Background: Social media has changed the way surgeons communicate worldwide, particularly in dissemination of trial results. However, it is unclear if social media could be used in recruitment to surgical trials. This study aimed to investigate the influence of Twitter in promoting surgical recruitment in The Emergency Laparotomy and Frailty (ELF) Study. Methods: The ELF Study was a UK-based, prospective, observational cohort that aimed to assess the influence of frailty on 90-day mortality in older adults undergoing emergency surgery. A power calculation required 500 patients to be recruited to detect a 10% change in mortality associated with frailty. A 12-week recruitment period was selected, calculated from information submitted by participating hospitals and the numbers of emergency surgeries performed in adults aged > 65 years. A Twitter handle was designed (@ELFStudy) with eye-catching logos to encourage enrolment and inform the public and clinicians involved in the study. Twitter Analytics and Twitonomy (Digonomy Pty Ltd) were used to analyse user engagement in relation to patient recruitment. Results: After 90 days of data collection, 49 sites from Scotland, England and Wales recruited 952 consecutive patients undergoing emergency laparotomy, with data logged into a database created on REDCap. Target recruitment (n = 500) was achieved by week 11. A total of 591 tweets were published by @ELFStudy since its conception, making 218,136 impressions at time of writing. The number of impressions (number of times users see a particular tweet) prior to March 20th 2017 (study commencement date) was 23,335 (343.2 per tweet), compared to the recruitment period with 114,314 impressions (256.3 per tweet), ending June 20th 2017. Each additional tweet was associated with an increase in recruitment of 1.66 (95%CI 1.36 to 1.97; p < 0.001). Conclusion: The ELF Study over-recruited by nearly 100%, reaching over 200,000 people across the U.K. Branding enhanced tweet aesthetics and helped increase tweet engagement to stimulate discussion and healthy competition amongst clinicians to aid trial recruitment. Other studies may draw from the social media experiences of the ELF Study to optimise collaboration amongst researchers.

The authors conducted a follow-up study of the attitudes of a group of alcoholism counselor trainees upon the completion of an intensive counselor training program. The instrument used in the assessment of attitudes was a questionnaire consisting of forty statements which the respondents were asked to scale. Subsequent to an earlier survey, administered at the initiation of the program, the results indicate positive development in attitudes and greater openness to the complications of alcoholism.

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The Improving Asthma Care Together (ImpACT) project implements a novel model of care which provides an integrated responsive services for asthma patients in Derby.AimThe hypothesis of this project was that rapid review by a specialist asthma nurse in the community during an asthma exacerbation, would result in an improvement in patient’s asthma control and their ability to self-manage their asthma.MethodsFour specialist asthma nurses were recruited to provide seven day cover for the service. Patients who reported increasing asthma symptoms could access the service by self-referral or referral from a healthcare professional. The intervention involved a face-to-face review or a telephone call from a specialist asthma nurse. Patients were offered a 30 min face to face review at a variety of GP locations in the region. A template for each ImpACT review was constructed and a management plan issued at each consultation. A questionnaire was devised and patients were asked to complete this approximately 6 weeks following the intervention. A 10 point scale was used to ask patient’s what their confidence levels were in self-managing their asthma (0=no confidence and 10=highly confident) and how they rated their asthma control (0=poor and 10=excellent).ResultsThis project commenced in January 2017. Between the start date and June 2017 a total of 884 patients were reviewed as part of the service. 397 face-to- face visits, 470 telephone consultations and 17 home visits. Patient’s self-rating of their asthma control significantly improved following the intervention (pre-intervention mean 3.4, standard deviation [SD] 2.2 versus post-intervention mean 8.1 [SD 1.4]; paired t-test <0.001; n=23). Patient’s self-reported confidence in managing their own asthma also significantly improved following the intervention (pre-intervention mean 4.1 [SD 2.5] versus post-intervention mean 8.9 [SD 1.1]; paired t-test <0.001; n=24). Total number of hospital admissions and emergency department attendances did not decrease compared to the previous year’s data during this period (308 in 2016 versus 352 in 2017).ConclusionResults to-date show that this integrated and responsive service for asthma exacerbation is well utilised and demonstrates a significant improvement in patient reported asthma control and confidence in self-managing their condition.