#EBUSTwitter: Novel Use of Social Media for Conception, Coordination, and Completion of an International, Multicenter Pathology Study

CONTEXT.—

Social media sites are increasingly used for education, networking, and rapid dissemination of medical information, but their utility for facilitating research has remained largely untapped.

OBJECTIVE.—

To describe in detail our experience using a social media platform (Twitter) for the successful initiation, coordination, and completion of an international, multi-institution pathology research study.

DESIGN.—

Following a tweet describing a hitherto-unreported biopsy-related histologic finding in a mediastinal lymph node following endobronchial ultrasound-guided transbronchial needle aspiration, a tweet was posted to invite pathologists to participate in a validation study. Twitter's direct messaging feature was used to create a group to facilitate communication among participating pathologists. Contributing pathologists reviewed consecutive cases of mediastinal lymph node resection following endobronchial ultrasound-guided transbronchial needle aspiration and examined them specifically for biopsy site changes. Data spreadsheets containing deidentified data and digital photomicrographs of suspected biopsy site changes were submitted via an online file hosting service for central review by 5 pathologists from different institutions.

RESULTS.—

A total of 24 pathologists from 14 institutions in 5 countries participated in the study within 143 days of study conception, and a total of 297 cases were collected and analyzed. The time interval between study conception and acceptance of the manuscript for publication was 346 days.

CONCLUSIONS.—

To our knowledge, this is the first time that a social media platform has been used to generate a research idea based on a tweet, recruit coinvestigators publicly, communicate with collaborating pathologists, and successfully complete a pathology study.

Carfentanil and Current Opioid Trends in Summit County, Ohio

Introduction

The Summit County Medical Examiner's Office (SCMEO) observed 52 unexplained deaths during the month of July 2016 in which drug overdose was suspected. A fentanyl screening immunoassay performed on autopsy specimens was positive, but gas chromatograph/mass spectrometry (GC/MS) failed to confirm its presence. Carfentanil, a large wildlife tranquilizer, was later identified through reference lab testing as the cause of the sudden increase in overdoses.

Methods

Due to the large volume of cases which followed, a method for identifying carfentanil was developed utilizing in-house instrumentation. In addition, a retrospective analysis for all drug overdose cases was conducted through the SCMEO database from January 2009 through December 2016.

Results

Assessment of the data revealed a 277% increase in yearly overdose-related fatalities when comparing 2009 to 2016. Carfentanil was not identified in any other fatal drug overdoses in the area before the first appearance in Akron in July of 2016. There was an initial spike of 35 deaths in both July and August, which then decreased to 12 deaths in December. There was an almost equal distribution of carfentanil as a single agent and carfentanil mixed with multiple other illicit drugs.

Discussion

Current observations suggest carfentanil concentrations in overdose cases are decreasing; however, it may be present in combination with other drugs, especially other fentanyl analogs. The lower concentrations of carfentanil are much more difficult to detect in urine and peripheral blood, therefore making the testing of scene paraphernalia, central blood, and organ tissue more of a necessity.

Grief education and bereavement support in Japan

This paper introduces the activities of the Japanese Association for Death Education and Grief Counseling, highlighting especially its grief education and bereavement support program. Because of greater life expectancy, most women in Japan will one day experience the death of their husbands, therefore pre-widowhood education programs are offered to married women in order to prepare them for widowhood. Memorial services, Buddhist, Christian and non-religious, are offered for bereaved persons. The search for a new self-identity after bereavement, the role of volunteer work, and the search for meaning in loss and bereavement are discussed. The issues of disenfranchised grief and grief after death from overwork are important themes in grief education.

[Death education as a way to improve the quality of life of cancer patients after a relapse]

Death education can help cancer patients to live the remaining days of their life more fully and thus can be helpful in improving their quality of life. Death education is not limited to learning only about dying and death. Death will eventually come to every human being; death education tries to teach a person how to live creatively and in a truly human way till the very end and thus can rightly be called life education. Especially after a relapse a cancer patient experiences an increase of fear and anxiety towards death. Death education can help to recognize the different types of fear and anxiety and to reduce exaggerated fear to a normal level. In order to achieve a death with dignity there is a need for total pain control; total pain includes physical, psychological, social and spiritual pain. Death education also teaches about music therapy, bibliotherapy, and art therapy as valuable elements in the care for the total person. Important aspects of total care are informed consent, informed choice and good communication between patient, family and medical staff. A warm relationship of trust is essential in the endeavor to improve the quality of life of cancer patients.

[The need for death education]

"Death Education" is at the same time "Life Education." For many years I have endeavored to create an awareness of the need for death education in Japan. In this paper I would like to stress the necessity of death education for the following three groups. 1. For medical personnel. Three objectives of death education: 1) Learn to understand the fears and anxieties of the patients facing death and try to reduce their excessive fears and anxieties. 2) Familiarize yourself with the ethical issues related to terminal care and try to establish a warm relationship based on trust and continue communication with the dying patient till the end. 2. For patients. 1) Be aware that the time of your life is limited and try to discover the preciousness of the remaining time. Meditate on the uniqueness of your own death. 2) Finish your unfinished business, reevaluate your human relationships and benefit from a life review therapy. 3) Remove the taboo on death, arrange your own funeral and consider the possibility of another life after death. 3. For the patient's family and friends. 1) Continue warm communication with the dying patient till the end. 2) Prepare for your own bereavement and grief. 3) Try to make your own grief process an opportunity for personal growth. When a cure is no longer possible for a dying patient, the focus of our endeavors should be loving care of the person. Death education can help us to provide better terminal care during the final stage of life.