Friday, 13 November 2009

#hcsmeu - mostly about #FDAsm (or is it #fdaSM?)

Today's Tweetup on #hcsmeu was mostly dominated by the current Food and Drugs Administration public hearing on social media.

I think it is great to have this debate but it is more than simply working out how best to distribute regulated information on the internet. The role of the prescriber is important and it can be overlooked in the rush to create more e-patients. Open information about drugs and treatments is important as well as promoting digital literacies. However, those seeking the information must also be able to judge whether or not the treatment is indicated or relevant. This requires a broader perspective ... and is why they will still need to talk to their doctor. The challenge with bringing the prescriber into this arena is that there is a conflict between the openness required for effective social media and the confidentiality needed for a personalised consultation.

My summary of the views from the #hcsmeu session is:

Q1 What can EU healthcare learn from this week's FDA Social Media hearing?

FDA are right to engage in this way. It seems they may already have draft guidelines in mind.
How quickly will the FDA be able to publish? Will it already be out of date or will the advice be too general for the expectations of those advocates social media?
Will / should / could the EU follow the FDA?
Is it more about language since English speakers around the world will be able to access American pharma social media anyhow (unless censored)?

Q2 Google, Yahoo call for expanded online drug ads; good for patients?

Good for advertising revenue and possibly good for patients.
Better to have regulated pharmaceutical information than hearsay and misinformation.
This may translate into more direct promotion of disease portals in the EU where direct to customer promotion (i.e. drug name appearing with drug indication - thanks @FarmerFunster) is not allowed.

Fascinomas at lunchtime

Went to the grand round in Truro again yesterday and there were two cases presented. Both were quite unusual and presented a real diagnostic challenge to the admitting teams. They were described as fascinomas.

Blogging your CPD is a bit of a challenge when you can't discuss the details of the cases. However, suffice to say it was a very useful reminder of (1) the possible rare causes of right heart failure, and (2) to always keep sepsis in mind when there is an unusual presentation and especially when the CRP is 300.

The small cakes were very good but the coffee is barely drinkable. Haven't tried the pasties yet as they all seem to go very quickly. Will be more forthright in the future.

Friday, 6 November 2009

#hcsmeu - eats shoots and leaves.

Wish I had assigned more focussed time to it and a better tool than plain old but managed to catch up with #hcsmeu 'Tweetup' today.

The debate on Health Care Social Media Europe focussed today on the three questions:
  1. Experiences in EU of sites rating physicians and/or hospitals? Which are the constraints?
  2. What are most effective ways to build a healthcare (provider and patient) community? Are there any ressources available?
  3. If DTC advertising to patients in EU is banned, but SM is global, can industry utilise SM to give EU patients info online (in keeping with the EC rules)?
The full list is available as a Google Doc.

It was quite hectic and I would have preferred a more standard chat interface as I had to reload the twitter search every now and then. My feeling was that there was a lot of direct unguarded talk (understandable with the 140 character limit) with the intent of defining what the social media business model would be in health. Gritty, informal and refreshing with lots of different perspectives. The medium favours this type of 'messy' discussion and, in a way, to understand what others think is a good introduction for making contacts but perhaps not about understanding the subject.

Analysing the themes of the first two questions (using the transcript) to me it looked like the following views were expressed:
  • Change seems inevitable.
  • Locality and mobility may be more important than ratings in patient choice especially in rural settings.
  • There are problems with patient feedback (in a simple 'rate your doctor' setting). How can it be made more objective?
  • A successful system needs the right design of community and the right mix of patient and professional, leadership and community.
  • Nobody pointed to very successful doctor / hospital rating sites but it was obvious there were many successful 'community' sites. [In my view mostly disease-specific.]
  • Would an emergent design be better?
  • There are difficulties with sustainable business models.
  • Difficult feedback from patients or communities can create even more problems with clinical governance.
As for Q3 I think the answer is simply yes ... but that may be me being too simplistic.

This sort of discussion needs more time and consideration than a quick hour of shooting off Tweets and leaving in time for lunch. However, its focussed nature and the fact that it endures after the event allows for additional networking between the attendees (such as pharmaguy introducing me to an example of an effective community before Web 2.0 as in DIABETES-EHLB) and analysis of comments (such as above).

Very interesting. Thanks Andrew Sprong and Silja Chouquet.

Links: (example entrepreneur-led community site currently in beta testing) blog
PharmaTimes: EU drugmakers agree breakthrough on patient information. 5/Nov/2009
Imaginatik Webinar "Crowdsourcing in Healthcare"

Thursday, 5 November 2009

BTS Emergency Oxygen guidelines at Truro

Attended the Medical Unit's lunchtime meeting at Royal Cornwall Hospital for the first time today where they had a talk on the recent BTS Emergency Oxygen Guidelines from one of their Oxygen champions Dr Coutts. The presentation was largely based on the BTS's lecture for doctors on Emergency Oxygen use in adults with an emphasis on the practical changes that will occur in the Trust.

Oxygen therapy is still variable and suboptimal (1). The Trust will adopt saturation targets of 94 - 98% for most patients and 88 - 92% for those thought to be at risk of Type 2 Respiratory Failure. Oxygen is to be prescribed on treatment charts as this is apparently not commonly done - was routine in Bridgend when I was there. However, in Truro this is going to be with the use of stickers that make the saturation target, mode of delivery and flow rate explicit. There was an interesting discussion about how they are going to try and extend this practice across the PCT. Overall was a good informal reminder of Venturi masks, nasal canulae, reservoir bags, flow rates, oxygen dissociation curves (2) and the boundary disputes between paramedics, physicians and intensivists. Reminded of the editorial a few years ago in the BMJ (3).

I wanted to pop a question at the end to the junior docs such as "does anyone know a condition where patients present critically ill to A&E and where oxygen therapy is contraindicated? (answer = paraquat poisoning)" but thought better of it. Was my first time as a guest after all.

1. Hale KE, Gavin C, O'Driscoll BR. Audit of oxygen use in emergency ambulances and in a hospital emergency department. Emerg Med J. 2008;25(11):773-776. Available at: [Accessed November 5, 2009].  
2. Thomson AJ, Drummond GB, Waring WS, Webb DJ, Maxwell SRJ. Effects of short-term isocapnic hyperoxia and hypoxia on cardiovascular function. J Appl Physiol. 2006;101(3):809-816. Available at: [Accessed November 5, 2009].  
3. Thomson AJ, Webb DJ, Maxwell SRJ, Grant IS. Oxygen therapy in acute medical care. BMJ. 2002;324(7351):1406-1407. Available at: [Accessed November 5, 2009]. 

Sunday, 1 November 2009

Updating myself on CCK09

Have been busy with other things lately and have not really been following the CCK09 course. It does seem generally a little quieter and that might reflect a "burn out" of some of the early enthusiasm.

Managed to catch up with the reading over the last few days and updated my concept map.

I am feeling far more satisfied with the rigour of debate that this learning theory has undergone but it is ironic (and intentional) that it is itself distributed and emergent.

There are works by Siemens and Downes that link to a lot of related theory but they are stored in many places in different forms: articles, videos, teleconference sessions, photos of whiteboards etc. The debate emerges through CCK08, CCK09 and other related networks and it is certainly impossible for any individual to find it all and know it all.