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Is maintenance BCG an unnecessary evil? Summary of the April 2015 #urojc

May 1, 2015/by Sophia Cashman

The current BCG shortage, and the effect this is having on our bladder cancer patients, is an issue that continues to weigh heavily on many urologists. With no immediate solution in sight, and limited availability, a variety of tactics are being advocated to optimally use the current supply.

The April 2015 International Urology Journal Club #urojc debate focused on the timely paper by Martínez-Piñeiro et al¹. This paper reported the results of a randomised trial evaluating the outcomes of BCG induction followed by a modified three year maintenance regimen versus standard BCG induction alone in patients with high-risk non-muscle-invasive bladder cancer. The investigators concluded there was no observed decrease in recurrence and progression rates in those receiving just induction compared to induction and maintenance regimen.

This very topical debate kicked off on Sunday 12^th April.

Coinciding with the USANZ Annual Scientific Meeting, this month’s debate gave both those who were live tweeting at the conference, and those learning about the benefits of social media as a new concept, the opportunity to see the #urojc debate in action.

One of the first points of discussion raised was the difference between the maintenance protocol used in the study, consisting of one BCG installation every three months for three years, and the standard SWOG schedule.

The lack of difference in outcome between the two groups raised the question as to whether this indicated that their modified maintenance protocol is less effective that the current strategies.

The theme of alternative maintenance schedules continued, with some variation in practice noted.

Some of the variability in maintenance may be due to the tolerability and side effects experienced.

Although there may be a degree of acceptance amongst patients if there is thought to be a chance of improvement in risks of disease recurrence or progression.

The reason for the variability of response to BCG therapy between patients remains unclear.

For the patient, the lack of understanding of why this is the case may be a cause of distress, especially when faced with adverse effects and toxicity.

Inevitably it was not long until the key on-going issue of the lack of available BCG was raised.

This issue continues to cause a lot of angst for both patients and their treating urologists, with no immediate solution evident. There may however be light at the end of a somewhat long tunnel with the restarting of production by Sanofi.

In the mean time, the downstream effects of the production delay continues to compromise the treatment options for bladder cancer patients.

As the availability remains largely outside of clinicians’ hands, perhaps our focus at present needs to be on other factors we can control in order to improve the outcomes for our bladder cancer patients.

This debate surrounding this paper has raised a number of key points that, in the face of the BCG shortage, are worth considering. Until the supply is re-established, the BCG we have needs to be optimally used – however perhaps the most effective maintenance schedule needs further investigation. Or perhaps, due to the variation in tolerability and effectiveness between individuals, maintenance therapy needs to remain a more fluid concept.

As always, the #urojc debate involved healthy international discussions. This gives the unique ability to understand the global viewpoints on the study findings, and the current BCG crisis. Analytics of the debate using the #urojc hash tag from the website www.symplur.com again demonstrated the excellent involvement from participants, with over 180,000 unique impressions.

Thanks to all of those who participated this month. We look forward to the #urojc May debate – I am sure it will be as lively as ever.

1. Martínez-Piñeiro L, Portillo JA, Fernández JM, et al. Maintenance Therapy with 3-monthly Bacillus Calmette-Guérin for 3 Years is Not Superior to Standard Induction Therapy in High-risk Non-muscle-invasive Urothelial Bladder Carcinoma: Final Results of Randomised CUETO Study 98013. European Urology March 2015 (Article In Press)

Urologists in the Yellow Submarine – a Periscope to the World

April 20, 2015/5 Comments/by Henry Woo

Over the last few weeks, there has been a lot of chatter about a new Social Media platform. Just when you thought that we had exhausted all possible ways that people could interact online, live video streaming is the talk of the town.

Last month, two competing live video streaming apps were launched. Meerkat initially gained popularity quite rapidly, particularly through Twitter, given the ease and immediacy of being able to share your live video streaming with twitter followers. Twitter acquired its competitor, Periscope, and Meerkat’s access to the twitter followers was cut off no sooner than it had began. Already there are arguments as to which of the two platforms are better but I can already sense from user reactions and expert opinion, that Periscope will be the one that will prevail. The might of Twitter will be very difficult to compete with.

Why on earth would urologists be interested in live broadcasts? The obvious application is live streaming of events such as conferences. The default option is perform a public broadcast and this will have particular value when there is an advocacy focus. There is also an option to broadcast privately only to followers of the Periscope account performing the broadcast. The latter may well be the best option for more sensitive material but there are still issues that need to be sorted out. In particular, there is no simple mechanism to determine which followers should be permitted to follow the broadcasting account in order to see a private live stream. It is inevitable that this will be simplified in the future, as it would be logical for this platform to find a mechanism to attract business users.

As things are at present, one needs to have a twitter account in order to sign on to broadcast using Periscope. This platform is designed for the mobile user – this is both for broadcasting and for watching the live stream. Attempting to do this on a desktop or laptop website is cumbersome and clumsy from my initial attempts to do so whereas the iOS App was straightforward and intuitive, particularly for those already familiar with the Twitter app.

Note the similarity of the iOS Periscope App with the Twitter App interface.

It is my belief that the first ever Periscope live stream broadcast from a medical conference was performed on Sunday 12 April 2015 at the Urological Society of Australia and New Zealand’s (USANZ) Annual Scientific Meeting. Declan Murphy used Periscope to broadcast a message from Prokar Dasgupta, Editor-in-Chief of the BJUI Journal. The video from the Periscope live stream is below. This first, at least for a urological conference, was tweeted by Declan Murphy.

A couple of hours later, I performed a live video stream from the Social Media session when Imogen Patterson gave an excellent presentation on managing our online reputations. During the feed, observers are able to make comments as well as to demonstrate their approval by tapping their screens to trigger a flow of hearts from the bottom right hand corner of the screen.

This is a screenshot from an unrelated live video feed. From the bottom left, the user is notified of those joining the observation of the feed as well as comments. From the bottom right, hearts float upwards in response to positive taps of the screen by watchers.

There are a few issues with Periscope as it is right now. The feed is only available for 24 hours before disappearing from the Periscope platform, however, a video recording minus the comments and hearts, can be stored in the photo stream on your mobile device. As mentioned before, you must have a twitter account to broadcast although you do not need one to view a broadcast. Thirdly, directed broadcasting should be simplified.

Social media platforms come and go but the ability to live stream is an exciting new development. For Periscope, it is my belief that the potential application for a use in medical education seems boundless. Live broadcasting is no longer the exclusive domain of television and cable networks.

Henry Woo (@drhwoo) is Associate Professor of Surgery at the Sydney Adventist Hospital Clinical School of the University of Sydney. He is the Editor-in-Chief of BJUI Knowledge, an innovative on-line CME portal that launches this year.

Racing ahead

March 3, 2015/1 Comment/by Declan Murphy

Since the new Editorial team assumed the reins here at the BJUI in January 2013, we have worked hard to embrace social media as the transformative communication technology it clearly is. While our priority is to only publish papers of the highest quality, we have also ensured that the reach and engagement of these papers are maximised using our social media platforms – Twitter, Facebook, YouTube, Instagram and Blogs@BJUI.

In this month’s BJUI, there are two intriguing papers that deal with this area but that deliver contrasting messages. The first from Nason et al. analyses the Twitter activity of all urology journals over a recent 6-month period. It is clear that the major journals have adopted Twitter as a preferred social media platform and it is gratifying to see how well the BJUI performs when assessed using the metrics in this paper. However, Fuoco and Leveridge report that most urologists in a Canadian survey believe that ‘social media integration into medical practice is impossible’ and attitudes towards the professional role of social media were ‘generally negative’.

Nevertheless, the power of social media in enhancing our personal and professional communication is undeniable and we at the BJUI expect more and more urologists to embrace social media in the coming years. We will continue to evolve our social media strategy to ensure the BJUI is a highly ‘social’ experience.

On another note, the BJUI is pleased to support an excellent conference taking place in Dublin in April in the memory of our previous Editor-in-Chief, Professor John Fitzpatrick, who passed away suddenly last year. The Inaugural John Fitzpatrick Irish Prostate Cancer Conference takes place from 23–24th April 2015 and has attracted an outstanding International Faculty of colleagues and friends who look forward to exploring the most challenging areas in prostate cancer in his memory. Details here https://www.globalteamwork.ie/prostate.html.

Declan G. Murphy – BJUI Associate Editor – Social Media

Department of Urology, University of Melbourne, Melbourne, VIC, Australia

Twitter @declangmurphy

You may have heard it on the grapevine, but UroVine is now here

February 6, 2015/4 Comments/by Henry Woo

I was first introduced to Vine by my good friend Dr Fernando Gomez Sancha over a very enjoyable dinner in Milan during the European Association of Urology meeting in March 2013. I thought that the concept was interesting and signed up on the spot.

Vine is a relatively new social media platform that allows users to create and share 6 second videos loops. It brings out amazing creativity with the very restrictive maximum 6 second video duration. It is not dissimilar to the Twitter where users have to work within the content limits of the platform where one only has a 140 character to make a point. However, Twitter is probably a lot easier than trying to create 6 second video content.

Although signed up to a Vine account, I did not use it very much initially. I was still a little unsure as to how I was going to be able make use of it either for personal or professional use. Gradually over time, I started playing around and making some personal Vine clips, mainly at concerts or at sports events. They were not particularly well thought out Vines and certainly of limited interest. I also tweeted a few of these Vines and I was impressed by the integration of Vine videos on the Twitter platform. I should not have been surprised since Twitter owns Vine.

On Twitter, one can watch a Vine loop video without having to click a link out of the App or website as is the case for say YouTube. Additionally, the short Vine clips were a perfect match for Twitter users who wanted small bite sized content in this time poor world. I then became fascinated with Vine having this repetitious loop – it is almost captivating to the extent that you cannot help but to watch at least 3 or more loops. The first loop is like “what was that”, the second loop is like “I think it’s what I thought I saw” and third loop is like “I get it” and the fourth loop is because you could not work out exactly when the third loop ended and accidentally watched it for an additional time. Have a look some Vine clips and you will then understand what I mean.

This repetition had me thinking about how can we find a medical education application to this platform. The answer was really in Twitter. The best way was to use Twitter and Vine together. If a specific Twitter account were to be created to link to specific Vines, we could create a powerful medical education tool. The repetitious nature of the video loop enables us to reinforce a learning point.

On 3 February 2015, #UroVine was established using the account @UroVine. Vine clips have already been tweeted associated with key learning points. I would love to hear your feedback and to have your Vines submitted for tweeting.

Making a Vine is very simple. It does not have to be HD or have cinema ready professional production. The simplest thing to do is to take your mobile phone with the Vine App and to shoot selected video running off your laptop. More important is that there needs to be clear learning point that needs to reinforced.

The combined use of Twitter and Vine specifically for medical education has the potential to be a very powerful tool. With recent provision of Twitter Activity metrics for each tweet and Vine loop data, there is the potential for some interesting analysis. It is my belief that this is a first and once again a demonstration that Urology is leading the way with innovation in medical education and social media. I hope you will join us.

Henry Woo (@drhwoo) is Associate Professor of Surgery at the Sydney Adventist Hospital Clinical School of the University of Sydney. He is the Editor in Chief of BJUI Knowledge, an innovative on-line CME portal that launches this year.

Social media makes global urology meetings truly global

February 5, 2015/1 Comment/by Stacy Loeb

The use of social media continues to expand in urology and the BJUI is proud to be at the forefront of these efforts. All of the global urology meetings now have their own twitter feed, which is indexed using a ‘hashtag’ (e.g. #EAU14, #AUA14). Analogous to a Medical Subject Heading (MeSH) in PubMed, hashtags are used to categorise related tweets together in one place, providing a convenient way to follow conference proceedings.

Surrounding the 2014 European Association of Urology (EAU) Congress (9–16 April 2014), there were a record 5749 tweets from 761 unique contributors. The BJUI and its editorial team represented four of the top 10 social media influencers based on the number of times that they were mentioned in the #EAU14 conference twitter feed.

Social media engagement continued to grow to new heights at the 2014 AUA meeting. From 14–23 May 2014, there were a total of 10 364 tweets from 1199 unique contributors in the #AUA14 conference twitter feed. The BJUI and its editorial team represented six of the top 10 influencers based on the total number of mentions.

In addition to urology conferences, the BJUI continues to actively participate in social media throughout the year. We provide a variety of specialised content such as videos, picture quizzes, and polls, as well as free access to the ‘Article of the Week’. This provides a great way to stay up-to-date on the latest research in a dynamic, interactive setting.

Finally, I would like to call your attention to two ‘Articles of the Week’ featured in this issue of BJUI, both of which will be freely available and open to discussion on twitter. The first by Kates et al. [1] deals with the interesting question of the optimal follow-up protocol during active surveillance. Using yearly biopsy results from the Johns Hopkins active surveillance programme, they report what proportion of reclassification events would have been detected had the Prostate Cancer Research International Active Surveillance (PRIAS) protocol been used instead (including less frequent biopsies and PSA kinetics).

Another feature ‘Article of the Week’ by Eisenberg et al. [2] addresses the controversial link between testosterone therapy and prostate cancer risk. Among men undergoing hormonal testing at their institution, they used data from the Texas Cancer Registry to compare the rates of malignancy between those who were and were not using testosterone supplementation. We hope that these articles will stimulate an interesting discussion and encourage you to join us on twitter.

Dr. Stacy Loeb is an Assistant Professor of Urology and Population Health at New York University and is a Consulting Editor for BJUI. Follow her on Twitter @LoebStacy

SoMe Guidelines in Urology: #urojc August 2014 summary

August 21, 2014/by Parth Modi

The August 2014 twitter-based international urology journal club (#urojc) took an introspective look at the newly published European Association of Urology recommendations on the appropriate use of social media.

This month’s article hit close to home as a panel of international urologists (many who are active on Twitter and #urojc) attempted to bring social media (SoMe) to the general public of urologists with some basic guidelines on effective, safe and honest communication. The article described the various social networks frequently used by physicians, highlighted some benefits of SoMe involvement, and pointed out the possible risks of SoMe. Recommendation statements emphasized clear, confidentiality, refraining from self-promotion, limits on patient-physician interaction and caution in engaging in SoMe.

From the start, it was evident that this was not a fluff piece and there was discussion to be had:

@CBayneMD started it off with concern about the recommendation to keep personal and professional content separate. Many argued that adding something personal kept the communication more interesting and reminded readers that behind the online persona is a person.

Good arguments were made on both sides. Using different SoMe outlets for personal and professional posts may make it easier to keep it appropriate.

The guideline section on refraining from self-promotion was generally well accepted, though some clarification was called for.

Another criticism was of the group of EAU panelists chosen to write the guideline. An excellent choice was made to include the twitter handles of the guidelines authors in the byline.

Several of the authors are undoubtedly SoMe experts.

@wandering_gu, one of the authors, defended the decision to include authors with varied levels of SoMe experience.

A common twitter disclaimer, amongst physicians, “RT (retweets) are not E (endorsements)” may or may not be worth much.

…but may be necessary, nonetheless.

@Dr_RPM summarizes the message of this guideline document.

Whether or not you agree with the EAU SoMe guidelines or the previously published BJUI SoMe Guidelines, it’s clear that SoMe in medicine, and especially urology, is an important part of the future. We should all continue to be thoughtful in our involvement with SoMe and encourage our friends and colleagues to participate. Thank you all for another exciting discussion. Make sure to keep an eye on @iurojc and #urojc for next month’s International Urology Journal Club!

Parth K. Modi is a PGY-4 urology resident at Rutgers-RWJMS in New Brunswick, NJ. He has an interest in urologic oncology, robotics and bioethics and tweets @marthpodi.

Social Media and Twitter from a Resident’s Perspective

August 19, 2014/4 Comments/by Zachary Klaasen

“Happy Twitterversary! You’ve just turned 1”

Really? As I stared bleary eyed, post-call at the email in my inbox I couldn’t believe what an ingenious idea such an email was (how many of us remember the day we started using Twitter?) and that another year as a resident (albeit on Twitter) was behind me.

No question I was a “slow adapter” to social media, in particular Twitter – it was too reactionary, I was too busy, it would take up too much time. I can’t remember how or why I was persuaded, but curiosity led to me to create a Twitter account in the middle of the night while waiting to put up a ureteral stent. Immediately my perception and the time frame in which I obtained information completely changed. I started adding accounts for sports and news outlets and…..urologists and urology journals. Who knew?!

Over the past year, I’ve become more comfortable and engaged with Twitter. As a resident, there are a number of opportunities and a few challenges associated with navigating and managing a successful and educational Twitter experience.

Opportunities:

1) World-wide collaborations with leaders in the field who may otherwise be “less accessible” – as a resident, this may be THE most important aspect of Twitter. For those of us pursuing fellowship, building research connections, etc., being able to have access to and follow program directors and leaders in urology is invaluable.

2) Centralization for notifications of publications that are recently in press – as an aspiring urologic oncologist and academician, this is very helpful. BJU International (@BJUIjournal), the Journal of Urology (@JUrology), European Urology (@EUplatinum), Urology Match (@UrologyMatch) and UroToday.com (@urotoday) are personally a few of the most active and informative accounts I follow.

3) Connected at meetings – the ability to be “everywhere”! Getting updates from multiple concurrent sessions has changed the way I attend meetings. AUA 2014 this past year in Orlando was my first meeting on Twitter – to be able to keep up to date on concurrent sessions while contributing to the session I was attending, enhanced and broadened my learning experience.

Drs. Tim Averch, Benjamin Davies, Stacy Loeb, Brian Stork , Henry Woo, Matt Cooperberg, Declan Murphy (Not pictured, Dr. Christopher Bayne). American Urological Association Social Media Committee – See more at: https://www.drbrianstork.com/blog/medical-student-perspective-aua14/

4) Quick hit knowledge “tidbits” – what immediately comes to mind is the evolution of the International Urology Journal Club. This has been very useful and has changed the social media landscape for international, real-time, educational discussions.

Like everything with being a resident, Twitter takes time. However, whether we are walking to a meeting, waiting in the OR, riding the elevator, there are opportunities throughout the day to stay involved and engaged. While I may occasionally miss out on discussions, such as the 48 hours of Urology Journal Club (which may just happen to correspond with a call week), one can always use hashtags (ie. #urojc) to go back and catch up on the banter and knowledge shared.

Personally, I have yet to encounter my attendings expressing concern about what I’m Tweeting or how I’m engaging in social media. To my knowledge, residents are not receiving any formal training or best practice training in social media during residency. As Twitter continues to evolve and the field of Urology continues to lead the medical foray into Twitter, a resident “social media ethics seminar” may be something the AUA considers during the national meeting. Perhaps this may be held in conjunction with the Twitter training sessions at the AUA Resource Center and may take into consideration the recent Engaging Responsibly with Social Media: the BJUI Guidelines and the EAU Recommendations. As importantly, medical students interested in Urology should be aware of their online profiles displayed on social networking websites, considering that program directors are increasingly utilizing this avenue to further evaluate residency applicants.

Until then, we may all consider sticking to the advice of ESPN Radio personality Colin Cowherd “Social media: Don’t do it after a cocktail or in your underwear.”

Zach Klaassen is a Resident in the Department of Surgery, Section of Urology Georgia Regents University – Medical College of Georgia Augusta, USA. @zklaassen_md

The Big Data challenge: amplify your content using video and maximise your impact

June 6, 2014/3 Comments/by Declan Murphy

It remains a great achievement for an author to have his or her work published in a peer-reviewed journal such as the BJUI. There is a tremendous sense of fulfilment when the e-mail from the Editor-in-Chief includes ‘accept’ in the subject heading. What may have been a long period from study design, through ethics approval, patient recruitment, intervention, data collection, statistical analysis, manuscript preparation, to final revisions, finally comes to an end – chapter closed, move on.

However, in this era of ‘Big Data’, we are now confronted with new challenges with respect to getting our content noticed. It is estimated that of all the data created in the history of mankind, from early cave drawings to medieval manuscripts and modern web 2.0 communication, >90% has been created in the past 2 years alone [1]. Two thousand years ago, 90% of the world’s content was thought to be archived in just one place, the Library of Alexandria in Egypt, and all of that content would easily fit on a flash drive today. With this massive amount of new data emerging, the current challenge is not just to get published, but also to get your work noticed. Are you always looking out for new methods of approaching potential customers? If the answer is yes, then you should definitely try out a geocoding service. Just imagine, you will have a large map in front of you, where the locations of all your customers are marked. You will know exactly where your customers live, and in which regions your products and services are most popular. Just think of what you can do with this knowledge. For starters, how about running some location based targeted marketing campaigns? These campaigns are sure to bring in lots of new customers, if you can fine-tune these properly. Geoparsing API by Geocodeapi.io can be done simply through address interpolation, which uses data from a street GIS where the street network is already inputted within the geographic coordinate space. Attributed in each street segment are address ranges, such as house numbers from one segment to another. Here is what geocoding does: (1) It takes an address, (2) matches it to a street and particular segment (e.g. a block), and (3) interpolates the address position. However, issues may arise in the geocoding process. What happens is that you have to distinguish between ambiguous addresses (say, “43 Hampton Drive” and “43E Hampton Drive”). It’s also a challenge when you geocode new addresses for a street that is not yet added to the GIS database. Using interpolation also entails a number of caveats, including the fact that it assumes that the parcels are evenly spaced along the length of the segment. This is quite unlikely in reality – it can be that a geocode address is off by a number of thousand feet. A more sophisticated geocoding application will match geocode information to the property level, using such tools as USPS address data, and cascade out to block, track or other levels depending on data matching accuracy.

This is where social media can help your content to rise above the morass and get into the mind of your target audience. At the BJUI, we have integrated social media into every aspect of the Journal [2], as it is clear that this is important for our readers [3]. The use of popular platforms, e.g. Twitter, YouTube, Facebook and Instagram, as well as our own blog site, allows us to greatly amplify the reach of our content, at lightning speed, and allows us to engage with our readers in a way that traditional print publishing never could.

In the video accompanying this editorial, we offer some practical advice to help our authors create high-quality video to augment their content. This advice includes:

Capture at the highest quality possible – digital video recorders outperform DVDs and are essential for laparoscopic and robotic work. For open surgery, a GoPro is our preferred capture device but an iPhone can also provide good footage.
Editing brings the video to life: video editing software is widely available and can transform your video from a dull procession into a vivid story. Add in additional footage (e.g. operating room footage to go with your laparoscopic video), still pictures, graphs, imaging etc, and add titles to help illustrate your key messages.
Output for social – your video-editing software will allow you to export your movie in a format optimised for YouTube (e.g. FLV file), or to upload directly to YouTube. Or just export it in a high-quality format and we will upload to YouTube for you.

We encourage the use of video to accompany any type of publication at BJUI, including web-only content such as blogs, and we require it for featured content such as the ‘Article of the Week’, ‘Article of the Month and Step by Step articles’. Videos in a surgical specialty like urology are often focused on procedural technique, but they do not have to be this limited and we encourage all other types of BJUI content to also be supplemented with video. Our BJUI Tube site and YouTube site contain good examples of how authors can describe their content with video by using figures and tables in an interview-style format. This latest video addresses issues around the capture and editing of videos to optimally complement your published work. These videos are then disseminated to a wider audience through our large social media network. All of our videos are ≈3 min in duration, as our analytics demonstrate that viewers ‘switch off’ when videos run for much longer.

We therefore encourage you to think social, think video, and help your content reach its maximum audience. We are here to help you!

Declan G. Murphy*^†‡, Wouter Everaerts^† and Stacy Loeb^§
*Peter MacCallum Cancer Centre, University of Melbourne, ^†The Royal Melbourne Hospital, ^‡Epworth Prostate Centre, Epworth Hospital, Melbourne, Australia, and ^§New York University, New York, USA

References

IBM. What is big data? 2013. Available at: https://www-01.ibm.com/software/data/bigdata/what-is-big-data.html. Accessed April 2014
Murphy DG, Basto M. Social media @BJUIjournal – what a start! BJU Int 2013; 111: 1007–1009
Loeb S, Bayne CE, Frey C et al. Use of social media in urology: data from the American Urological Association. BJU Int 2014; 113: 993–998

Engaging responsibly with social media: the BJUI Guidelines

April 30, 2014/1 Comment/by Declan Murphy

The final, peer-reviewed version of this paper has been accepted for publication in BJUI.
You can find it here. Please cite this article as doi: 10.1111/bju.12788

The social media revolution is well underway. Facebook, Twitter, YouTube, Instagram, Weibo, Blogger, LinkedIn, and many other social media platforms, have now penetrated deeply into our lives and have transformed the way in which we communicate and engage with society. The statistics are staggering. As of mid-2014, the total number of global users of the following platforms has exceeded billions of people from every nation in the world:
- Facebook – over 1.3 billion users
- Twitter – over 280 million active users
- YouTube – over 1 billion people view YouTube each month
- Instagram – over 200 million users
- LinkedIn – over 270 million users

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Social media has also become very popular among-st healthcare professionals both on a personal and professional basis. The reach and engagement which social media enables, along with the incredible speed with which information is disseminated, clearly creates opportunities for advances in healthcare communication. However, because healthcare professionals also have serious professional responsibilities which extend to their communication with others, there are dangers lurking in social media due to the inherent lack of privacy and control.

As a result, major professional bodies have now issued guidance for their members regarding their behaviour using social media. These include bodies representing medical students, general practitioners, physicians, oncologists, the wider medical community, as well as major regulatory bodies such as the Federation of State Medical Boards and the General Medical Council (GMC) in the UK, whose role is to licence medical practitioners. The guidance from the latter, part of the GMC’s Good Medical Practice policy, has significant implications as failure to comply with this guidance could impact a doctor’s licence to practice. All health care providers engaging in social media need to familiarize themselves with the relevant institutional, local, and national guidelines and policies.

There are many examples of healthcare providers who have faced disciplinary action following content posted on social media platforms. For example, posting photos of a drunk patient to Instagram and Facebook [1] is likely to result in serious disciplinary and legal action. In another case, a doctor in the USA was dismissed from her hospital and censured by the State Medical Board when she posted online details of a trauma patient [2]. Although her posting did not reveal the patient’s name, enough information was posted for others in the community to identify the patient. Furthermore, a review of physician violations of online professionalism and disciplinary action taken by State Medical Boards in the USA demonstrated that this case was not isolated [3]. Over 90% of State Medical Boards reported that at least one of several online professionalism violations had been reported to each of them. The most common violations were inappropriate patient communication online, often of a sexual nature. While the most frequent plaintiffs were patients and their families, it is noteworthy that complaints by other physicians were reported in half of State Medical Boards. Overall, serious disciplinary action including licence restriction, suspension or revocation occurred in over half of cases. There is clearly a need for healthcare professionals to be aware of their responsibility when communicating online.

So what of urology and social media? There is no doubt that many urologists have embraced social media with great enthusiasm, and urology has been one of the specialties leading the way [4-7]. The BJUI has been at the forefront of this enthusiasm as we have implemented a wide-ranging and evolving social media strategy including an active presence on the main social media platforms, a popular blog site, and a strategy to integrate our journal content across these platforms [8]. We now also recognise achievements in social media in urology through our annual Social Media Awards and by introducing a formal teaching course at the 2013 British Association of Urological Surgeons (BAUS) Annual Meeting, the first such course at a major urology meeting. While continuing to encourage the development of social media in urology as one of our key strategies, we also recognise that there are risks inherent in engaging in social media and that clinicians must be aware of these risks.

We therefore propose the following guidelines for healthcare professionals to ensure responsible engagement with social media. Much of this content is in alignment with advice issued by the other bodies listed above.

Always consider that your content will exist forever and be available to everyone. Although some social media platforms have privacy settings, these are not foolproof and one should never presume that a post on a social media platform will remain private. It should instead be assumed that all social media platforms lack privacy and that content will exist forever.
If you are posting as a doctor, you should identify yourself. The GMC guidance has specifically commented on anonymity. They advise that if you are identifying yourself as a doctor then you should also give your name, as a certain level of trust is given to advice from a doctor. People posting anonymously should be very careful in this regard as content could always be traced back to its origins, particularly if it became a matter for complaint.
State that your views are your own if your institutions are identifiable. It is commonplace for clinicians to identify their institutional affiliation in their social media profile. While not an excuse for unprofessional activity, it is good practice to state that your views are your own, particularly if you occupy leadership positions within that institution.
Your digital profile and behaviour online must align with the standards of your profession. Whatever standards are expected of the licencing body for your profession must be upheld in all communications online. You should also be aware that what you post, even in a perceived personal environment such as Facebook, is potentially accessible by your employers. As employers they will have a certain standard of behaviour that they expect. For example, use of inappropriate language or images of drunkenness could result in disciplinary action.
Avoid impropriety – always disclose potential conflicts of interest. The American Society of Clinical Oncology (ASCO) includes this important point in their guidance. Influencers in social media can hold powerful sway and clinicians have a responsibility to use this influence responsibly and manage any potential conflicts.
Maintain a professional boundary between you and your patient. It is not unusual for patients to be interested in their doctor’s social network. While most people do not restrict their Twitter and instagram followers for public profiles (and therefore all tweets must uphold professional standards), it is reasonable to politely decline a friend request on Facebook by stating that you keep your personal and professional social networks separate. The BMA guidance specifically advises against patients and doctors becoming friends on Facebook and advises that they politely refuse giving the reasons why.
Do not post content in anger and always be respectful. It is considered inappropriate to post personal or derogatory comments about patients OR colleagues in public. Defamation law could apply to any comment made in the public domain.
Protect patient privacy and confidentially at all times. There is an ethical and legal duty to protect patient confidentiality at all times, and this equally applies to online communication including social media. If posting a video or image, consent needs to be obtained for this even if the patient is not directly identifiable. Content within a post or image, including its date and location and your own identity, may indirectly identify a patient to others. The GMC guidance also states that you must not ‘discuss individual patients or their care with those patients or anyone else’. Thus posting about a case you have just seen could be in breach of these recommendations.
Alert colleagues if you feel they have posted content which may be deemed inappropriate for a doctor. Quite unintentionally, colleagues may post content which may be regarded as unprofessional for any of the reasons listed above. Although a digital shadow may always persist, deleting the online content before it becomes more widely disseminated may help mitigate the damage.
Always be truthful and strive for accuracy. All online content in social media should be considered permanent. It should also be considered that anyone in the world could potentially access this content. Therefore, truthfulness and accuracy are simple standards which should be upheld as much as possible.

Social media is a very exciting area of digital communication and is full of opportunities for clinicians to engage, to educate and to be educated. However, risks exist and an understanding of the boundaries of professional responsibility is required to avoid potential problems. Adherence to simple guidelines such as those proposed here may help clinicians achieve these aims.

Declan G Murphy^1-2, Stacy Loeb³, Marnique Y Basto¹, Benjamin Challacombe⁴, Quoc-Dien Trinh⁵, Mike Leveridge⁶, Todd Morgan⁷, Prokar Dasgupta⁴, Matthew Bultitude⁴

¹University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, Australia, ²Epworth Prostate Centre, Epworth Healthcare Richmond, Melbourne, Australia, ³New York University, USA, ⁴Guy’s Hospital, King’s College London, UK, ⁵Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA, ⁶Department of Urology, Queen’s University, Kingston, ON, Canada, ⁷Department of Urology, University of Michigan, Ann Arbor, MI, USA

References

ABC News. Chicago doctor allegedly posted photos of drunk patient on social media. Available at: https://jobs.aol.com/articles/2013/08/21/chicago-doctor-drunk-patient-photos-facebook/
Above the Law. ER doc forgets patient info is private, gets fired for facebook overshare. Available at: https://abovethelaw.com/2011/04/er-doc-forgets-patient-info-is-private-gets-fired-for-facebook-overshare/.
Greysen SR, Chretien KC, Kind T, Young A, Gross CP. Physician violations of online professionalism and disciplinary actions: a national survey of state medical boards. JAMA 2012; 307: 1141-1142.
Prabhu V, Lee T, Loeb S et al. Twitter Response to the United States Preventive Services Task Force Recommendations against Screening with Prostate Specific Antigen. BJU Int 2014; doi: 10.1111/bju.12748
Loeb S, Catto J, Kutikov A. Social media offers unprecedented opportunities for vibrant exchange of professional ideas across continents. Eur Urol 2014; doi: 10.1016/j.eururo.2014.02.048
Loeb S, Bayne CE, Frey C, et al. Use of social media in urology: data from the American Urological Association. BJU Int 2013; doi: 10.1111/bju.12586
Matta R, Doiron C, Leveridge MJ. The dramatic rise of social media in urology: trends in Twitter use at the American and Canadian Urological Association Annual Meetings in 2012 and 2013. J Urol 2014; doi: 10.1016/j.juro.2014.02.043
Murphy DG, Basto M. Social media @BJUIjournal – what a start! BJU Int 2013; 111: 1007-1009

The final, peer-reviewed version of this paper has now been accepted for publication in BJUI. You can find it here. Please cite this article as doi: 10.1111/bju.12788

The 2nd BJUI Social Media Awards – April 2014

April 22, 2014/1 Comment/by Declan Murphy

Following the inaugural BJUI Social Media Awards presented at the 2013 AUA Annual Meeting in San Diego, this year’s awards moved across the Atlantic to the EAU Annual Congress in Stockholm. Both of these conferences play host to intense social media activity and it is fitting that the BJUI Social Media Awards gets to acknowledge the Uro-Twitterati on both continents! Individuals and organisations were recognised across 16 categories including the top gong, The BJUI Social Media Award 2014, awarded to an individual or organization who has made an outstanding contribution to social media in urology in the preceding year. The 2013 Award was won by the all-conquering Urology Match portal which continues to innovate in social and digital media. There had been much anticipation and speculation ahead of time about who would win the top and bottom gongs, and whether or not the King of Twitter, Ben Davies @daviesbj, would be acknowledged

In keeping with the informality of the 2013 BJUI Social Media Awards (held in an Irish Bar in San Diego), this year’s ceremony was held in the Acoustic Bar of the Scandic Grand Central in beautiful Stockholm. Fifty of the World’s leading social media enthusiasts in urology gathered to meet up in person and to see who would be recognised. Yours truly once again played the role of MC wearing my hat of BJUI Social Media Editor, ably assisted by Matt Bultitude, BJUI Website Associate Editor, and Editor-in-Chief Prokar Dasgupta.

The full list of awardees, along with some examples of “best practice” in the urology social media-sphere can be found on this Prezi (https://prezi.com/iukizmhni9_w/bjui-social-media-awards-2014/). The winners are also listed here:

Most Read Blog@BJUI – The Melbourne Consensus Statement – accepted by Matt Cooperberg on behalf of the authors
Most Commented Blog@BJUI – Dr Rajiv Singal, Toronto, Canada
Best Blog Comment – Dr John Davis, Houston, USA
Best BJUI Tube Video – Blue Light cystoscopy RCT – accepted by Shamim Khan on behalf of colleagues at Guy’s Hospital
Best Urology Conference for Social Media – EAU Annual Congress, Stockholm 2014
Best Social Media Campaign – Stacy Loeb, for her birthday party campaign
“Did You Really Tweet That” Award – Ben Davies, Pittsburgh, USA
Best Urology App – jointly awarded to BJUI (Matt Bultitude) and European Urology (Cathy Pierce) for new iPad apps
Innovation Award 2014 – @UroQuiz – Nathan Lawrentschuk, Melbourne, Australia (accepted by Paul Anderson)
#UroJC Award – Vincent Misral, Paris, France
Best Selfie – Mike Leveridge, Toronto, Canada
Best Urology Facebook Site – American Urological Association (accepted by Matt Cooperberg)
Best Urology Journal for Social Media – European Urology (Jim Catto)
Best Urology Organisation – Urological Society of Australia & New Zealand (David Winkle)
The BJUI Social Media Award 2014 – Stacy Loeb, New York, USA

BJUI Editor Prokar Dasgupta presenting awards to Jim Catto, Matt Cooperberg and Stacy Loeb

Many of the Award winners were present to collect their awards themselves, including the omnipresent Stacy Loeb who was awarded our top gong to huge applause.

A special thanks to our outstanding BJUI team at BJUI in London, Scott Millar and Helena Kasprowicz, who manage our social media and website activity and who were present on the night.

For more pictures from the evening, please visit BJUI Associate Editor John Davis’ Flickr https://www.flickr.com/photos/jdhdavis/sets/72157643916525665/ page.

Declan Murphy is Associate Editor for Social Media at BJUI. He is a urologist in Melbourne, Australia

Follow Declan on Twitter @declangmurphy and BJUI @BJUIjournal