Decision Making Among Patients with Unruptured Aneurysms: A Qualitative Analysis of Online Patient Forum Discussions

Variation in academic neurosurgery departments' #neurosurgery social media influence

Background

Social media use is increasingly common among academic neurosurgery departments, but its relationship with academic metrics remains underexamined.

Methods

We examine the relationship between American academic neurosurgery departments' number of followers on Twitter, Instagram, and Facebook and the following academic metrics: Doximity Residency rankings, US News & World Report rankings (USNWR) of their affiliated medical schools, and the amount of NIH funding of those schools.

Results

Few departments had disproportionate number of followers. A greater proportion of programs had Twitter accounts (88.9%) than had Instagram (72.2%) or Facebook (51.9%) accounts (p=0.0001). Programs identified as "Influencers" had more departmental NIH funding (p=0.044), more institutional NIH funding (p=0.035), better Doximity residency rankings (p=0.044), and better affiliated medical school rankings (p=0.002). Number of Twitter followers had the strongest correlation with academic metrics, yet only modest correlations were identified to departmental NIH funding (R=0.496, p=0.0001), institutional NIH funding (R=0.387, p=0.0072), Doximity residency rank (R=0.411, p=0.0020), and affiliated medical school ranking (R=0.545,p<0.0001). On multivariable regression, only being affiliated with a medical school in the top quartile on the USNWR rankings, rather than neurosurgery departmental metrics, predicted having more Twitter (OR=5.666, p=0.012) and Instagram (OR=8.33, p=0.009) followers.

Conclusion

American academic neurosurgery departments preferentially use Twitter over Instagram or Facebook. Their Twitter or Instagram presences are associated with better performance on traditional academic metrics. However, these associations are modest, suggesting that other factors contribute to a department's social media influence. A department's affiliated medical school may contribute to the department's social media brand.

A survey of the radiological follow-up of unruptured intracranial aneurysms in the United Kingdom

OBJECTIVE

Unruptured intracranial aneurysms (UIA) are common. For many the treatment risks outweigh their risk of subarachnoid haemorrhage and patients undergo surveillance imaging. There is little data to inform if and how to monitor UIAs resulting in widely varying practices. This study aimed to determine the current practice of unruptured UIA surveillance in the United Kingdom.

METHODS

A questionnaire was designed to address the themes of surveillance protocols for UIA including when surveillance is initiated, how frequently it is performed, and when it is terminated. Additionally, how aneurysm growth is managed and how clinically meaningful growth is defined were explored. The questionnaire was distributed to members of the British Neurovascular Group using probability-based cluster and non-probability purposive sampling methods.

RESULTS

Responses were received from 30 of the 30 (100.0%) adult neurosurgical units in the United Kingdom of which 27 (90.0%) routinely perform surveillance for aneurysm growth. Only four units had a unit policy. The mean patient age up to which a unit would initiate follow-up of a low-risk UIA was 65.4 ± 9.0 years. The time points at which imaging is performed varied widely. There was an even split between whether units use a fixed duration of follow-up or an age threshold for terminating surveillance. Forty percent of units will follow-up patients more than 5 years from diagnosis. The magnitude in the change in size that was felt to constitute growth ranged from 1 to 3mm. No units routinely used vessel wall imaging although 27 had access to 3T MRI capable of performing it.

CONCLUSIONS

There is marked heterogeneity in surveillance practices between units in the United Kingdom. This study will help units better understand their practice relative to their peers and provide a framework forplanning further research on aneurysm growth.

Content, Readability, and Accountability of Freely Available Online Information for Patients Regarding Epiretinal Membranes

PURPOSE

To assess content, readability, and accountability of online information for patients regarding epiretinal membranes (ERMs).

METHODS

Cross-sectional study evaluating nine major medical websites on ERMs. Fifteen questions assessed patient-relevant content. Four indices estimated U.S. grade literacy level of the text. JAMA benchmarks (authorship, attribution, disclosure, currency) evaluated website accountability.

RESULTS

Average content score was 36.78 (SD 13.91, 95% CI ±0.64) from a possible maximum of 60, with significant variability between websites (H = 22.68, p=0.004). Mean reading grade level was 12.29 (SD 2.30, 95% CI ±1.50). No website achieved all JAMA benchmarks; only one website fulfilled three of the four. Content score did not correlate with Google rank (order of listed websites, r = -0.23, p=0.55) or JAMA benchmarks (r = 0.19, p=0.62) but significantly correlated with mean reading grade (r = 0.67, p=0.05).

CONCLUSION

Online information regarding ERMs varies significantly, may not adequately answer common patient questions, and is written at too complex a literacy level for the average patient.

Qualitative research methods in neurosurgery: an unexplored avenue

OBJECTIVE

Explore the value and potential of qualitative research to neurosurgery and provide insight and understanding to this underused methodology.

BACKGROUND

The definition of qualitative research is critically discussed and the heterogeneity within this field of inquiry explored. The value of qualitative research to the field of neurosurgery is articulated through its contribution to understanding complex clinical problems.

DISCUSSION

To resolve some of the misunderstanding of qualitative research, this paper discusses research design choices. We explore approaches that use qualitative techniques but are not, necessarily, situated within a qualitative paradigm in addition to how qualitative research philosophy aids researchers to conduct interpretive inquiry that can reveal more than simply what was said by participants. Common research designs associated with qualitative inquiry are introduced, and how complex analysis may contribute more in-depth insights is explained. Approaches to quality are discussed briefly to support improvements in qualitative methods and qualitative manuscripts. Finally, we consider the future of qualitative research in neurosurgery, and suggest how to move forward in the qualitative neurosurgical evidence base.

CONCLUSION

There is enormous potential for qualitative research to contribute to the advancement of person-centred care within neurosurgery. There are signs that more qualitative research is being conducted and that neurosurgical journals are increasingly open to this methodology. While studies that do not engage fully within the qualitative paradigm can make important contributions to the evidence base, due regard should be given to immersive inquiry within qualitative paradigms to allow complex, in-depth, investigations of the human experience.

Social Media in Neurosurgery: A Systematic Review

OBJECTIVE

Social media has been used increasingly in neurosurgery by individuals. We aimed to identify demographics and preferences of social media use, describe the scope of social media use, and characterize its utility.

METHODS

A systematic review was conducted using PubMed, Embase, and Scopus databases. Titles and abstracts from articles identified in the search were read and selected for full-text review. Studies meeting prespecified inclusion criteria were reviewed in full and analyzed for relevant data.

RESULTS

Of 431 resultant articles, 29 were included. Patients and caregivers most commonly used Facebook and Twitter, whereas nearly 50% of neurosurgeons used LinkedIn and Doximity. Patient and caregiver users of social media tended to be <35 years old. Content of posts varied from requesting/providing information (∼40%) to seeking emotional support/forming connections (∼30%). A total of 20.6% of videos were irrelevant to clinical neurosurgery. Factual accuracy of most videos was poor to inadequate. Social media use was associated with greater academic impact for neurosurgical departments and journals. Posts with photos and videos and weekend posts generated 1.2-2 times greater engagement.

CONCLUSIONS

Patients and caregivers who use social media are typically younger than 35 years old and commonly use Facebook or Twitter. Neurosurgeons prefer Doximity and LinkedIn. Social media yields information regarding common symptoms and uncovers novel symptoms. Videos are poor-to-inadequate quality and often irrelevant to clinical neurosurgery. Optimizing social media use will augment the exchange of ideas regarding clinical practice and research and empower patients and caregivers.