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very strong evidence—and quite often independent replication.
This reasoning was behind my statement that independent repli-cation of the fi ndings would be ideal. I understand that such a trial might never happen owing to costs and logistical challenges, but one can at least suggest it. Again, I would like to congratulate the ResQ trialists for their substantial accomplishment and look forward for many high-quality clinical trials to come.
I declare that I have no confl icts of interest.
Peter Nagele
nagelep@wustl.edu
Department of Anesthesiology, Washington University School of Medicine, Box 8054, St Louis, MO 63110, USA
1 Lafuente-Lafuente C, Melero-Bascones M. Active chest compression-decompression for cardiopulmonary resuscitation.
Cochrane Database Syst Rev 2002; 3: CD002751.
2 Aufderheide TP, Nichol G, Rea TD, et al. The Resuscitation Outcomes Consortium (ROC) PRIMED impedance threshold device (ITD) cardiac arrest trial: a prospective, randomized, double-blind, controlled clinical trial.
Circulation 2010; 122: 2215–26 (abstr).
Social networking and
health
By 2010, 60% of adults in the UK were using the internet every day or almost every day, and this fi gure continues to increase.1 Although
the use of the internet is becoming increasingly common in areas such as e-commerce and social networking, health systems continue to lag in their use of such technology to communicate with patients.2 The
confl icting opinions expressed in the World Report by Sharmila Devi (April 2, p 1141)3 only extend the
confusion around the use of social networking for com munication with patients. We need a more pragmatic approach to the introduction of new technologies. As well as seeking to produce new evidence, we should be using current evidence on how social networking might be used to improve com munication with patients.
An alternative approach could involve considering the use of social networking in terms of wider clinical behaviour. Would you consider searching for additional information on your patient if the internet did not make it easy to do so with one click? Would you socialise with patients out of choice in a personal capacity? Would you feel threatened by your patients talking in the waiting room about their diff ering treatments? Most clinicians would feel confi dent in answering these questions.
Concerns about the eff ect of new technology on the doctor–patient relationship were probably being expressed when telephones were fi rst introduced more than 100 years ago. Rather than viewing new technology as a threat, we should use the opportunities it off ers to improve the effi ciency and eff ectiveness of health systems and to improve people’s knowledge of their health and illnesses. We declare that we have no confl icts of interest.
*Helen Atherton, Azeem Majeed
helen.atherton07@imperial.ac.uk
Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK 1 Offi ce for National Statistics. Internet access
2010. http://www.statistics.gov.uk/cci/ nugget.asp?id=8 (accessed April 13, 2011). 2 Liddell A, Adshead S, Burgess E. Technology
in the NHS: transforming the patient’s experience of care. London: The Kings Fund, 2008. http://www.kingsfund.org.uk/ publications/technology_in_the.html (accessed June 1, 2011).
3 Devi S. Facebook friend request from a patient? Lancet 2011; 377: 1141–42.
Sharmila Devi1 airs the ethical
dilemmas surrounding the use of social networking sites by health professionals. Last year we formed a group of representatives from the Australian Medical Associ ation, the New Zealand Medical Association, and the Australian and New Zealand Medical Students’ Associations, and produced guidelines on the use of social media by medical professionals.2
Our guidelines explore the issues that social media present for doctors, such as confi dentiality and doctor–patient
boundaries. Rather than prescriptive advice, we present scenarios and discuss the potential ethical and practical implications to educate readers. Unlike our American counterparts, we have not explicitly advocated the formal reporting of unprofessional online behaviour; instead we encourage medical practitioners to notify col-leagues discreetly themselves.
Looking ahead, we believe that more research is required, particularly into the changing relationship between health-care providers and patients, as social media acquires a more prominent role in society, and into potential uses for social media in the delivery of health care. Although change is inevitable, maintenance of professional and ethical standards is essential to protect health profes sionals and patients. We will update our guidelines as more evidence emerges, and look forward to what transpires from other groups working in this area.
We declare that we have no confl icts of interest.
*Sarah J Mansfi eld, Michael A Bonning, Stewart G Morrison, Hugh O Stephens, Sheng-Hui Weng, Andrew W Perry, Rob C Olver
s.mansfi eld1@gmail.com
Australian Medical Association, PO Box 6090, Kingston, ACT 2604, Australia (SJM, MAB, SGM, AWP); Australian Medical Students Association, Kingston, ACT, Australia (HOS, RCO); and New Zealand Medical Association, Wellington, New Zealand (SHW) 1 Devi S. Facebook friend request from a
patient? Lancet 2011; 377: 1141–42. 2 Mansfi eld SJ, Morrison SG, Stephens HO, et al.
Social media and the medical profession.
Med J Aust 2011; 194: 642–44.
Facebook use leads to
health-care reform in
Taiwan
Social networking services are trans-forming the delivery of health care. Facebook, for example, is now commonly used by medical students, patients, and other stakeholders in the health-care system.1,2 We
describe how Facebook enabled collaboration between stake holders
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2084 www.thelancet.com Vol 377 June 18, 2011
and vowed to spend more resources for hospitals to improve emergency-room over crowding and quality of care.
This case has implications for the future of health care, since it shows how social networking can break down the rigid social and pro fessional hierar chical structures that can hinder reform.
We declare that we have no confl icts of interest.
Shabbir Syed Abdul, Che-Wei Lin, Jeremiah Scholl, Luis Fernandez-Luque, Wen-Shan Jian, Min-Huei Hsu, Der-Ming Liou,*Yu-Chuan Li
jaak88@gmail.com
Institute of Biomedical Informatics, National Yang Ming University, Taipei, Taiwan (SSA, DML); Emergency Department, Taipei Medical University Hospital, Taipei, Taiwan (CWL); Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden (JS); Northern Research Institute, University of Tromsø, Norway (LFL); School of Health Care Administration, Taipei Medical University, Taipei, Taiwan (WSJ); Department of Health, Taipei Hospital, Taipei, Taiwan (MHH); and Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei 110, Taiwan (YCL)
1 Jain SH. Practicing medicine in the age of Facebook. N Engl J Med 2009; 361: 649–51. 2 Thompson LA, Dawson K, Ferdig R, et al. The
intersection of online social networking with medical professionalism. J Gen Intern Med 2008; 23: 954–57.
3 Taiwan Society of Emergency Medicine. Facts about the Taiwan Society of Emergency Medicine. http://www.sem.org.tw/tsem/sem_ en.html (accessed March 17, 2011). in emergency-medicine policy in
Taiwan, which led to reforms.
The Taiwan Society of Emergency Medicine3 has been in slow-moving
negotiation with the Department of Health for the past several years over an appropriate solution to emergency-room over crowding. A turning point was reached on Feb 8, 2011, when an emergency physician who was an active social network user and popular blogger among the emergency-room staff created a Facebook group called “Rescue the emergency room”. Within a week about 1500 people—most of the emergency department staff around Taiwan—became members of this group and started discussing actively and sharing their experiences. One of the members then posted the group’s concerns and problems on the Facebook profi le of the Taiwanese Minister of Health. This caused the minister to join the group and get engaged in the discussion. A multiparty dialogue involving many diff erent stakeholders and perspectives was suddenly possible.
Early on one of the members posted “Is there any use of these posts? Does our minister have time to read Facebook?” The Minister replied by posting “every message is read by me and my staff ”. This modest gesture satisfi ed the emergency-room staff that their concerns were being taken seriously by the Department of Health, and further motivated them to engage in discussing the issue. By March 11, there were about 1800 members, 455 posts, and 3745 comments and “likes” on these posts. The number of members and posts is increasing every hour.
After monitoring these discussions, the Minister and his team decided to make a surprise visit to emergency departments in ten diff erent cities. The next day, in a press release, he also promised to initiate dialogue with the Bureau of National Health Insurance on organisational issues aff ecting emergency departments
Department of Error
Hewish M, Cunningham D. First-line treatment of advanced colorectal cancer. Lancet 2011;
377: 2060–62—In this Comment (June 18), the fourth sentence of the fourth paragraph should have read: “Other potential biomarkers include loss of PTEN expression,9 mutations in
TP53,10 EGFR gene copy-number changes,9 and
EGFR promoter hypermethylation.” Also, in
the fi gure sublegend, the last sentence should have ended: “if either allele has ≥20 repeats, benefi t is reduced.” [The correction is a change of > to ≥.] These changes have been made to the online version as of June 17, 2011, and to the printed version.
Frederic Sierakowski/R
ex F
eatures
