Social media: a review and tutorial of applications in medicine and health care.

Background: Social media are dynamic and interactive computer-mediated communication tools that have high penetration rates in the general population in high-income and middle-income countries. However, in medicine and health care, a large number of stakeholders (eg, clinicians, administrators, professional colleges, academic institutions, ministries of health, among others) are unaware of social media's relevance, potential applications in their day-to-day activities, as well as the inherent risks and how these may be attenuated and mitigated.

Objective: We conducted a narrative review with the aim to present case studies that illustrate how, where, and why social media are being used in the medical and health care sectors.

The role of diet in predicting iron deficiency anemia in HIV-positive women.

Purpose: The association between medical, social, and nutritional factors and iron deficiency anemia was examined in adult women who had tested positive for human immunodeficiency virus (HIV) and were living in the Greater Vancouver Area.

Methods: This was a cross-sectional observational study of 102 HIV-positive women, aged 19 or older, who were patients of one of three chosen community health clinics in Vancouver, British Columbia. Information on usual dietary intake and other nutrition-related factors was collected with a short diet survey, while medical information and laboratory data were obtained from each participant's medical chart.

Clinical decision rules to improve the detection of adverse drug events in emergency department patients.

Objectives: Adverse drug events (ADEs) are unintended and harmful consequences of medication use. They are associated with high health resource use and cost. Yet, high levels of inaccuracy exist in their identification in clinical practice, with over one-third remaining unidentified in the emergency department (ED).

Birth outcomes among older mothers in rural versus urban areas: a residence-based approach.

Purpose: We examined the association between rural residence and birth outcomes in older mothers, the effect of parity on this association, and the trend in adverse birth outcomes in relation to the distance to the nearest hospital with cesarean-section capacity.

Methods: A population-based retrospective cohort study, including all singleton births to 35+ year-old women in British Columbia (Canada), 1999-2003. We compared birth outcomes in rural versus urban areas, and between 3 distance categories to a hospital (<50, 50-150, >150 km).

Outcomes of emergency department patients presenting with adverse drug events.

Study Objective: Our objectives are to describe the outcomes of patients presenting to the emergency department (ED) because of an adverse drug event and to compare them with outcomes of patients presenting for other reasons.

Methods: This prospective observational study was conducted at Vancouver General Hospital, a 955-bed tertiary care hospital. We prospectively enrolled adults presenting to the ED between March and June 2006, using a systematic sampling algorithm.

An epidemiological survey of chlamydial and gonococcal infections in a Canadian arctic community.

Background: Sexually transmitted infections are leading causes of morbidity for Canadian Aboriginal women. To date, very few initiatives have been successful in screening, treating, and limiting these infections among these populations.

Objectives: To evaluate the efficacy of universal screening, treatment and contact tracing as a means of capturing a more accurate count of chlamydia and gonorrhea prevalence and limiting transmission among Inuit communities.

The Delphi process in dental research.

Objective: To explore how Delphi formal consensus procedures may augment decision making in oral health care in the absence of high-quality clinical and epidemiological data.

Methods: A review and appraisal of the literature regarding the Delphi method was conducted using Medline databases and Google.

Results: The Delphi method has a long history that highlights both its strengths and limitations.

Measure for measure? The challenge of new thinking about patient safety.

Penfold and colleagues, in this issue of Healthcare Papers, provide a comprehensive and substantive critique of the hospital standardized mortality ratio (HSMR) as a measure of patient safety, and suggest a useful alternative. However, although measurement is not trivial, new thinking about patient safety presents a much greater challenge than just issues related to measurement. The measurement issue highlights the need for a re-conceptualization of what it takes, from a systems perspective, to achieve safety.

Determinants of sexually transmitted infections among Canadian Inuit adolescent populations.

The health status of Canadian Inuit is considerably lower than that of their ancestors. The introduction of previously unknown diseases (e.g.

Incidence and demographics of hand fractures in British Columbia, Canada: a population-based study.

Purpose: To identify population-based hand fracture annual incidence rates, demographics, and seasonal and geographic variations from all patients seeking treatment for a hand fracture in British Columbia, Canada from May 1, 1996 to April 20, 2001.

Methods: All Medical Service Plan and Hospital Separation records that included International Classification of Diseases-9 codes for metacarpal (815), phalangeal (816), and multiple (817) fractures were extracted from the British Columbia Linked Health Dataset, along with the individual registry demographic records linked to each hand fracture.

Results: A total of 72,481 hand fractures were identified.

Identification of modifiable work-related factors that influence the risk of work disability in rheumatoid arthritis.

Objective: To define work-related factors associated with increased risk of work disability (WD) in people with rheumatoid arthritis (RA).

Methods: Questionnaires were mailed to all RA patients who used a province-wide arthritis treatment program between 1991 and 1998 (n = 1,824). The association between risk factors and WD (defined as no paid work due to RA for at least 6 months) was assessed using multiple logistic regression analysis, controlling for significant sociodemographic and disease-related variables.

Insulin, macronutrient intake, and physical activity: are potential indicators of insulin resistance associated with mortality from breast cancer?

High levels of insulin have been associated with increased risk of breast cancer, and poorer survival after diagnosis. Data and sera were collected from 603 breast cancer patients, including information on diet and physical activity, medical history, family history, demographic, and reproductive risk factors. These data were analyzed to test the hypothesis that excess insulin and related factors are directly related to mortality after a diagnosis of breast cancer.

Beneath the calm surface: the changing face of physician-service use in British Columbia, 1985/86 versus 1996/97.

Background: Although expenditures on health care are continually increasing and often said to be unsustainable, few studies have examined these trends at the level of services delivered to individual patients. We analyzed trends in the various components that contributed to changes in overall expenditures for physician services in British Columbia from 1985/86 to 1996/97.

Methods: We obtained data on all fee-for-service payments to physicians in each study year using the British Columbia Linked Health Data set and analyzed these at the level of individual patients.

Waist-to-hip ratio and breast cancer mortality.

High insulin levels have been associated with increased risk of breast cancer and poorer survival after a breast cancer diagnosis. Waist-to-hip ratio (WHR) is a marker for insulin resistance and hyperinsulinemia. In this study, the authors tested the hypothesis that elevated WHR is directly related to breast cancer mortality.

Conspicuous consumption: characterizing high users of physician services in one Canadian province.

Objectives: To examine medical care use and costs, patterns of morbidity and co-morbidity, and other patient characteristics of high users of physician services in British Columbia.

Methods: This population-based study uses physician claims, hospital discharge summaries and vital statistics data linked at the level of the individual to compare characteristics of high users, other users and non-users of physician services in the Province of British Columbia, Canada. The study included all enrolled adults in the universal health care plan during fiscal year 1996/97.

Modified Delphi survey for decision analysis for prophylaxis of post-radiation osteonecrosis.

Objectives: to augment epidemiological data from the literature, assist Bayesian perspectives and a decision analytic framework for the minimization of post-radiation osteonecrosis (PRON; osteoradionecrosis) and its impacts in irradiated head and neck cancer patients.

Materials And Methods: a modified Delphi process survey of 15 international clinical experts was used to identify and assess outcome data and factors related to PRON risk, extraction, and factor suitability for formal decision analysis. Clinimetric pain and function outcome scales were created and assessed for relevance to quality of life.

Carbohydrates and colorectal cancer risk among Chinese in North America.

Previous studies have analyzed total carbohydrate as a dietary risk factor for colorectal cancer (CRC) but obtained conflicting results, perhaps attributable in part to the embedded potential confounder, fiber. The aim of this study was to analyze the nonfiber ("effective") carbohydrate component (eCarb) separately and to test the hypothesis that effective carbohydrate consumption is directly related to CRC risk. The data (473 cases and 1192 controls) were from a large, multicenter, case-control study of Chinese residing in North America.