads of articles in the clinical pain sciences. Sixteen PLOS ONE articles were blogged and released via Facebook, Twitter, LinkedIn and on one of two randomly selected dates. The other date served as a control. The primary outcomes were the rate of HTML views and PDF downloads of the article, over a seven-day period. The critical result was an increase in both outcome variables in the week after the blog post and social media release. The mean ± SD rate of HTML views in the week after the social media release was 18±18 per day, whereas the rate during the other three weeks was no more than 6±3 per day. The mean ± SD rate of PDF downloads in the week after the social media release was 4±4 per day, whereas the rate during the other three weeks was less than 1±1 per day (p<0.05 for all comparisons). However, none of the recognized measures of social media reach, engagement or virality related to either outcome variable, nor to citation count one year later (p>0.3 for all). We conclude that social media release of a research article in the clinical pain sciences increases the number of people who view or download that article, but conventional social media metrics are unrelated to the effect.
PMCID: PMC3714259  PMID: 23874810
24.  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.
PMCID: PMC3261844  PMID: 22276119
25.  Paediatricians, social media and blogs: Ethical considerations 
Paediatrics & Child Health  2012;17(5):267-269.
The use of blogs, Facebook and similar social networking sites is rapidly expanding and, when compared with e-mail, may be having a significantly different impact on the traditional doctor-patient relationship. Characteristics specific to these online platforms have major implications for professional relationships, including the ‘Facebook effect’ (the relative permanence of postings) and the ‘online disinhibition effect’. The present practice point illustrates relevant ethical considerations and provides guidance to paediatricians and others concerning the prudent professional and personal use of social networking media.
PMCID: PMC3381922  PMID: 23633902
Blogs; Ethics; Facebook; Paediatricians; Professionalism; Social networking

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