My Brush with God

My favourite twitter account is God. I have followed it religiously. I had been one of the almost 1.8 million followers who eagerly awaited his witty one to two sentence tweets. Whilst they will undoubtedly offend any given large proportion of the population, they equally provide comic relief for an adulating audience. I love this account and it is one of the first accounts that I recommend all new twitter subscribers follow. Each day, I would look forward to God’s latest instalments and I would retweet my favourites to my own humble following.

This all changed when I saw the following tweet appear on the timeline. I often screenshot the ones that I like for possible future use in a presentation on social media where I would highlight the use of humour to gather an audience. 

I saw the following tweet:-

I screenshot it and then was trying to retweet it but discovered that it had been deleted. I then tweeted to God with the cheeky line as follows

He was clearly not impressed when he send me a private direct message as follows:-

Clearly God was not impressed.  You dare to take up a point with God, you run the risk of him unleashing his power over us.  I shamefully dared to do so.

Immediately following this I was placed into purgatory and blocked by the account.  This is the first time that I am aware of being blocked on twitter.  If others have blocked me, then I have not known about it.  

Anybody who follows God knows that the account is not for one who is sensitive.  He will unleash his fury and nobody is immune from the wrath of God.  I am now God-less but will now survive on screenshots of his best tweets sent to me by DM by friends. Yes, I could set up another twitter account but this be trying to escape from the purgatory that I have been banished to. I need to do my time and hopefully one day I will be released.  Please pray for me.  Please tell him that I am sorry.

(David Javerbaum is a well known comedy writer in the US. On social media, he is particularly known for his very popular account known as @TheTweetofGod.)


Addendum 2 February 2015

Last night I was messaged by God who essentially stated that he hoped that I had learned my lesson in purgatory and that I was being welcomed back into the promised land. I had been forgiven. I thank everybody for their prayers and on line appeals for forgiveness. Clearly he was listening.

Once again, this is my favourite Twitter account. I have seen him put followers into periods of time out in purgatory with the usual expletive laiden barrage but he is always forgives.  Whilst I knew my time out was temporary, it was for how long that I was unsure about. Do follow @TheTweetofGod but don't take it too seriously because it never is.

The 2nd Addendum 2 February 2015

I had a dream. Crazy dream. It was good whilst it lasted.
For those who know, God only ever follows one account. It used to be Ricky Gervais but he later dropped him for Justin Bieber.  This of course fits well with his book called the Book of Biebs.

First Changes of Suprapubic Catheters. A Need to Change a Stupid Policy

A suprapubic catheter is a tube that is placed through the lower abdomen into the urinary bladder as a way of managing problems associated with the storage of urine or emptying of the bladder.  Placement is a minor surgical procedure and essentially involves filling the bladder to capacity and then literally stabbing the lower abdomen with a sharp pencil like device (trocar) through which the catheter can then be introduced.  A syringe port allows us to inflate a balloon located towards the tip of the catheter with water and this helps hold it in place.

(Image from http://www.registerednursern.com)

Within days, a scar tissue type reaction forms around the tube and within a couple of weeks, there is  channel lined with scar tissue which we refer to as a tract.  This channel or tract acts a conduit through which the tube can be easily changed. Patients who have these suprapubic catheters (SPC) ideally should have them changed every 4 to 6 weeks.  Changing these catheters is a simple task and expertly performed by nurses.  In hospitals where there resources do not have such nursing expertise, the task is often relegated to the most junior and least experienced of medical officers, interns.

A policy regarding the first change of a SPC came into being a number of decades ago and the exact origins of this policy are unlikely to ever be determined.  The policy is that the first change of the SPC should be performed in a hospital. And thereafter, SPC changes could then be done in the community. It is one of those unwritten policies that entered healthcare folklore in the total absence of evidence.  It is a folklore tightly held by a number of administrative or officious types who want nothing of a challenge to this dogma.

I recently had a twitter rant over this as a result of an elderly patient of mine being literally forced to return to hospital for a simple change of SPC that could have been done in the community.  I could not care less about the wastage of the precious hospital resources but what I did care about was the enormous disruption associated with having to get the patient prepared and transported to hospital to have a simple procedure that takes about 10 minutes to perform.  We tried reasoning with the person in charge of the local community nurse services to only receive a blunt response that it was POLICY that the first change of SPC be carried out in the hospital.  I asked for where this policy is written but we all know the reason why this request was not responded to  - obviously there is NO SUCH WRITTEN POLICY. 

Okay, are we subjecting the patient to risk by doing the first SPC change in the community or are we placing the community nurse under untenable litigation risk?  Of course not.  What is the worse that arise from a bungled SPC change?  The catheter may not be able to be replaced because the tract was too tortuous or the catheter balloon might be blown up in the middle of the tract instead of in the lumen of the bladder.  This happens rarely and something that could just as likely occur in the hospital.  If a problem occurs, is it a dire medical emergency? No. A urethral catheter can generally be placed until a replacement SPC procedure can be arranged or they can be sent to the hospital.  The long term sequelae from such an event – remote if anything could be thought of. 

Outside hospitals, it is the community nurses who perform regular catheter changes week in week out.  They are highly skilled and to state that they lacked the capability to do a first change of catheter is nothing short of insulting.  I am sure that both you and I would much rather have a skilled community nurse perform a catheter change at home rather than trudging our way to hospital to have a less experience intern medical officer do the change.  Interestingly, many of the community nurses that I have interacted with are in themselves quite happy to do the first change but are not permitted by their superiors who remain opposed to change. 

Lets get back to evidence.  A highly talented urology nurse consultant, Colleen McDonald from Westmead Hospital, performed a study onirst changes of SPC in the community versus that performed in the hospital environment. I really do not need to go into the detail of what the study showed.  The title of the paper says it all.

McDonald.C & McFarland,M. (1999).  First Suprapubic Catheter Change...from Hospital to Community....A Clinical Practice Change.  Journal of Stomal Therapy Australia, 20(3), 14-15

Some Tips on Successful Conference Tweeting

Recently, I have heard disappointed comments about the lack of conference tweet activity for given healthcare conferences. On each occasion, it seemed fairly obvious as to why this was the case.  Having participated in quite a number of conferences by the way of Twitter, I have made a number of observations of what seems to make the difference.

1. Must Be Good WiFi

This is perhaps the greatest impediment to the success of conference tweeting. Frequently, the systems are tested when the conference centre is empty and of course everything works fine.  As soon as the conference commences and people are using the system, it comes to a grinding halt.  Once again, there is no greater impediment to conference tweeting than the lack of adequate WiFi.

2. Conference Twitter Account

This account would help define to observers what the conference is and what official conference hashtag has been assigned. This account should tweet out updates, announcements as well as interact with key twitter accounts through replies, favourites and retweeting.  This account can also act as a catalyst for activity if the twitter stream is quiet.  With this comes the assigning of a person to look after this account during the course of the conference.

3. Appropriate Hashtag

The hashtag should appear relevant to the conference and should use the minimum number of characters.  Ideally the number of characters should be no more than 6 or 7 characters.  Any more detracts from the precious 140 character count and would limit the information that can be shared to the hashtag audience.  Only one hashtag should be assigned.  Sub-hashtags only lead to confusion and in combination with the main hashtag, chew up valuable characters.

An example of a misleading hashtag was when the #uro12 was assigned to the American Urological Association meeting when the hashtag of #AUA12 would have made much more sense.  An example of wasted characters is the Royal Australasian College of Surgeons using #RACS2014 when #RACS14 would have been more appropriate.  With the RACS meeting this year, there were no fewer than 4 hashtags being used by various conference tweeters and the twitter stream from this meeting was a disaused the hashtag #CFAConf14.  A long hashtag hampers expression and detracts from participation. Including the space, #CFAConf14 chewed up 10 characters when a simpler #CFA14 would have been appropriate. With the 2014 RACS meeting mentioned above, there were no fewer than 4 different hashtags being used by various conference tweeters and the twitter stream from this meeting was a total mess.  

4. Engage KOL Twitter Users

Conference organisers should seek out the key opinion leaders who are active on twitter in advance of the meeting.  Organisers could consider requesting specific accounts to be assigned to tweet proceedings from specific sessions.  Having predetermined users involved creates a core group of participants.  People are reluctant to be a sole or one of only few tweeters for a conference. 

5. Twitter Boards

Strategically placed monitors showing the twitter feed are often a magnet for the attention of conference attendees.  The most organized meetings will have such monitors outside every meeting room as well as in the registration and trade exhibition areas.

6. Twitter Instruction

At the American Urological Association annual meeting this year, opportunities for small group or one-on-one instruction on twitter basics and how to conference tweet.  Alternatively having a course or conference session on social media as was the case at the European Association of Urology congress (#EAU14) and Urological Society of Australia and New Zealand ASM (#USANZ14) respectively was particular done well. These sessions were not only well attended but also created an explosion of activity on the conference hashtags during these sessions.

7. Publicity

The role of social media at the conference needs to be publicized and prominently implied.  The hashtag should appear on all background slides that appear at the beginning of conference sessions as well as all publications such as the conference proceedings and conference badges as examples.  Such publicity adds negligible if at all any cost to the conference but is returned many times over by increasing the engagement of those attending as well as reaching a much larger global audience in virtual attendance.

8. Register on Symplur

Registering a health conference hashtag with the Symplur Healthcare Hashtag Project is free.  This provides access to basic twitter statistics.  Tweeting these during the conference often generated interest when enormity reach of the conference tweets is realized.

There are probably other ideas that would enhance conference twitter activity that I have forgotten about so please feel free to add your comments.  One example is to allow participants to ask questions via twitter - on occasions I have actually offered this to the audience when I have chaired sessions. A few questions do come in although this is not a deal breaker for twitter engagement at a conference. I look forward to your comments.

First Data Published from a Twitter Based Journal Club

It is pleasing to report the ongoing success of the International Urology Journal Club on Twitter.  The first 12 months experience has culminated in the publication of a manuscript in the journal European Urology.  This is the highest impact journal in the field of urology at 10.476.   

Link to the article is at:-

http://www.sciencedirect.com/science/article/pii/S0302283814001134

The manuscript is expected to be indexed on Pubmed any day from now.

The 48-hour asynchronous format has worked well for time poor surgeons who find it difficult to commit to a designated on line meeting time.  The format has also enabled global involvement given that time zones are no longer an issue.  This is not to cast criticism at the fixed time journal clubs.  As a relatively small surgical specialty, global involvement is necessary to have sufficient participation to make it viable.  Larger specialty interest groups enable regional fixed time journal clubs to flourish.

Following on from our model is the commencement of a respiratory and sleep medicine journal club (#rsjc) and one from the general surgeons (#igsjc). We are eager to see that they succeed.

We will see more online journal clubs and hopefully more data to quantify participation and value as a CME learning tool.

Keys to a Successful International Journal Club on Twitter

The concept of an international twitter journal club in urology arose subsequent to urologist Dr Mike Leveridge tweeting from his local real time Journal Club meeting at Queen’s University in Canada catching the attention of international colleagues who wanted to join in on the discussion.  The twitter discussion that followed, came to realization that we were actually participating in a journal club discussion on twitter and agreed that this idea was worth pursuing.  Given that the ‘uro-twitterati’ were a truly global community, we were challenged with the logistical problems of a fixed time twitter chat.  The logical solution was to use an asynchronous chat model and it was agreed that we would hold journal club meetings over a 48 hour period of time to foster international engagement.

The account @iurojc was created with the agreed hashtag #urojc and history made as the first truly global surgical journal club on twitter.   From the outset, our team of supporters were eager to see that this project was not a ‘fly by night’ operation and several measures were put in place as follows:-

• 1.     Asynchronous chat over 48 hours to enable global involvement without the constraints of time zones.  Whilst ‘international’ engagement could potentially be achieved with fixed time twitter journal club chats, it could only be achieved across a relative narrow band of time zones (eg transatlantic) 
• 2.     Cutting edge publications are selected for discussion.  Papers that are within 4 weeks of publication on line ahead of print in the major urology journals provide incentive for participants who wish to be at the forefront of latest findings and opinion.
• 3.     Engage journals to provide open access of the selected articles on line for easy access for participants.  This has been a huge benefit to participants who do not have ready access to manuscripts hidden behind a journal paywall.
• 4.     Invitation of authors to participate in the twitter discussion.  This has been an essential part of the #urojc since its inception and provides insights that conventional and SoMe journal clubs could not otherwise achieve.  What if the author does not have a twitter account or does not wish to create one?  For one author, the invitation provided the incentive to join twitter and for another, we created a guest account which was actively used for one of the discussions.
• 5.     A Best Tweet Prize is offered subsequent to each month’s discussion. We specifically do not offer donated prizes from companies offering products directly associated with the patient doctor interaction.  Our supporters are primarily entities associated with medical education, particularly the major journals in urology.  Prizes are generally valuable and include annual on-line subscriptions, fee exempt open access publication fees or free major conference registration as examples. Journal article and Best Tweet Prize winners selection are made independent of prize donors.  If a journal is supporting the Best Tweet Prize, the manuscript for discussion is intentionally selected from a different journal.
• 6.     Routine follow-back of urology followers on Twitter and following of any urologists that we become aware of.  This policy maintains an open door for feedback and suggestions without users having to request a follow for direct messaging.  Our experience with direct messaging makes clear that not all followers wish to make public their questions or suggestions.

The #urojc has now been in operation since November 2012 on a monthly basis and typically we would have 35-40 active participants with each discussion and many more watching the discussion.  The @iurojc account currently has over 600 followers.  At the recent BJU International SoMe Awards held during the American Urological Association Annual Meeting in San Diego in May 2013, the #urojc was awarded the prize for “Innovation in Social Media”.  The #urojc continues to go from strength to strength and we welcome support and collaboration from the twitter community.

______________________________

Henry Woo is the coordinator of the International Urology Journal Club on Twitter which can be followed @iurojc and his personal account can be followed @DrHWoo.  He is a urological surgeon and Associate Professor of Surgery at the Sydney Adventist Hospital Clinical School of the University of Sydney