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Digital Doctor Conference 2013

Digital consumerism is progressing relentlessly and whilst the advantages of new technology are evident in our personal lives, there is a palpable air of concern amongst the medical profession. “The Digital Doctor” team are positively embracing the benefits of moving healthcare into a new era and hope to direct the use of new technology in a constructive manner that will benefit both healthcare professionals and patients. To achieve these aims the “Digital Doctor Conference 2013”, was held for its second year last November, again kindly sponsored by the British Computer Society and held at their excellent headquarters in Covent Garden, London. The conference was attended by IT professionals, doctors, medical students and patients; thus group sessions contained some perspective on every aspect of healthcare technology. The organisers are also an eclectic mix of doctors and IT professionals, united by their interest in improving Health IT.

The conference included plenary talks, interactive group sessions and workshops. Eminent plenary speakers included Martin Murphy, Clinical Director at NHS Wales Information Service.

Martin challenged us to redefine our relationship with our patients in a new era where clinical information will be in control of patients and access to healthcare professionals can be as easy as a click away. How can we do all this safely in the light of the Snowden revelations? References to Stevan Wing’s (one of the organisers) two favourite books George Orwell’s 1984 and Aldous Huxley’s A Brave New World remind us of the superstition that underlie the beliefs, fears and challenges of society.

Software mediated care – implications for our patients and ourselves from Digital Doctor on Vimeo.

Popular teaching sessions at the conference were daily life IT tools, including the “Inbox Zero” philosophy, how to collaborate online, keeping up to date with RSS readers and Stevan Wing gave an introduction to the open-source “R project” for statistics. Other sessions focused on how to develop IT systems. This insight is useful both to allow healthcare professionals to construct their own IT solutions but also to help translate ideas to IT professionals. One such example being Sarah Amani, who used her experience as a mental health nurse to develop a mental health app for young people, called “My Journey”. In her inspiring plenary, co-presented with Annabelle Davis who developed the Mind of my Own app, she makes the point that the vast majority of young people rely on email, social media and online services therefore this is the best place to reach them. A session giving the methods and practicalities of developing IT systems was given by Rob Dyke, Product Development Manager of Tactix4. To help delegates get their ideas to reality Ed Wallitt, one of the organisers and the founder of Podmedics, built on earlier sessions about how to code, how a website works and information design, explaining how to use wireframes and prototypes, to achieve professional design of websites and apps.

Existing NHS IT systems were explained using the example of an emergency patient admission. Tracking the patient journey from home to hospital, via A+E, then transfer to ward, rehab back home, with GP clinic the final destination. At each stage a different IT system is employed such as the emergency 999 network and the N3 private network. Concepts such as the NHS spine were introduced and explained. A complex web of systems were shown to be in use, with numerous safety mechanisms; providing some explanation as to the difficulties faced by employees in the NHS.

Delegates were able to implement this teaching in the “App factory”, to solve problems they face in daily life or work. Three app ideas were created and presented by separate teams. These were a teaching log for doctors to record teaching sessions and simultaneously get feedback from students, a productivity app to provide useful information for new doctors to know about any hospital, however the winning idea was a patient facing app for use in hospital, to track updates in ongoing care.

In another session Matthew Bultitude, an Associate Editor of BJUI, was invited by Nishant Bedi (another organiser) for his vision of the future of medical journals. Journals are key in shaping the way medical practice is conducted and the dissemination of information is as important as ever in the digital age. Paperless journals may be the future however traditional business models rely on paper journals for revenue and many journals have yet to feel confident in moving all of their content exclusively online. Yet there are signs of change with European Urology adopting a paperless format for members from Jan 2014, now surely others will follow?

Under new leadership, the BJUI has recently focused on revolutionising its online presence, starting with a complete website overhaul. Amongst many changes to its design, the website now hosts an article of week, user poll, blogs and picture quiz. Numerous metrics for the website now show significant improvement in website visitors, duration of visit (1 to 3 min) and “bounce” rate. The increasing importance of social media for health professionals is demonstrated by the fact that more than ¼ of website traffic now arrives from Twitter and Facebook, having previously been dominated by search engines. Matthew finished by discussing alternatives to impact factor, such as the journal’s “Klout” score or “individual article” metrics, which are likely to be increasingly important as medical journals develop more web and social media presence. Extremely accurate individual “article level metrics” are calculated by checking number of views, tweets and re-tweets, and mentions in review sites (such as F1000 Prime). It is clear to see how powerful this could be, for example when discussing viewing numbers and duration of reading, Matthew can inform us that currently BJUI Blog articles are each read for a total of 5 min, with even the 15th most popular article receiving almost 500 views.

This talk was paired with one from the futuristic journal “F1000 Prime”. This journal provides an extra layer of expert peer review, using scientific articles that are already published in other journals. Thus articles selected by F1000 Prime direct users to the most significant developments in their chosen field, the expert reviews of the articles include an article rating, relevance to practice and whether there are any new findings. Research has shown that selection of an article by F1000 Prime, is an accurate indicator of future impact factor. Users may also receive email alerts of recommended relevant papers and they are able to nominate articles, follow the recommendations of an expert reviewer. Also refreshingly, any submissions to the journal, receive a completely transparent peer review process, openly available to any user.

Conference attendees were given the patients’ perspective of Health IT, by a panel chaired by Anne-Marie Cunningham (another organiser). These real life stories, gave insight into the mindset of people suffering from demanding chronic disease, both at home and in the hospital. Importance is given to people taking ownership of their health; both rare and common diseases were mentioned including Addison’s disease, asthma and mental health issues, where 24 hour support is an unfulfilled requirement and there is a need for a more integrated approach. Positive examples were given with one patient gaining reassurance by regular home peak-flow monitoring that can be reviewed remotely by her respiratory consultant. This helps to determine optimal timing for clinic review, with other similar examples seen in home blood pressure or blood sugar monitoring. Importantly social media and support groups can provide 24 hour advice and connect patients with expert doctors or similar sufferers all over the world. It was clear that the lack of hospital WiFi disconnects some patients from their online support networks, when they are actually most vulnerable. Other complaints centred around the underuse of email appointments and text alerts, which could empower patients to chase their own appointments or scans. 

Delegate feedback suggests this conference is unique and covers a rapidly expanding area of Medicine. We look forward to the next conference in 2014. The Digital Doctor 2013 conference program and highlights are available from the website or directly on our vimeo chanel. For updates and upcoming events follow us on Twitter @thedigidoc and the podcast is available from iTunes or our website. 

Mr. Nishant Bedi
Core Surgical Trainee (Urology), West Midlands Deanery

Dr Stevan Wing
Academic Neurology Registrar, East of England and The University of Cambridge 

 

Annabelle Davis

Out with the old; In with the new. Stats and metrics: The BJUI website 2013

Is it already over twelve months since the new Editor took over and the new BJUI web journal was launched? The old one had served its purpose well but the editorial board had decided the change of leadership dictated a clean new website would be launched in January 2013. Decisions were hard. Out went non-journal content such as case reports and in its place we created four main content areas with the aim of maintaining fresh, regularly changing content. These (article of the week; BJUI blogs; picture quiz of the week; BJUI poll) you will by now be familiar with, but how has the new web journal performed? Let’s look at the metrics over the last year.


The BJUI website prior to 2013

Firstly, most of the figures referred to in this article are for the www.bjui.org site only. They do not include direct access to the journal articles in the Wiley Online Library where the issues are stored. Thus analysing overall visitor numbers is not that valid and doesn’t allow for meaningful comparison. However, it appears there has been an increase in web visits of at least 10%. When we drill deeper, this is where we really notice a change. Readers now spend on average over 3 minutes on the site per visit. This is a dramatic change from previously – in 2012 the mean visit duration was just 87 seconds!

More and more people today decide to get involved with an online business, due to the fact that having a business operated through the internet offers a lot of advantages over doing it the traditional way. Online business means that you can do business right at the comforts of your own home. Thus, there is no need for you to get dress and step out of your house to earn a living. However, there are many important things that you need to learn more about in getting your online business off the ground. One of which is the creation of your own website, and the need to obtain hosting, in order to get it launched onto the World Wide Web.

Knownhost web hosting can be obtained through a company who have its own servers, where websites are hosted. In other words, a hosting service is one of the necessities in getting your own website visible through the internet. For sure, there are many ways that you can have your own web page today, such as creating a free blog or a free website. However, in most cases, these types of services are limited and having one of those pages does not mean that you entirely own them, since another website is actually hosting it.

In a nutshell, website hosting is very important because you simply could not launch your own website without having it. The hosting service provider is the one that will provide you with the space where you can upload your files that are related to your site, and they are also the ones who will ensure that your website is visible to people when they type your site’s address on their favorite web browsers.

Since there are a lot of web hosting service providers available in the market today, selection is very important in order to get associated with a reliable one. When you are able to obtain a hosting account from a reliable provider, you will be able to avoid loss of sales caused by downtimes. There are actually hosting service providers, which do not have reliable servers. In other words, they encounter a lot of downtimes, and because of that, your business would lose a lot of sales opportunities. This is because server downtimes mean that your website would not be visible on the net during those times. Thus, people who are suppose to make certain purchases, may decide to buy the items from your competitors.

In relation to that, aside from the importance of hosting for your online business, you should also become more aware of the importance of selecting a reliable web host; and one of the best ways to do that is by learning about the features of the hosting account that they can offer to you.

Geographically, the top country by visit is the United States with 22% of all visits, closely followed with the UK (21.6%) with Australia third. In total there were visits from 189 countries with both India and Japan making the top 10 (numbers of visitors) emphasising the journal’s global reach. This is truly an international journal.

 
Global subscriptions to BJUI represented as a “heat map”

Another major difference we have noticed is in bounce rate. This refers to the percentage of people who leave immediately after visiting the page they landed on i.e. if everyone only looks at the first page they come to then the bounce rate would be 100%. In 2012 the bounce rate was 66% – and this has improved significantly to 50% in 2013. This rate is never going to be very low – people come directly to a blog, quiz or just go straight onto the author guidelines or an article on Wiley Online Library. But to see such a reduction is encouraging and vindicates the approach we have taken with the web.

When we look at traffic sources, again we see another big change. This is how the visitor came to the site i.e. do they type in the web address, use a search engine or get driven to the site by social media. As you might expect, the largest single source of traffic (45%) is from Google – these visitors also spend over 3 minutes on the site with a bounce rate of 40% – so the site is not being found by accident and readers move onto other pages. 24% of traffic is direct but what is new behaviour is that 12% is from Twitter and 6% from Facebook – so social media is now driving nearly 20% of all website traffic. Facebook visitors also spend over 4 minutes on the site – they come for a reason! Of course there are the quirks – a men’s health magazine drove 1% of visits to a specific article on penis extenders! Those readers aren’t urologists as they only spend 16 seconds on the site with a bounce rate of 99.4% – this, however, does give credibility to the use of these statistics.

Apart from the homepage, the majority of social media-driven traffic is to the blogs. This has been highly successful with regular topical blogs and comments. Blog traffic has been high with the most popular (Melbourne Consensus Statement) receiving over 6500 views and 58 comments. Whilst this is clearly the highest, the top 8 blogs all have over 1000 views. Time spent on these blogs is high with several being read for an average of over 6 minutes. In January 2014 we added widgets to our blogs that allow you to see the number of reads each blog has received, and also  to allow tweeting and Facebook liking directly from the blog. Blogs posted prior to this time also have these features but the number of reads prior to January 2014 are not displayed. With this section being so popular are Letters to the Editor dead?

In a recent poll, we asked you what single feature you had liked best. Exactly equal with 34% were the blogs and the free Articles of the Week (which have also been popular in the web metrics with over 13,000 views). Picture quizzes have been successful with over 10,000 views. These demonstrate a shorter time on the page as one would expect (100 secs) but also a lower bounce rate (48%) – these readers often go elsewhere on the site. The video section has also been popular with over 2000 views although obtaining good quality videos is challenging and we encourage authors to submit video with their articles to further drive this section.

 

How does this translate to actual journal article downloads? Interestingly our approach has led to an increase of over 35% in full text downloads from Wiley Online Library compared with 2012. This is exciting and shows the web journal has been very successful not only in driving website activity as described above but also in promoting core journal content.

So for 2014 we have a new App to view the journal. Currently only on the Apple platform (80% of mobile devices used in 2013 to view the website were Apple), this is free to download although requires a log-in to view full content (available via your institutional subscription, from Wiley or from your society). It works really well on the iPhone as well as the iPad and allows access to not only the monthly journal but ‘Early View’ articles as well. This is already my preferred method for reading the journal and I highly recommend trying it.

With high-quality web and mobile interfaces, the question has to be are we ready to go paperless? As the Web Editor I should of course say yes. We discussed this at length at our first board meeting in November 2012. Due to our diverse international readership it was felt to be too early for such innovation. This will inevitably happen and another major urology journal has taken this step in 2014 (€60 supplement for the print version of European Urology). It is surely only a matter of time until digital is the standard platform. Hopefully you, the readers, will tell us when the time is right.

Matthew Bultitude
Associate Editor, Web

Quality has no boundaries

The new year has arrived bringing with it new expectations of success. It gives us the opportunity to reflect on 2013 and plan for the year ahead. We hope you enjoyed the new web journal www.bjui.org that we have introduced. It has certainly increased our full paper downloads each month which means that our readers do care. Thank you! Your loyalty makes the many hours of hard work – 24/7 – all worthwhile. We have an international team which allows someone, somewhere to be making constant improvements to the BJUI for your reading pleasure.

Many of our readers while congratulating us, commented that perhaps we had focussed on being of greater relevance to the younger generation. Imagine my surprise when at a recent Men’s Health meeting in London, my old chief came up to me for a discussion about the controversies of PSA testing following publication of the AUA guidelines [1] and a consensus statement from down under on blogs@BJUI [2]. He had read it all on the web much earlier than when these articles eventually make it to the print journal. Like him, many of our readers see and read an article or blog online but do not necessarily comment on it. As a new metric, we will start indicating the number of times an article is read in addition to the number of comments it receives.

At the BJUI we do not make New Years resolutions. It is much easier to act. During our editorial board meeting last October it became obvious that we were receiving high quality papers from all over the world. In this issue, we have the great pleasure of showcasing a superb article on circumcision from Uganda [3]. Men with or without HIV, which is highly prevalent in Africa, tend to heal well after circumcision. This does not appear to be affected by their CD4 counts. This is a large study, relevant to all urologists and I would urge you to read it and the accompanying editorial from Paul Hegarty [4].

This article also gave us the idea of highlighting the geographical location of the article of the month on the front cover. Another inspirational concept from Tet Yap our associate editor for design. More about that in coming editions.

Finally Maxine Sun is back with a SEER study showing that the extent of lymphadenectomy during radical nephrectomy in patients with nodal metastasis, does not affect survival. Like any database, missing entries may have confounded the results and it is critical from a scientific standpoint to understand the resultant bias [5]. For those wishing to learn health services research a good starting point is to read the Sun Blog on SEER at our web journal.

Here’s looking forward to interacting with you in 2014.

Prokar Dasgupta
Editor in Chief, BJUI

Guy’s Hospital, King’s Health Partners

References

  1. Ballentine Carter H. American Urological Association (AUA) Guideline on prostate cancer detection: process and rationaleBJU Int 2013; 112: 543–547
  2. Murphy D. The Melbourne Consensus Statement on Prostate Cancer Testing. [email protected] Available at: https://www.bjuinternational.com/bjui-blog/the-melbourne-consensus-statement-on-prostate-cancer-testing/. Accessed 20 November 2013
  3. Kigozi G, Musoke R, Kighoma N et al. Male circumcision wound healing in HIV-negative and HIV-positive men in Rakai, Uganda. BJU Int 2014; 113: 127–132
  4. Hegarty P. Circumcision – follow up or not? BJU Int 2014; 113: 2
  5. Sun M, Trinh Q-D, Bianchi M et al. Extent of lymphadenectomy does not improve the survival of patients with renal cell carcinoma and nodal metastases: biases associated with the handling of missing data. BJU Int 2014; 113: 36–42

Original publication of this editorial can be found at: BJU Int 2014; 113: 1. doi: 10.1111/bju.12575

Beyond our wildest dreams

In this podcast Prokar Dasgupta summarises the success of the BJUI over 2013. For more on podcasts, including how to record your own, go to Podcasts Made Simple.

 

If anyone had suggested to me in January 2013 that our full article downloads would increase by 15% and the Melbourne Consensus Statement on PSA testing would be viewed over 5000 times @ BJUI.org, I would have stared at them in disbelief. The launch of our web portal in addition to an innovative paper journal, has achieved just that. And much more. We remain one of the Big Three in urology with a Klout score greater than any of our colleagues. These are impossible to achieve via papyrus alone.

The common theme amongst all the fantastic innovation that our Associate Editors have introduced is the highest quality of original articles that we have attracted and published this year. I wanted to take this opportunity to highlight them and thank all our authors for sending us their best manuscripts.

The updated Partin tables (2006–11) remains our most cited paper published in 2013 [1]. It is sheer coincidence that I selected it as our first article of the month in January. It has allowed surgeons to avoid lymphadenectomy during radical prostatectomy in non-palpable Gleason 3+4 disease as the risk of a positive lymph node is <2%. The accompanying 3 minute video on the BJUI Tube channel is an excellent summary for the busy urologist.

I had to appease a number of oncologists when Cooperberg and colleagues showed that radiation for prostate cancer was about 2.5 times more expensive than radical prostatectomy in a comprehensive lifetime cost-utility analysis [2]. Peace was rapidly established at the annual meeting of the British Uro-Oncology group (BUG) where I participated in a balloon debate on the subject this autumn.

The thematic variations continue. It seems that 12 weeks of Tadalafil is effective in ejaculatory and orgasmic dysfunction in patients with ED [3]. Sexual medicine remains an exciting section of the BJUI and I am grateful to the andrologists on our editorial board for diligently reviewing the large number of papers that we receive from investigators in this field.

And finally we had two practice changing randomised trials in stone disease. Plasma vaporisation performed better than balloon dilatation for creating PCNL tracts [4]. For the curious, there is a video demonstrating the method if you wish to learn it.

The Portland trial has a simple message that you just can’t ignore; a single dose of NSAID before ureteric stent removal prevents severe pain afterwards. This is going to become standard of care if it has not already [5].

Many of our readers will wonder why we continue with a paper journal when the web has been so successful? The map here shows our global reach, which includes a number of subscribers who prefer to, or by necessity, read the print journal (∼30%). Moreover in a BJUI Online Poll, 75% of our readers reported taking the paper journal out of its plastic sheath and reading it, with over 50% doing so within a week. The transition will thus take longer and while the web remains our main portal, the beautifully designed paper BJUI will still land on your doorstep.

Prokar Dasgupta
Editor in Chief, BJUI

Guy’s Hospital, King’s Health Partners

References

  1. Eifler JB, Feng Z, Lin BM et al. An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int 2013; 111: 22–29
  2. Cooperberg MR, Ramakrishna NR, Duff SB et al. Primary treatments for clinically localised prostate cancer: a comprehensive lifetime cost-utility analysis. BJU Int 2013; 111: 437–450
  3. Paduch DA, Bolyakov A, Polzer PK, Watts SD. Effects of 12 weeks of tadalafil treatment on ejaculatory and orgasmic dysfunction and sexual satisfaction in patients with mild to severe erectile dysfunction: integrated analysis of 17 placebo-controlled studies. BJU Int 2013; 111: 334–343
  4. Chiang PH, Su HH. Randomized and prospective trial comparing tract creation using plasma vaporization with balloon dilatation in percutaneous nephrolithotomy. BJU Int 2013; 112: 89–93
  5. Tadros NN, Bland L, Legg E, Olyaei A, Conlin MJ. A single dose of a non-steroidal anti-inflammatory drug (NSAID) prevents severe pain after ureteric stent removal: a prospective, randomised, double-blind, placebo-controlled trial. BJU Int 2013; 111: 101–105
Original publication of this editorial can be found at: BJU Int 2013; 112: 1051–1052. doi: 10.1111/bju.12524

 

 

 

BJUI Online

 

 

Matthew Bultitude, BJUI Associate Editor, discusses the direction the Journal has taken towards the web. The video includes an explanation of the key features that can be found on the BJUI website, including the Article of the Week, Picture Quizzes, Polls, Blogs and Videos.

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