Sunday 31 August 2014

@GeriMedJC still growing!

The moderator account for the Geriatric Medicine Journal Club (#GeriMedJC) is up to 90 followers after launching a month ago.

There's a nice international representation! The top ten countries in the audience for the Geriatric Medicine Journal Club blog are as follows:

According to Tweetreach, this week's #GeriMedJC activity made 15,643 impressions.

Saturday 30 August 2014

First #GeriMedJC

Two articles were discussed for the first #GeriMedJC:

Long article (45 minutes is dedicated to discussion in the live version of the journal club):
The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts. Ann Intern Med. 2014 Apr 15;160(8):526-33.

Short article (15 minutes is dedicated to discussion in the live version of the journal club):
Multidimensional Frailty Score for the Prediction of Postoperative Mortality Risk. JAMA Surg. 2014;149(7):633-640.

This is what Symplur analytics had to say about the discussion:

Missed the discussion?  You can get the transcript of the #GeriMedJC tweet chat here.

Follow @GeriMedJC on Twitter for the announcement on the next #GeriMedJC!

Monday 25 August 2014

@GeriMedJC is gaining followers all over the world!

This has been an exciting week for #GeriMedJC. The moderator account,@GeriMedJC, now has 78 followers including physicians, other allied health care workers, and organizations from all over the world. This should make for a very lively discussion for the first tweet chat Geriatric Medicine Journal Club on August 29, 2014 at 08:00 EDT / noon GMT.





According to Tweetreach, a number of impressions have also been made:

This blog is also getting a few views from around the world, including Zambia.  Welcome!  Hearing what geriatric medicine is like internationally would be of great interest!

Don't forget to read the two articles in advance of the first #GeriMedJC tweet chat on August 29, 2014 at 08:00 EDT / noon GMT:

Long article (45 minutes is dedicated to discussion in the live version of the journal club):
The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts. Ann Intern Med. 2014 Apr 15;160(8):526-33. 
Access the article here.

Short article (15 minutes is dedicated to discussion in the live version of the journal club):
Multidimensional Frailty Score for the Prediction of Postoperative Mortality Risk. JAMA Surg. 2014;149(7):633-640. 
Access the article here. 

Sunday 24 August 2014

Any easy way to stream the tweet chat for the first #GeriMedJC

Gearing up for the first Geriatric Medicine Journal Club tweet chat, #GeriMedJC, and need any easy way to follow and engage in the conversation?

Try TChat.io and log in using your Twitter account. 

Enter the hashtag #GeriMedJC a few minutes before the chat. This program filters out all other tweets so you can focus on discussing this one topic.

Every tweet anyone publishes with the hashtag #GeriMedJC, will show-up in the stream. Any tweet you type in the box will have #GeriMedJC added to the back of it, so other people using this (or similar programs) will be able to see your tweet even though they may not follow you.

Make sure you read the two chosen articles ahead of time:

Long article (45 minutes is dedicated to discussion in the live version of the journal club):
The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts. Ann Intern Med. 2014 Apr 15;160(8):526-33. 
Access the article here.

Short article (15 minutes is dedicated to discussion in the live version of the journal club):
Multidimensional Frailty Score for the Prediction of Postoperative Mortality Risk. JAMA Surg. 2014;149(7):633-640. 
Access the article here. 


Friday 22 August 2014

Long article chosen for the first #GeriMedJC.

What does a long article mean?  In the live version of the Geriatric Medicine Journal Club, 45 minutes is devoted to the presentation and discussion of the article.  Do you use the Confusion Assessment Method (CAM) to help detect delirium?  How about the CAM-S for measuring severity? The chosen long article will be of great interest:

The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts. Ann Intern Med. 2014 Apr 15;160(8):526-33. 

The article can be found on Annals of Internal Medicine here and abstract is posted below. Engage in the discussion August 29, 2014 at 08:00 EDT / noon GMT and don't forget to use the hashtag #GeriMedJC.  We would especially love to hear the perspective from the across the pond where the the 4AT is being promoted through organizations such as the Scottish Delirium Association.


BACKGROUND: Quantifying the severity of delirium is essential to advancing clinical care by improved understanding of delirium effect, prognosis, pathophysiology, and response to treatment.

OBJECTIVE: To develop and validate a new delirium severity measure (CAM-S) based on the Confusion Assessment Method.

DESIGN: Validation analysis in 2 independent cohorts.

SETTING: Three academic medical centers.

PATIENTS: The first cohort included 300 patients aged 70 years or older scheduled for major surgery. The second included 919 medical patients aged 70 years or older.

MEASUREMENTS: A 4-item short form and a 10-item long form were developed. Association of the maximum CAM-S score during hospitalization with hospital and posthospital outcomes related to delirium was evaluated.

RESULTS: Representative results included adjusted mean length of stay, which increased across levels of short-form severity from 6.5 days (95% CI, 6.2 to 6.9 days) to 12.7 days (CI, 11.2 to 14.3 days) (P for trend < 0.001) and across levels of long-form severity from 5.6 days (CI, 5.1 to 6.1 days) to 11.9 days (CI, 10.8 to 12.9 days) (P for trend < 0.001). Representative results for the composite outcome of adjusted relative risk of death or nursing home residence at 90 days increased progressively across levels of short-form severity from 1.0 (referent) to 2.5 (CI, 1.9 to 3.3) (P for trend < 0.001) and across levels of long-form severity from 1.0 (referent) to 2.5 (CI, 1.6 to 3.7) (P for trend < 0.001).

LIMITATION: Data on clinical outcomes were measured in an older data set limited to patients aged 70 years or older.

CONCLUSION: The CAM-S provides a new delirium severity measure with strong psychometric properties and strong associations with important clinical outcomes.

Short article chosen for the first #GeriMedJC.

What does a short article mean?  In the live version of the Geriatric Medicine Journal Club, 15 minutes is devoted to the presentation and discussion of the article.  Frailty is very hot these days and the surgeons are onto the concept. The chosen short article is timely:

Multidimensional Frailty Score for the Prediction of Postoperative Mortality Risk. JAMA Surg. 2014;149(7):633-640. 

The article can be found on JAMA Surgery here and abstract is posted below.  Join the discussion August 29, 2014 at 08:00 EDT / noon GMT and don't forget to use the hashtag #GeriMedJC.

Importance  The number of geriatric patients who undergo surgery has been increasing, but there are insufficient tools to predict postoperative outcomes in the elderly.

Objective  To design a predictive model for adverse outcomes in older surgical patients.

Design, Setting, and Participants  From October 19, 2011, to July 31, 2012, a single tertiary care center enrolled 275 consecutive elderly patients (aged ≥65 years) undergoing intermediate-risk or high-risk elective operations in the Department of Surgery.

Main Outcomes and Measures  The primary outcome was the 1-year all-cause mortality rate. The secondary outcomes were postoperative complications (eg, pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned intensive care unit admission), length of hospital stay, and discharge to nursing facility.

Results  Twenty-five patients (9.1%) died during the follow-up period (median [interquartile range], 13.3 [11.5-16.1] months), including 4 in-hospital deaths after surgery. Twenty-nine patients (10.5%) experienced at least 1 complication after surgery and 24 (8.7%) were discharged to nursing facilities. Malignant disease and low serum albumin levels were more common in the patients who died. Among the geriatric assessment domains, Charlson Comorbidity Index, dependence in activities of daily living, dependence in instrumental activities of daily living, dementia, risk of delirium, short midarm circumference, and malnutrition were associated with increased mortality rates. A multidimensional frailty score model composed of the above items predicted all-cause mortality rates more accurately than the American Society of Anesthesiologists classification (area under the receiver operating characteristic curve, 0.821 vs 0.647; P = .01). The sensitivity and specificity for predicting all-cause mortality rates were 84.0% and 69.2%, respectively, according to the model’s cutoff point (>5 vs ≤5). High-risk patients (multidimensional frailty score >5) showed increased postoperative mortality risk (hazard ratio, 9.01; 95% CI, 2.15-37.78; P = .003) and longer hospital stays after surgery (median [interquartile range], 9 [5-15] vs 6 [3-9] days; P < .001).

Conclusions and Relevance  The multidimensional frailty score based on comprehensive geriatric assessment is more useful than conventional methods for predicting outcomes in geriatric patients undergoing surgery.

Sunday 17 August 2014

The second week for #GeriMedJC on Twitter.

This is what Symplur analytics had to say about the hashtag's second week.


It's not surprising that activity is a bit quiet as the hashtag is a timed, monthly tweet chat.  We anticipate that when the journal club is happening (first one slated for August 29, 2014 at 8:00 EDT / noon GMT), that'll be when the bulk of Twitter activity will take place.

In the meantime, there has been some exciting stuff happening from the new followers front for the moderator's account, @GeriMedJC.  There are have been several new followers including representation from other Canadian provinces (@JennyBasran) as well as medical schools across the pond (@MMGgeris).



Friday 15 August 2014

Twitter also has its own analytic metrics!

Just turned on the analytics option for the @GeriMedJC account.  Unfortunately, data prior to turning this feature on is not available.  This may be useful going forward to track impressions (times a user is served a tweet in timeline or search results) and engagements (total number of times a user interacts with a tweet).  This is what Twitter analytics had to say about the @GeriMedJC followers in terms of location, gender and who the followers follow:


Sunday 10 August 2014

Symplur analytics for #GeriMedJC

Have you taken a look at Symplur's Healthcare Hashtag Project? The goal of the Healthcare Hashtag Project is to make the use of Twitter more accessible for providers and the healthcare community as a whole. It is a tool for finding conversations of interest and importance.  It also provides great analytics such as top influencers, tweet activity and Twitter transcripts.

Check out the scope of #GeriMedJC's first week on Twitter!




Who is looking at this blog?

This blog is just a way of chronicling the development of #GeriMedJC.  While the main project is on Twitter, the microbloging application, this "macro"blog is also getting some views around the world:

Saturday 9 August 2014

TweetReach: How far has #GeriMedJC gone in its first week?

TweetReach is an interesting Twitter analytics tool.  We have 57 followers so far.  Here is what TweetReach had to say about #GeriMedJC's first week:


A tweet chat (#GeriMedJC) sounds great, but what happens at the real journal club?

The University of Toronto Division of Geriatric Medicine organizes a monthly Geriatric Medicine Journal Club where residents and faculty have the opportunity to critically appraise recent geriatric medicine literature. Two Geriatric Medicine residents review and present a critical appraisal of an original research article. There is one long presentation of 45 minutes and one short presentation of 15 minutes. The meetings take place on the fourth Friday of each month from 08:00 to 09:00. The Journal Club is broadcast by video-conference via the Ontario Telemedicine Network (OTN) to satellite sites around the province of Ontario including:

Baycrest Hospital (Toronto)
Mount Sinai Hospital (Toronto)
North York General Hospital (Toronto)
Orillia Soldier’s Memorial Hospital (Orillia)
St. Joseph’s Health Centre (Toronto)
St. Mary’s General Hospital (Kitchener-Waterloo)
Grandriver Hospital (Kitchener-Waterloo)
Sunnybrook Health Sciences Centre (Toronto)
St. Michael's Hospital (Toronto)
Trillium Hospital (Mississauga)

It is the hope that the #GeriMedJC hashtag will complement the live journal club discussion but also allow for participation internationally for a much more enriched analysis of the literature.

Why even have a tweet chat (#GeriMedJC) to complement a live journal club?

The urology community has really been the leader in using Twitter as a medium for academic discussion of recent medical literature. The hashtag #urojc is an asynchronous 48-h monthly journal club focusing on recent articles. Traditionally, journal clubs have been confined to physical space and time. Wouldn't it be great to have discussions engaging an international representation?  Here is an interesting study of the successes of #urojc including growth and sustainability.

International Urology Journal Club via Twitter: 12-month experience. Eur Urol. 2014 Jul;66(1):112-7.
The article can be accessed here.

Let's make this happen for #GeriMedJC!

We may have one article chosen for our first #GeriMedJC Geriatric Medicine Journal Club! The final decision will be confirmed.

The following recent article was proposed for review.  What do you think about this choice?

Vitamin D and the risk of dementia and Alzheimer disease

Neurology. Published online before print August 6, 2014.

Thomas J. Littlejohns, MSc, William E. Henley, PhD, Iain A. Lang, PhD, Cedric Annweiler, MD, PhD, Olivier Beauchet, MD, PhD, Paulo H.M. Chaves, MD, PhD, Linda Fried, MD, MPH, Bryan R. Kestenbaum, MD, MS, Lewis H. Kuller, MD, DrPH, Kenneth M. Langa, MD, PhD, Oscar L. Lopez, MD, Katarina Kos, MD, PhD, Maya Soni, PhD* and David J. Llewellyn, PhD*

Objective: To determine whether low vitamin D concentrations are associated with an increased risk of incident all-cause dementia and Alzheimer disease.

Methods: One thousand six hundred fifty-eight elderly ambulatory adults free from dementia, cardiovascular disease, and stroke who participated in the US population–based Cardiovascular Health Study between 1992–1993 and 1999 were included. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were determined by liquid chromatography-tandem mass spectrometry from blood samples collected in 1992–1993. Incident all-cause dementia and Alzheimer disease status were assessed during follow-up using National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria.

Results: During a mean follow-up of 5.6 years, 171 participants developed all-cause dementia, including 102 cases of Alzheimer disease. Using Cox proportional hazards models, the multivariate adjusted hazard ratios (95% confidence interval [CI]) for incident all-cause dementia in participants who were severely 25(OH)D deficient (<25 nmol/L) and deficient (≥25 to <50 nmol/L) were 2.25 (95% CI: 1.23–4.13) and 1.53 (95% CI: 1.06–2.21) compared to participants with sufficient concentrations (≥50 nmol/L). The multivariate adjusted hazard ratios for incident Alzheimer disease in participants who were severely 25(OH)D deficient and deficient compared to participants with sufficient concentrations were 2.22 (95% CI: 1.02–4.83) and 1.69 (95% CI: 1.06–2.69). In multivariate adjusted penalized smoothing spline plots, the risk of all-cause dementia and Alzheimer disease markedly increased below a threshold of 50 nmol/L.

Conclusion: Our results confirm that vitamin D deficiency is associated with a substantially increased risk of all-cause dementia and Alzheimer disease. This adds to the ongoing debate about the role of vitamin D in nonskeletal conditions.

The article can be accessed here.


Tuesday 5 August 2014

#GeriMedJC

@symplur has a few categories in which a hashtag can be registered.  The site seems perpetually bugged with failed attempts to register new hashtags under the "tweet chat" category, and thus the hashtag for this journal club, #GeriMedJC, was submitted today to @symplur as a "regular" category hashtag.  No error message popped up --- hooray!  We should find out in a few days if the registration was successful and can start commenting on users, metrics and other fun stats.

Friday 1 August 2014

A Twitter-based Geriatric Medicine Journal Club (#GeriMedJC) ? Sounds like a great idea ... except I don't use Twitter!

The Twitter version of the Geriatric Medicine Journal Club facilitates continuing medical education (CME) and promotes international  discussion of recent literature in Geriatric Medicine. #GeriMedJC will occur monthly concurrent with the live journal club that takes place at the Division of Geriatric Medicine at the University of Toronto.  To follow the discussion please use #GeriMedJC and include this in all your tweets.

Don't yet have a Twitter account?  Follow these steps:

1. Sign up for Twitter at twitter.com using your name and email address.

2. After you have created a Twitter account you will be asked to follow a few people. Add @GeriMedJC. This account is where the date, time and articles for the the next Geriatric Medicine Journal Club will be announced.

3. To follow or participate with any tweets for the journal club tweet chat, use #GeriMedJC. For any tweets you write, add #GeriMedJC in the tweet (this serves as a "keyword" and enables anyone interested to follow the discussion without necessarily following all the participants directly).

A few other useful links include:

Basics of twitter: http://www.momthisishowtwitterworks.com/
Twitter guide to lingo: http://mashable.com/2013/07/19/twitter-lingo-guide/

CPSO and CMA guidelines on the appropriate use of social media

Date and time for first Geriatric Medicine Journal Club tweet chat (#GeriMedJC)

August 29, 2014 at 08:00 EDT / 12:00 noon GMT.
Articles to be announced.

Maintenance of Certification credits

Eventually, we will register the tweet chat #GeriMedJC to be eligible for the Royal College of Physicians and Surgeons Section 1 (self-accredited) Maintenance of Certification credits. Tweeting would be required to obtain the credits.

Geriatric Medicine Journal Club (#GeriMedJC)

It has been a long time coming, but to follow in the footsteps of the International Urology Journal Club (#urojc) and the Respirology and Sleep Journal Club (#rsjc), a Geriatric Medicine Journal Club has been born on Twitter! @GeriMedJC was created today and monthly journal club tweet chats will use the hashtag #GeriMedJC.

Now if only @symplur would fix the bug that is currently not allowing the registration of new health care hashtags, metrics and influencers for #GeriMedJC will be available.

This will be a monthly journal club based on the University of Toronto Division of Geriatric Medicine journal club which is held at one of the various academic health sciences centres in Toronto.  Each month two recent papers will be selected for discussion.  The chosen articles will be announced on Twitter in advance.  Dates and times will be announced monthly.  The goal of the tweet chat (#GeriMedJC) will be to complement the discussion at the journal club but to also allow a broader international audience to chime in!

Follow us on Twitter @GeriMedJC !