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Online Discussion on #KidneyStones: A Longitudinal Assessment of Activity, Users and Content


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Introduction: Twitter is a popular microblogging platform for the rapid dissemination of information and reciprocal exchange in the urological field. We aimed to assess the activity, users and content of the online discussion, #KidneyStones, on Twitter. Methods: We investigated the Symplur Signals analytics tool for Twitter data distributed via the #KidneyStones hashtag over a one year period. Activity analysis reflected overall activity and tweet enhancements. We assessed users' geolocations and performed an influencer analysis. Content analysis included the most frequently used words, tweet sentiment and shares for top tweets. Results: 3,426 users generated over 10,333 tweets, which were frequently accompanied by links (49%), mentions (30%) and photos (13%). Users came from 106 countries across the globe and were most frequently from North America (63%) and Europe (16%). Individual and organisational healthcare professionals made up 56% of the influencers of the Twitter discussion on #KidneyStones. Besides the words 'kidney' (used 4,045 times) and 'stones' (3,335), 'pain' (1,233), 'urine' (1,158), and 'risk' (1,023) were the most frequently used words. 56% of tweets had a positive sentiment. The median (range) number of shares was 85 (62-587) for the top 10 links, 45.5 (17-94) for the top 10 photos, and 44 (22-95) for the top 10 retweets. Conclusion: The rapidly growing Twitter discussion on #KidneyStones engaged multiple stakeholders in the healthcare sector on a global scale and reached both professionals and laypeople. When used effectively and responsibly, the Twitter platform could improve prevention and medical care of kidney stone patients.
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Online Discussion on #KidneyStones: A
Longitudinal Assessment of Activity, Users
and Content
Johannes Salem
*, Hendrik Borgmann
, Matthew Bultitude
, Hans-Martin Fritsche
Axel Haferkamp
, Axel Heidenreich
, Arkadiusz Miernik
, Andreas Neisius
Thomas Knoll
, Christian Thomas
, Igor Tsaur
1Department of Urology, University Hospital, Cologne, Germany, 2Department of Urology, University of
Medicine, Mainz, Germany, 3Stone Unit, Guy's and St. Thomas' NHS Foundation Trust, London, United
Kingdom, 4Department of Urology, Caritas St Josef Hospital, University of Regensburg, Regensburg,
Germany, 5Department of Urology, University Medical Center, Freiburg, Germany, 6Department of
Urology, Klinikum Sindelfingen-Böblingen, Sindelfingen, Germany
These authors contributed equally to this work.
Twitter is a popular microblogging platform for the rapid dissemination of information and
reciprocal exchange in the urological field. We aimed to assess the activity, users and con-
tent of the online discussion, #KidneyStones, on Twitter.
We investigated the Symplur Signals analytics tool for Twitter data distributed via the #Kid-
neyStones hashtag over a one year period. Activity analysis reflected overall activity and
tweet enhancements. We assessed usersgeolocations and performed an influencer analy-
sis. Content analysis included the most frequently used words, tweet sentiment and shares
for top tweets.
3,426 users generated over 10,333 tweets, which were frequently accompanied by links
(49%), mentions (30%) and photos (13%). Users came from 106 countries across the globe
and were most frequently from North America (63%) and Europe (16%). Individual and
organisational healthcare professionals made up 56% of the influencers of the Twitter dis-
cussion on #KidneyStones. Besides the words kidney(used 4,045 times) and stones
(3,335), pain(1,233), urine(1,158), and risk(1,023) were the most frequently used
words. 56% of tweets had a positive sentiment. The median (range) number of shares was
85 (62587) for the top 10 links, 45.5 (1794) for the top 10 photos, and 44 (2295) for the
top 10 retweets.
PLOS ONE | DOI:10.1371/journal.pone.0160863 August 18, 2016 1/11
Citation: Salem J, Borgmann H, Bultitude M, Fritsche
H-M, Haferkamp A, Heidenreich A, et al. (2016)
Online Discussion on #KidneyStones:A Longitudinal
Assessment of Activity, Users and Content. PLoS
ONE 11(8): e0160863. doi:10.1371/journal.
Editor: Jeff M Sands, Emory University Department
of Medicine, UNITED STATES
Received: April 10, 2016
Accepted: July 26, 2016
Published: August 18, 2016
Copyright: © 2016 Salem et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are
Data Availability Statement: The information
underlying this study is available from the Symplur
Signals database, and can be accessed under www. with a fee-based account
subscribed for the hashtag #KidneyStones. The time
period was set from 1st October 2014 to 1st October
2015. We paid US$1,099 for a one month explorative
Funding: The authors have no support or funding to
The rapidly growing Twitter discussion on #KidneyStones engaged multiple stakeholders in
the healthcare sector on a global scale and reached both professionals and laypeople.
When used effectively and responsibly, the Twitter platform could improve prevention and
medical care of kidney stone patients.
The microblogging social media platform, Twitter, enjoys increasing popularity in the health-
care sector. Currently, over 70% of urologists in Australia and New Zealand have a social
media presence, with Twitter being the second most commonly used form after LinkedIn,
which serves a completely different purpose [1]. Urologists using Twitter during the European
Association of Urology (EAU) and the American Urological Association (AUA) congresses
regarded it as beneficial for professional networking, disseminating information, research,
advocacy, and career development [2]. Impressively, 1,860 users generated 15,419 tweets in
total at the EAU14 and AUA14 congresses [3]. Notably, the Twitter-based International Urol-
ogy Journal Club, #urojc, has established a high-level academic discussion of urologic manu-
scripts [4]. In attempt to standardise the online discussion about urological care, a particular
structuring of the key urology-related hashtags has recently been proposed [5]. Interestingly,
the high technology field of endourology was the first urologic subspeciality assessed for Twit-
ter activity during the 2013 World Congress of Endourology [6]. Most recently, a Twitter dis-
cussion during the Third Meeting of the European Association of Urology Section of
Urolithiasis 2015 comprised 94 users contributing 446 tweets [7].
In slightly more than a decade, the prevalence of urolithiasis in the United States has
increased from 5.2% to 8.8% [8], having a substantial socioeconomic impact [9] and incre-
mentally affecting younger patients [10]. Since evidence has been provided for both highly
prevalent urologic conditions and also diseases with young patient age at onset evoking more
Twitter activity than their counterparts [11], a vibrant Twitter discussion on stone disease is
likely. Interestingly, in conditions with broad-based Twitter communities, such as breast can-
cer, patients have reported an increase in disease knowledge from participating in Twitter dis-
cussions [12].
In the current investigation, we aimed to assess the potential of Twitter to constitute a
potential platform for the dissemination of contemporary evidence on prevention, diagnosis
and treatment of stone disease. Hypothesising that a Twitter discussion on #KidneyStones
might appreciably involve both healthcare givers and laypeople, as well as encourage consider-
able global public awareness, we investigated the characteristics of its activity, users and
Materials and Methods
The study was approved by the Ethics Commission of the Faculty of Medicine of the University
of Cologne. We performed an extensive analysis of activity, users and content of the online dis-
cussion on #KidneyStones on Twitter, using the Symplur Signals database. Symplur (www. is a Twitter analysis website that maintains a database of healthcare-related
Twitter conversations. Symplur Signals ( is a fee-based research
analytics tool that promotes the understanding of healthcare as seen by patients, doctors and
other stakeholders with access to healthcare social media data points.
Online Discussion on #KidneyStones
PLOS ONE | DOI:10.1371/journal.pone.0160863 August 18, 2016 2/11
Competing Interests: The authors have declared
that no competing interests exist.
In October 2015, we searched the Symplur Signals database for analytic insights into the
online discussion on #KidneyStones for the time period 1st October 2014 to 1st October 2015.
The activity analysis comprised the assessment of overall tweet activity, tweet metrics, engage-
ment metrics and tweet language metrics. Overall tweet activity was recorded as the number of
tweets and users, and these were related to time periods. We performed a detailed analysis of
the tweet transcript (exact list of all tweets) to assess the issues inducing peak activities. The
tweet metrics analysis was performed by retrieving statistics about ratio and frequency of
retweets, tweets with links, tweets with photos, tweet replies and tweets where one or more
Twitter users were mentioned. Engagement metrics were retrieved by obtaining the number of
users who tweeted over a set period of time, grouped by the number of tweets sent. A tweet lan-
guage analysis illustrated the language used by active participants over a set period of time.
Language type was identified by a natural language processing algorithm directly provided by
the Twitter application programming interface.
User analysis included the cumulative user report, usersgeolocations, and an influencer
analysis of the top influencers in the #KidneyStones discussion. Cumulative and new users
were recorded for monthly intervals. Cumulative users did not represent recurring users, but
were counted as a new user the first time they used the #KidneyStones hashtag and as a previ-
ous user in subsequent reporting periods, regardless of activity. The geolocation of users was
recorded when users sent tweets tagged with certain geolocation data. We analysed the top 100
contributors to the #KidneyStones discussion, as measured by number of tweets in the influen-
cer analysis. For this purpose, we performed a Twitter profile analysis and assigned these top
influencers to these healthcare categories, in line with the Symplur Signals healthcare category
definitions: physician; patient; healthcare professional; caregiver/advocate; researcher/aca-
demic; individual other healthcare; individual other non-healthcare; organisation provider;
organisation research/academic; organisation government; organisation advocate/support;
organisation pharma; organisation other healthcare; organisation other non-healthcare, and
spam [13].
We used the Symplur Signals tools for content analysis. The 100 most frequently used
words in tweets on #KidneyStones were analysed and counted. Since multiple hashtags are
often used within a single tweet, we used the hashtag network graph to analyse hashtags accom-
panying the #KidneyStones discussion and their relationships. The sentiment report analysed
tweets for positive and negative sentiment by a natural language processing algorithm. The
algorithm is based on two custom dictionaries, one for positive words and one for negative
words. Each word in the dictionaries has a weighting from one to five, with five being the high-
est. Finally, we investigated the most frequently shared links, photos and the most frequently
retweeted tweets. We performed statistical calculations using the Statistical Package for the
Social Sciences 22.0 software (SPSS Inc., Chicago, IL, USA). Values are described as median
and range.
Table 1 shows overall activity for the #KidneyStones online discussion on Twitter for the time
period of one year. 3,426 users produced 10,806 tweets. Fig 1 portrays the weekly number of
tweets on #KidneyStones, which slightly increased over the investigated time period. The peak
tweet activity occurred during a strategic massive tweet activity of key influencers, evoking a
large amount of retweets (influencers: @virtualclinicng, 9th March 2015 and 11th March 2015,
41 tweets on kidney stones prevention leading to a peak of over 500 tweets in a week; @mayo-
clinic, 11th July 2015, 41 tweets on kidney stones prevention during a radio show leading to a
peak of over 400 tweets in a week).
Online Discussion on #KidneyStones
PLOS ONE | DOI:10.1371/journal.pone.0160863 August 18, 2016 3/11
Out of 10,333 total tweets, 5,013 (49%) were accompanied by links, 3,101 (30%) by men-
tions and 1,337 (13%) by photos. 2,441 (24%) were retweets and 229 (2%) were tweet replies.
2,798 users (82%) generated one tweet, 331 (10%) two, 244 (7%) three to nine, and 53 (2%) 10
or more tweets. 9,942 (96%) of tweets were in the English language.
Fig 2 demonstrates that the monthly number of users contributing to the #KidneyStones
online discussion on Twitter from October 2014 grew steadily, with a median of 262 (range
189454) new users per month. The median number of active users contributing to the #Kid-
neyStones online discussion was 304.5 per month (range 227545). Users came from 106 coun-
tries and from all continents around the globe (Fig 3). The S1 Table lists the location of users
according to country and continent. North American users were most active (63%), ahead of
Table 1. Overview of tweet activity for the #KidneyStones online discussion on Twitter over a time period of one year.
Metric Total Per Month Per Week Per Day Per Hour
Tweets 10,333 849 198 28.3 1.18
Tweets per user 3.02 0.248 0.0578 0.00826 0.000344
Users who tweeted 3,426 282 65.7 9.39 0.391
Fig 1. Tweet activity for the #KidneyStones online discussion on Twitter during the one year period. The weekly numbers of
tweets are represented as columns.
Online Discussion on #KidneyStones
PLOS ONE | DOI:10.1371/journal.pone.0160863 August 18, 2016 4/11
European users (16%) and Asian users (10%). The top 100 influencers in the #KidneyStones
online discussion on Twitter, according to the number of tweets posted in the study period,
and stratified by healthcare category, are shown in Fig 4. Individuals not involved in healthcare
(38%) and healthcare organisations (37%; organisations: provider, advocate/support, govern-
ment, other) were the main influencers in the discussion. There were no spam accounts among
the top 100 influencers.
A content analysis of the most frequently used words in the #KidneyStones online discus-
sion on Twitter is shown in Fig 5. Besides kidney(used 4,045 times) and stones(3,335),
Fig 2. Growth in number of users contributing to the #KidneyStones online discussion on Twitter.
Online Discussion on #KidneyStones
PLOS ONE | DOI:10.1371/journal.pone.0160863 August 18, 2016 5/11
pain(1,233), urine(1,158), and risk(1,023) were the top words. The S2 Table presents the
complete content analysis with the 100 most frequently used words in #KidneyStones tweets.
The largest thematic proportion of tweets focused on disease awareness and prevention (35 of
100 words). The sentiment analysis revealed that 56% of the tweets had a positive sentiment
and 44% had a negative sentiment. The median (range) number of shares for the top 10 links
was 85 (62587) and 45.5 (1794) for the top 10 photos. The top 10 retweets had a median of
44 (2295) retweets. The #KidneyStones hashtag was often related to the #health, #renalcolic,
#renalcalculus and #kidney hashtags.
We performed a longitudinal assessment of activity, users and content of the online discussion
on #KidneyStones, using the Symplur Signals health analytics database. Over the one year
period, Twitter activity was reflected by 10,806 tweets, which were frequently enhanced with
links and mentions, and were posted predominantly in English. Together, 3,426 users from 106
countries contributed to the online discussion, with non-professional individuals and health-
care organisations being the main influencers. Content was dominated by the words kidney,
stones,pain,urineand risk, and tweets had more positive than negative sentiments. The
top links, photos and retweets were shared up to 100 times.
The Twitter activity of 10,806 tweets found for #KidneyStones in the study period is much
higher than 880 tweets found in 2012 for urinary tract infection, another urological disease
[14]. The majority of Twitter activity data in the literature are published on urological oncology
diseases, such as #testicularcancer (10,376 tweets in 2014) or #prostatecancer (79,242 tweets in
2014) [15]. Comparisons of tweet activity between #KidneyStones as a benign disease and
malignant diseases are compromised since the potentially life-threatening character of onco-
logical topics has been shown to provoke an over-representation on Twitter [14].
The tweet metric analysis showed that contributors interacted using retweets (24%) and
mentions (30%) in their tweets. Relevant tweets inducing retweets are of high interest to the
Fig 3. Geolocation of users contributing to the #KidneyStones online discussion on Twitter. The colour tone reflects the number of users
per country: the colour shifts from light tones (countries with few or no users) to dark tones (countries with many users).
Online Discussion on #KidneyStones
PLOS ONE | DOI:10.1371/journal.pone.0160863 August 18, 2016 6/11
Twitter community, which is underlined by the recently introduced concept of the Twitter
impact factor [16]. Moreover, almost half of the tweets were enhanced by a link. This is encour-
aging since the combination statement + proofis a basic principle in science which can be
translated to Twitter as the combination statement + link. A tweet analysis on the topic of
dementia showed that the top users applied links more frequently than average users [17]. Sim-
ilarly, successful tweets from public state health departments contained links in the majority of
tweets [18]. Thus, a high number of links used in tweets for #KidneyStones appears to enhance
the reach of tweets and enables followers to check the trustworthiness of the short information
presented in one tweet. Additionally, links enable more information to be conveyed in the
tweet than the 140 characters would otherwise allow.
The Twitter discussion on #KidneyStones is global, involving users from all continents.
Usage rates of social media were 74% among American urologists in 2013 [19] and 70% among
Australian urologists in 2014 [1]. As social media adoption rates continue to grow, so did the
number of cumulative contributors to the #KidneyStones discussion. This is in line with our
previous study on urologic oncology, with steadily increasing tweet activity over time [15].
Twitter allows for rapid, informal, and thus low-threshold, participation in an online discus-
sion. These characteristics make it appealing for laypeople to join in the conversation. Notably,
Fig 4. Top 100 influencers in the #KidneyStones online discussion on Twitter according to tweet volume stratified by healthcare category.
Healthcare organisation consists of 8% provider, 1% government, 15% advocate/support and 13% other healthcare organisations (from darker blue to lighter
blue). Healthcare individual consists of 13% doctors, 2% healthcare practitioners and 4% other healthcare individuals (from darker turquoise to lighter
Online Discussion on #KidneyStones
PLOS ONE | DOI:10.1371/journal.pone.0160863 August 18, 2016 7/11
individuals such as patients, relatives and interested people who are not primarily involved in
healthcare accounted for a large number of the top influencers in the #KidneyStones discus-
sion. Similarly, individual and organisational healthcare professionals contributed as top influ-
encers, which demonstrates the potential of Twitter for disseminating valuable knowledge
from professionals on preventive, diagnostic and therapeutic options to the populace.
Particularly noteworthy is the finding of the content analysis, revealing that words symbolis-
ing disease awareness and prevention are most frequently used in tweets on #KidneyStones.
Primary prevention of kidney stones has been shown to be cost-effective for a national health-
care system [20]. This is crucial, particularly considering the rapidly increasing costs of urolith-
iasis treatment, predicted to be more than US$1 billion annually in the United States by 2030
Fig 5. Bubble chart visualising the 100 most frequently used words in tweets in the #KidneyStones online discussion on Twitter. The larger the
bubble, the more a word is used. Colours only aid differentiation and have no other significance.
Online Discussion on #KidneyStones
PLOS ONE | DOI:10.1371/journal.pone.0160863 August 18, 2016 8/11
[9]. Importantly, urolithiasis is associated with a 3050% risk of recurrence within seven years
of initial treatment [21,22]. Secondary nonmedical prevention with fluid intake, specific die-
tary therapy, adoption of a healthylifestyle [2325] as well as preventive pharmacological
treatment [2628] were reported to effectively reduce recurrence rates. Unfortunately, due to
patient and provider scepticism about the evidence of secondary prevention effectiveness, it is
infrequently utilised in daily routines [29,30]. An additional hurdle to the implementation of
preventive measures is low patient compliance; roughly half of stone formers were reported to
adhere to a prescribed preventive therapy in a contemporary series [30]. Considering the
under-utilised potential of primary and secondary prevention of urolithiasis, the Twitter plat-
form might make a beneficial contribution in these areas. The #KidneyStones Twitter discus-
sion can deliver currently valid guidelines and recommendations on urolithiasis prevention to
laypeople and thus lead to both a decrease of recurrence rates and increased cost-savings. In
this context, using links and photos to enhance a tweets content and its reach can therefore be
a successful strategy. The most shared link in our analysis was distributed 587 times and the
most shared photos and retweets were spread up to nearly 100 times.
Although the #KidneyStones hashtag is proposed as standardised communication descrip-
tor [5], we acknowledge that this single hashtag cannot capture all the information that is
exchanged on urolithiasis on the Twitter platform. Particularly during congresses with high
tweet activity using multiple hashtags, discussions on stone disease might take place beside the
#KidneyStones channel.
We also used the Symplur Signals analytics platform for a systematic assessment of health-
care social media data. The automated data extraction and analysis algorithms allow for the
analysis of a vast amount of data, but cannot detect linguistic nuances, such as ambiguity or
irony when analysing content. Lastly, Twitter is a rapidly growing and changing social media
platform, implying that the results of our contemporary analysis might be out-dated in the
near future.
Notwithstanding the aforementioned limitations, several practice-oriented conclusions can
be drawn from the findings of the current study. The Twitter discussion on #KidneyStones is
maintained by users from all over the world and evokes a remarkable number of tweets, under-
scoring the global reach of this microblogging platform. Healthcare organisations, as one of the
top influencers in the discussion, have a unique opportunity to raise the awareness of patients
and providers for nonmedical and pharmacological prevention, eventually reducing recurrence
rates and care-related expenditure. Patients and other laypeople substantially contributing to
the discussion have the option of being discreetly and noncommittally counselled by experts,
optimising shared decision-making. Finally, given responsible Twitter usage, the dissemination
of novel diagnostic and therapeutic developments in the area of urolithiasis between stakehold-
ers and patients might be considerably accelerated.
The Twitter discussion on #KidneyStones engaged multiple stakeholders in the healthcare sec-
tor on a global scale and involves both professionals and laypeople. Considering the rapidly
increasing prevalence and treatment-related costs of urolithiasis, Twitter might promote
shared decision-making and contribute to the optimisation of patient care.
Supporting Information
S1 Table. Geolocation of users of the #KidneyStones online discussion on Twitter.
Online Discussion on #KidneyStones
PLOS ONE | DOI:10.1371/journal.pone.0160863 August 18, 2016 9/11
S2 Table. Top 100 words used in the #KidneyStones online discussion on Twitter.
The authors wish to thank all the participants in the lively Twitter discussion on
Author Contributions
Conceived and designed the experiments: JS HB IT.
Performed the experiments: JS HB IT.
Analyzed the data: JS HB MB HMF A. Haferkamp A. Heidenreich AM AN TK CT IT.
Contributed reagents/materials/analysis tools: JS HB IT.
Wrote the paper: JS HB MB HMF A. Haferkamp A. Heidenreich AM AN TK CT IT.
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PLOS ONE | DOI:10.1371/journal.pone.0160863 August 18, 2016 11 / 11
... Several studies have demonstrated hashtags' utility in amplifying content associated with various topics and events. The inclusion of hashtags in tweets facilitated the promotion of disease-specific tweets (12)(13)(14)(15), Twitter-based chats and journal clubs (16)(17)(18)(19), and meeting or conferencerelated content (20)(21)(22)(23)(24)(25)(26)(27)(28). Hashtags have also been previously demonstrated as an effective tool for content-specific education (13,29). ...
... Table 1 depicts the top 10 locations of users that tweeted content containing #MedTwitterAI who provided location data in their profiles. The most common locations of users were the United States (378), United Kingdom (80), Canada (65), India (46), Spain (29), France (24), Italy (16), Australia (16), Germany (16), and Brazil (15). Tweets with a detected language were mainly posted in English FIGURE 3 | Percentage of #MedTwitterAI-posting healthcare stakeholders (data derived from Symplur Signals). ...
... This Twitter campaign was unique given the interdisciplinary nature of subject, on the interface of computer science, engineering, and medical communities. Previous literature surrounding the use of hashtags in healthcare-associated content amplification tended to pertain to a single community (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Several methodological distinctions are also apparent within our analysis. ...
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Background Artificial intelligence (AI) has the potential to reshape medical practice and the delivery of healthcare. Online discussions surrounding AI's utility in these domains are increasingly emerging, likely due to considerable interest from healthcare practitioners, medical technology developers, and other relevant stakeholders. However, many practitioners and medical students report limited understanding and familiarity with AI.Objective To promote research, events, and resources at the intersection of AI and medicine for the online medical community, we created a Twitter-based campaign using the hashtag #MedTwitterAI.Methods In the present study, we analyze the use of #MedTwitterAI by tracking tweets containing this hashtag posted from 26th March, 2019 to 26th March, 2021, using the Symplur Signals hashtag analytics tool. The full text of all #MedTwitterAI tweets was also extracted and subjected to a natural language processing analysis.ResultsOver this time period, we identified 7,441 tweets containing #MedTwitterAI, posted by 1,519 unique Twitter users which generated 59,455,569 impressions. The most common identifiable locations for users including this hashtag in tweets were the United States (378/1,519), the United Kingdom (80/1,519), Canada (65/1,519), India (46/1,519), Spain (29/1,519), France (24/1,519), Italy (16/1,519), Australia (16/1,519), Germany (16/1,519), and Brazil (15/1,519). Tweets were frequently enhanced with links (80.2%), mentions of other accounts (93.9%), and photos (56.6%). The five most abundant single words were AI (artificial intelligence), patients, medicine, data, and learning. Sentiment analysis revealed an overall majority of positive single word sentiments (e.g., intelligence, improve) with 230 positive and 172 negative sentiments with a total of 658 and 342 mentions of all positive and negative sentiments, respectively. Most frequently mentioned negative sentiments were cancer, risk, and bias. Most common bigrams identified by Markov chain depiction were related to analytical methods (e.g., label-free detection) and medical conditions/biological processes (e.g., rare circulating tumor cells).Conclusion These results demonstrate the generated considerable interest of using #MedTwitterAI for promoting relevant content and engaging a broad and geographically diverse audience. The use of hashtags in Twitter-based campaigns can be an effective tool to raise awareness of interdisciplinary fields and enable knowledge-sharing on a global scale.
... Hashtags represent relevant terms or phrases spelled without spaces and with a hash sign (#) in front, and they have been widely used for tagging relevant content on social media (Otsuka et al., 2016). Previous research found that hashtag use on Twitter is an efficient tool (1) to increase the visibility of scientific meetings and conferences (Callister et al., 2019;Cheung et al., 2018;D'Anna et al., 2019;Ferguson et al., 2014;Nason et al., 2015;Negrón, 2019), (2) to form Twitter-based journal clubs (Gardhouse et al., 2017), (3) to monitor online discussions focused on relevant biomedical topics Bundy et al., 2018;Grabbert et al., 2020;Hage et al., 2018;Salem et al., 2016;Yu et al., 2020), (4) to address specific aspects such as the public disclosure on social media of identifiable patient information by healthcare professionals (Ahmed et al., 2020a), (5) to build focused Twitter chats (Carroll et al., 2017), and (6) to be used for rapid dissemination of information in medical crises (Kudchadkar and Carroll, 2020). The major feature of Twitter is that it enables registered users to publicly share short 280-character texts, also known as tweets, which may contain hashtags, hyperlinks, mentions of other users, and sometimes even attached images or video clips. ...
... Considering the covered time-frame (five weeks), the identified number of tweets and users is relatively high as compared to other previously studied hashtags with biomedical relevance. Thus, #MaleInfertility has been reported to have been used in 11,325 tweets by 3241 users for the period August 2015-November 2018 , the annual tweets mentioning #Incontinence were reported to be 13,823 in 2015, and the number raised to 19,996 in 2018 (Grabbert et al., 2020), and the hashtag #KidneyStones was reported to have been used in 10,333 tweets by 3426 users over one year (Salem et al., 2016). ...
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The open innovation hub Digital Health and Patient Safety Platform (DHPSP) was recently established with the purpose to invigorate collaborative scientific research and the development of new digital products and personalized solutions aiming to improve human health and patient safety. In this study, we evaluated the effectiveness of a Twitter-based campaign centered on using the hashtag #DHPSP to promote the visibility of the DHPSP initiative. Thus, tweets containing #DHPSP were monitored for five weeks for the period 20.10.2020-24.11.2020 and were analyzed with Symplur Signals (social media analytics tool). In the study period, a total of 11,005 tweets containing #DHPSP were posted by 3,020 Twitter users, generating 151,984,378 impressions. Analysis of the healthcare stakeholder-identity of the Twitter users who used #DHPSP revealed that the most of participating user accounts belonged to individuals or doctors, with the top three user locations being the United States (501 users), the United Kingdom (155 users), and India (121 users). Analysis of co-occurring hashtags and the full text of the posted tweets further revealed that the major themes of attention in the #DHPSP Twitter-community were related to the coronavirus disease 2019 (COVID-19), medicine and health, digital health technologies, and science communication in general. Overall, these results indicate that the #DHPSP initiative achieved high visibility and engaged a large body of Twitter users interested in the DHPSP focus area. Moreover, the conducted campaign resulted in an increase of DHPSP member enrollments and website visitors, and new scientific collaborations were formed. Thus, Twitter campaigns centered on a dedicated hashtag prove to be a highly efficient tool for visibility-promotion, which could be successfully utilized by healthcare-related open innovation platforms or initiatives.
... Hence, tweets have hashtags for categorization. For example, #NephMadness, #ISNwebinars, #NephPearls, and so on (26). The use of hashtags aids in categorization of the content which makes it easy to search. ...
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Social media is defined as “a group of Internet-based applications that build on the ideological and technological foundations of Web 2.0, that allow the creation and exchange of user-generated content”. Social media can be used in medical education to enhance knowledge sharing among peer groups and the public in general. The internet revolutionized learning by allowing easier dissemination of knowledge that did not depend on printing and physical distribution of books, journals, or magazines. According to a report from 2018, 95% of students have access to smartphones and 45% are online at any given time. Social media platforms are powerful tools to spread knowledge by the way of stories, videos, and educational games. Both formal and informal learning can be achieved with the use of social media. The microblogging website Twitter has become a popular social media platform by many in medical education including the nephrology community. Twitter, for example, is used to build communities, discuss journal articles, inform the community of conferences, share infographics and visual abstracts of original research work. As an example, it can be difficult for women in nephrology to connect and travel to make a physical presence. The use of social media allows women to connect via webinars and Women in Nephrology (WIN) India live Twitter chats. Thus, social media can help facilitate networking and collaboration with nephrologists all over the world. Social media has limitations as well. Insensitive posts can have a detrimental effect on one’s career. A survey has shown that increased use of social media can contribute to addiction, anxiety, diminished self-esteem, and even depression. Hence, in order to effectively use social media to contribute positively to one’s career, we recommend considering the positive and negative aspects of social media.This review will discuss the various social media platforms and how they have been applied to nephrology education.
... enable input from other doctors on complex clinical cases4 and facilitate the exchange of information between healthcare organizations, patients, and providers.5 In my own experience, I have found social media to be a rich source of information on the latest medical news. ...
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... capability to assign health care stakeholder designation based on Twitter account biographies (Attai, Radford, & Cowher, 2016;Bundy et al., 2018aBundy et al., , 2018bHage et al., 2018aHage et al., , 2018bPinho-Costa et al., 2016;Rabarison et al., 2017;Salem et al., 2016). Only tweets that included the #SaludTues hashtag were included in the metrics. ...
U.S. Latinos are 1.5 times more likely to develop Alzheimer’s disease (AD) than non-Latino Whites. To raise awareness of and action around this rising public health issue, Salud America!, a national Latino health advocacy network, organized three #SaludTues tweetchats on Twitter between 2018 and 2020. For the three Alzheimer’s tweetchats ─Aug. 14, 2018, June 6, 2019, and Oct. 6, 2020─Salud America! partnered with global groups that advocate for AD solutions in Latino and other communities. We analyzed the three tweetchats’ #Saludtues hashtag usage, participant demographics, and other metrics using Symplur analytics software. For the first tweetchat in 2018, there were 579 tweets with a total of 3.89 million impressions; the second tweetchat in 2019 had a bigger impact with 704 tweets with 5.72 million impressions; the third tweetchat had the biggest impact with 932 tweets and 6.62 million impressions. Most tweetchat participants were from states with large Latino populations, and most tweets indicated positive sentiment related to increasing awareness of solutions to AD issues among Latinos. The three Alzheimer’s-focused #SaludTues tweetchats particularly served as unique testing grounds for the fast dissemination and increasingly exposed many people to the issue of AD and the need to advocate for the Latino community.
... However, several implementation issues remain open. While reforming medical education curricula takes time, conferences and social media campaigns targeting online biomedical communities can be quite impactful as suggested by recent experience in other healthcare ventures [24,25] Finally, this effort must be promptly communicated. Both climate change and telemedicine are quite technical, while their implementation needs funding and regulatory support. ...
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The carbon footprint associated with healthcare has recently raised concerns about how medical practice can be made more sustainable. At the same time, Telemedicine has grown enough to enable medical practitioners to provide reliable healthcare services remotely. The propagation of telehealth amid the COVID-19 pandemic serves as an opportunity to work more consistently towards lowering healthcare’s carbon footprint by decreasing transportation and other carbon-emitting activities. Efforts in research methodology, medical education and policy are necessary to further investigate how it can contribute to lowering the footprint of the healthcare sector.
Objectives: The purpose of this study is to conduct the first bibliometric analysis which examines eHealth communication technologies in prostate cancer care, and the utilization of internet-based health information and communication technology by men with prostate cancer. Methods: Original articles were extracted from the Science Citation Index Expanded (SCI-E) on Web of Science (WOS) and analyzed concerning their distributions. Quantitative guidance directed investigation of findings from previous studies and trending issues within the field. The WOS, VOSViewer and CiteSpace IV were used for information analysis. Results: 302 articles were included in the final analysis. There has been a 165 % increase in productivity over the past decade. The leading country by publication was the USA (145 articles = 48.02 %). Journals which published the highest number of original articles were the Journal of Medical Internet Research (6.95 %), and Patient Education and Counseling (4.64 %). Discussion and practice implications: The field of research which examines utilization and impacts of internet-based health information on men with prostate cancer is growing and diverse. Research frontiers are 'Information quality and diversity', 'eHealth literacy', 'decision making', and 'survivorship and advanced disease'. Clinicians should be aware of several significant limitations which exist within the current field of research.
Social media systems and crowdsourced data sites were incredibly active during disasters. Residents, first responders, and officials all turn to these systems to impart information and make calls for assistance. These systems will likely continue to hold a central informational and communication role in future disasters. Analyzing the trends and information that come from these sources in real-time aids the recovery process and help public agencies, first responders and researchers more quickly assess damages during and immediately after a disaster. Traditional sources, such as the initial FEMA damage estimates can miss areas of heavy impact and are often time delayed by several weeks. Using Harris County, Texas in the Houston region and the 2017 Hurricane Harvey flooding, the study provides a novel use-case in crisis informatics. The study leverages calls for help during the flooding event to mine address-level information to proxy damage estimates at the parcel-level. The study finds 36- to 53% of Twitter-sourced damage estimates are not captured in the FEMA estimates, significantly augmenting initial estimates with new data – feasibly within hours after the information is first tweeted. Empirically, the study evaluates how parcel-level FEMA damage estimates and Twitter-sourced damage estimates complement each other to proxy damaged structures.
Aim Bedwetting is a common paediatric condition. #Bedwetting has been established as the official hashtag to structure Twitter discussions about the condition. We analysed online Twitter discussions for #Bedwetting. Methods Symplur, a Twitter analytics service was employed to aggregate Twitter activity, users and content including #Bedwetting, between October 2013 and November 2018. Activity was analysed via tweet volume and user adoption. Users were assorted using geographic location, occupation and affiliation data. Content in #Bedwetting Tweets was undertaken by retrieving information about retweets, links, frequently used words and hashtags. Results A total of 101 412 tweets and 9957 users utilising #Bedwetting were identified. Most tweets were sent with links (93%). The average ± SD number of tweets using #Bedwetting per month increased from 96 ± 87 in 2013 to 2935 ± 1644 in 2015. Tweet volume decreased to 1960 ± 257 in 2016 and subsequently increased to 2901 ± 1110 in 2017. New users increased from 4 in 2013 to 9957 users in 2018. Users tweeted from 69 countries. Advocacy organisations comprised 35% of the top 100 influencers. Common words in #Bedwetting tweets were ‘potty’, ‘best’ and ‘training’. Popular associated hashtags were #Pottytraining, #Solutions and #Moms. Hyperlinks in #Bedwetting tweets included advocacy, academic and commercial websites. Conclusions Our analysis of #Bedwetting highlights that Twitter is frequently used to discuss the condition's diagnosis and management. Various stakeholders in health care are utilising the platform to build awareness about bedwetting. We identified that Twitter is being employed to drive web traffic to other internet websites.
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Introduction: Social media sites and services have become intimately woven into our interpersonal communications and have begun to stake a visible place in healthcare. Disease-specific Twitter hashtags, online patient groups and participation by patients, practitioners and advocacy groups are emblematic of this new paradigm. Methods: A literature review and summary of resources and publications on bladder cancer and social media. Results: A majority of Western patients have access to and use the Internet for health information. Urologists and oncologists have used bladder-cancer-specific messaging at international meetings infrequently as compared to prostate and other non-urologic cancers. An active community does participate in online discussion, with differences between medical practitioners and patients/advocates. Advice is given with the aim of unifying this discussion.
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Background: Despite reported benefits, many women do not attend breast cancer support groups. Abundant online resources for support exist, but information regarding the effectiveness of participation is lacking. We report the results of a Twitter breast cancer support community participant survey. Objective: The aim was to determine the effectiveness of social media as a tool for breast cancer patient education and decreasing anxiety. Methods: The Breast Cancer Social Media Twitter support community (#BCSM) began in July 2011. Institutional review board approval with a waiver of informed consent was obtained for a deidentified survey that was posted for 2 weeks on Twitter and on the #BCSM blog and Facebook page. Results: There were 206 respondents to the survey. In all, 92.7% (191/206 )were female. Respondents reported increased knowledge about breast cancer in the following domains: overall knowledge (80.9%, 153/189), survivorship (85.7%, 162/189), metastatic breast cancer (79.4%, 150/189), cancer types and biology (70.9%, 134/189), clinical trials and research (66.1%, 125/189), treatment options (55.6%, 105/189), breast imaging (56.6%, 107/189), genetic testing and risk assessment (53.9%, 102/189), and radiotherapy (43.4%, 82/189). Participation led 31.2% (59/189) to seek a second opinion or bring additional information to the attention of their treatment team and 71.9% (136/189) reported plans to increase their outreach and advocacy efforts as a result of participation. Levels of reported anxiety before and after participation were analyzed: 29 of 43 (67%) patients who initially reported “high or extreme” anxiety reported “low or no” anxiety after participation (P<.001). Also, no patients initially reporting low or no anxiety before participation reported an increase to high or extreme anxiety after participation. Conclusion: This study demonstrates that breast cancer patients’ perceived knowledge increases and their anxiety decreases by participation in a Twitter social media support group.
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Background Twitter is increasingly used to estimate disease prevalence, but such measurements can be biased, due to both biased sampling and inherent ambiguity of natural language. Objective We characterized the extent of these biases and how they vary with disease. Methods We correlated self-reported prevalence rates for 22 diseases from Experian’s Simmons National Consumer Study (n=12,305) with the number of times these diseases were mentioned on Twitter during the same period (2012). We also identified and corrected for two types of bias present in Twitter data: (1) demographic variance between US Twitter users and the general US population; and (2) natural language ambiguity, which creates the possibility that mention of a disease name may not actually refer to the disease (eg, “heart attack” on Twitter often does not refer to myocardial infarction). We measured the correlation between disease prevalence and Twitter disease mentions both with and without bias correction. This allowed us to quantify each disease’s overrepresentation or underrepresentation on Twitter, relative to its prevalence. ResultsOur sample included 80,680,449 tweets. Adjusting disease prevalence to correct for Twitter demographics more than doubles the correlation between Twitter disease mentions and disease prevalence in the general population (from .113 to .258, P
Background: Social media use in academia and urology is rising. Specifically, individual journals now have Twitter accounts (Twitter Inc, San Francisco, CA, USA) and regularly tweet academic content. Objective: To present and evaluate the Twitter impact factor (TIF), a novel means of measuring a journal's academic influence in the realm of social media. Design, setting, and participants: Journal Citation Reports (JCR; Thomson Reuters, New York, NY, USA) for 2014 was queried for urologic academic journals. English-language journals with active Twitter accounts since 2013 were included. The total number of followers, tweets, and retweets over a 2-yr period were collected. Outcome measures and statistical analysis: Each journal's TIF was calculated based on the number of retweets per original relevant tweet. Comparisons between the TIF and the journal impact factor (JIF) as well as the Klout score were made using the Pearson correlation. Results and limitations: Of 33 journals listed in the JCR for 2014, 7 (21%) had a Twitter presence as of 2013. The number of JCR-listed journals with a Twitter handle increased by 29% in 2014. There was an increase in the mean number of relevant tweets per journal during the study period and a 130% increase in the number of retweets over 1 yr. European Urology (1.80) and BJU International (1.46) had the highest TIFs. The journals with the highest number of Twitter followers were European Urology (5807) and the Journal of Urology (4402). The journals with the highest numbers of relevant tweets were European Urology (1159) and BJU International (1090). There was a positive but statistically insignificant association between the TIF and the JIF (r=0.64, p=0.12). There was a strongly positive linear correlation between the TIF and the Klout score (r=0.84, p=0.0086). Conclusions: With the increasing use of social media by individuals and academic journals, the TIF can be a useful tool to measure the academic reach and impact of a journal on Twitter. Patient summary: Social media is an increasing part of the way in which practitioners and academicians communicate. The TIF can be used to analyze the impact of journal Twitter feeds and their social media content.
Objectives: To analyse the activity, content, contributors, and influencers of the Twitter discussion on urologic oncology. Materials and methods: We performed a comprehensive quantitative and qualitative Twitter analysis for the hashtags #prostatecancer, #bladdercancer, #kidneycancer, and #testicularcancer. Symplur was used to analyse activity over different time periods and the top influencers of the Twitter discussion. Tweet Archivist and Twitonomy analysis tools were used to assess characteristics of content and contributors. Results: Twitter discussion on urologic oncology in 2014 contained 100,987 tweets created by 39,326 participants. Mean monthly tweet activity was 6,603±2,183 for #prostatecancer, 866±923 for #testicularcancer, 457±477 for #bladdercancer and 401±504 for #kidneycancer. Twitter activity increased by 41% in 2013 and by 122% in 2014. The content analysis detected awareness, cancer, and risk as frequently mentioned words in urologic oncology tweets. Prevalently used related hashtags were the general hashtag #cancer, awareness hashtags, and the respective cancer/urology tag ontology hashtags. Contributors originated from 41 countries on 6 continents and had a mean of 5,864±4,747 followers. They tweeted from platforms on exclusively mobile devices (39%) more frequently than from desktop devices (29%). Health care organizations accounted for 58% of the top influencers in all cancers. The largest proportion of physicians were among the #prostatecancer and #kidneycancer (each 9%) influencers and individual contributors were most frequent in the discussion on #kidneycancer (57%) and #testicularcancer (50%). Conclusion: There is a significant and growing activity in the Twitter discussion on urologic oncology, particularly on #prostatecancer. The Twitter discussion is global, social, and mobile, and merits attention of stakeholders in health care as a promising communication tool.
Background and objectives: The prevalence of nephrolithiasis in the United States has increased substantially, but recent changes in incidence with respect to age, sex, and race are not well characterized. This study examined temporal trends in the annual incidence and cumulative risk of nephrolithiasis among children and adults living in South Carolina over a 16-year period. Design, setting, participants, & measurements: We performed a population-based, repeated cross-sectional study using the US Census and South Carolina Medical Encounter data, which capture all emergency department visits, surgeries, and admissions in the state. The annual incidence of nephrolithiasis in South Carolina from 1997 to 2012 was estimated, and linear mixed models were used to estimate incidence rate ratios for age, sex, and racial groups. The cumulative risk of nephrolithiasis during childhood and over the lifetime was estimated for males and females in 1997 and 2012. Results: Among an at-risk population of 4,625,364 people, 152,925 unique patients received emergency, inpatient, or surgical care for nephrolithiasis. Between 1997 and 2012, the mean annual incidence of nephrolithiasis increased 1% annually from 206 to 239 per 100,000 persons. Among age groups, the greatest increase was observed among 15-19 year olds, in whom incidence increased 26% per 5 years (incidence rate ratio, 1.26; 95% confidence interval, 1.22 to 1.29). Adjusting for age and race, incidence increased 15% per 5 years among females (incidence rate ratio, 1.15; 95% confidence interval, 1.14 to 1.16) but remained stable for males. The incidence among blacks increased 15% more per 5 years compared with whites (incidence rate ratio, 1.15; 95% confidence interval, 1.14 to 1.17). These changes in incidence resulted in doubling of the risk of nephrolithiasis during childhood and a 45% increase in the lifetime risk of nephrolithiasis for women over the study period. Conclusions: The incidence of kidney stones has increased among young patients, particularly women, and blacks.
Background: Over recent years, Twitter has demonstrated an expanding role in scientific discussion, surgical news and conferences. This study evaluates the role of Twitter in urological conferences, with comparison to other surgical specialties. Methods: A retrospective analysis of Twitter metrics during the two largest recent English-speaking conferences for each surgical specialty was performed. Using, all 'tweets' under the official conference hashtag from 0000 hour the first day to 24.00 hour the final day were assessed. The number of impressions, 'tweeters' and rates of 'tweeting' were analysed. Results: Nine of 18 conferences examined had official hashtags registered with Symplur Healthcare Hashtags. Plastic and urological surgery had both major conferences registered. Only one of two conferences for each cardiothoracic, general, orthopaedic, otolaryngology and paediatric was registered. Both major neurosurgical and vascular conferences were unregistered. Urological conferences were associated with significantly more Twitter activity than non-urological surgical conferences in all parameters, with greater than triple the number of impressions, tweets and 'tweeters'. Urological surgical conferences were associated with 337% more tweets and 164% more impressions per conference day, than non-urological surgical conferences. Conclusion: Twitter has been used to supplement surgical conferences. In this regard, the urological community leads the way compared to the remainder of surgical specialty communities.
Introduction: Twitter use has grown exponentially within the urological community. We aimed to determine the perceptions of the impact of Twitter on users' clinical practice, research, and other professional activities. Methods: We performed an 11-item online survey of Twitter contributors during two major urological meetings: the European Association of Urology (EAU) and the American Urological Association (AUA) annual meetings. During the EAU 2014 meeting, we distributed the survey via the meeting official Twitter feed. During the AUA 2014 meeting, we applied a new method by directly sending the survey to Twitter contributors. We performed a subset analysis for assessing the perceived impact of Twitter on the clinical practice of physicians. Results: Among 312 total respondents, the greatest perceived benefits of Twitter among users were for networking (97%) and disseminating information (96%), followed by research (75%), advocacy (74%) and career development (62%). In total, 65% of Twitter users have dealt with guidelines on online medical professionalism and 71% of physician users found that Twitter had an impact on their clinical practice, and 33% had made a clinical decision based on an online case discussion. Conclusions: Our results suggest that Twitter users in the urological community perceive important benefits. These benefits extend to multiple professional domains, particularly networking, disseminating information, remote conference participation, research, and advocacy. This is the first study that has been disseminated to targeted individuals from the urological community directly through tweets, providing a proof of principle for this research method.
Purpose: Rates of adherence to thiazide diuretics, alkali citrate therapy, and allopurinol-collectively referred to as preventive pharmacological therapy-among patients with kidney stones are low. This lack of adherence may reduce the effectiveness of secondary prevention efforts, leading to poorer clinical health outcomes in patients with kidney stones. To examine the impact that medication non-adherence has on the secondary prevention of kidney stones, we compared clinical health outcomes between patients who adhered to their regimen and those who did not. Materials and methods: Using medical and pharmacy claims data, we identified adult patients with a physician-coded diagnosis for kidney stones. Among the subset with a prescription fill for a preventive pharmacological therapy agent, we then measured adherence to therapy within the first six months of initiating treatment using the proportion of days covered (PDC) formula. We defined adherence as a PDC value at or above 80%. Finally, we fitted multivariable logistic regression models to examine the association between medication adherence and the occurrence of stone-related clinical health outcome [an emergency department (ED) visit, hospitalization, or surgery for stone disease]. Results: Among the 8,950 patients who met study eligibility criteria, slightly more than half (51.1%) were adherent to preventive pharmacological therapy. The frequency of ED visit, hospitalization, and surgery for stone disease was significantly lower among adherent patients. After controlling for sociodemographic factors and the level of comorbid illness, patients who were adherent to therapy had 27% lower odds of an ED visit [odds ratio (OR), 0.73; 95% confidence interval (CI), 0.64-0.84], 41% lower odds of hospital admission (OR, 0.59; 95% CI, 0.49-0.71), and 23% lower odds of surgery for stone disease (OR, 0.77; 95% CI, 0.69-0.85) than non-adherent patients. Conclusion: Our data highlight the consequences of non-adherence to preventive pharmacological therapy among patients with kidney stones. In order to improve adherence, further research is needed to understand patient- and provider-level factors that contribute to lower adherence.
Standardizing social media hashtag descriptors is likely to facilitate communication and promote collaboration in both health care provider and patient communities.