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Fig. 4 Sample screenshot from Figure 1™ (Courtesy Figure 1, Inc.) Orthobullets™ - www.orthobullets.com Orthobullets is specifically designed as an educational resource for orthopaedic surgeons. It provides high-quality clinical cases, videos and sample exam questions targeting sub-specialist areas of orthopaedics including trauma, spine, paediatrics and reconstructive surgery. Interactive cases can be uploaded and discussed. Orthobullets is very popular amongst US- and Europebased orthopaedic trainees.
Figure 1- www.figure1.com Figure 1 is an iPad, iPhone and Android-based free multimodal platform that enables clinical photo sharing and multidisciplinary case discussions. Anonymous clinical images can be uploaded with patient consent, a relevant history, examination findings and investigation results. These are shared amongst the Figure 1 community, which includes over 150 000 healthcare professionals extending over 100 countries. This can be particularly useful in discussing specialist cases and cases that are endemic in one part of the world and rare in another. Image sharing is not only limited to patient images. Users can share anything that can be captured using their smartphone such as electrocardiograms (ECGs), cardiotocograms (CTG), slit-lamp images, retinal photographs, histology slides, or even investigation results such as blood gas findings. This can be particularly useful in orthopaedic surgery in sharing radiograph images, ultrasound, CT and, MRI scans or intra-operative images in order to recognise pathologies, or even identify novel surgical techniques. This has proven to be not only a great way to improve diagnosis, treatment and overall patient care, but also a valuable teaching and learning tool. It has many built-in features such as ‘paging’, which allows users to contact a specific specialty of verified users, and ‘automatic face-blocking’ which detects faces and automatically blocks them in order to reinforce privacy requirements (Fig. 4). Discussion Communities outside North America, especially in the UK and Australia, are relatively limited in the number of multimodal networks that specifically target orthopaedic surgeons. It is evident that there is a delay in embracing the already available communication technologies when it comes to healthcare. This limited access arises for a variety of reasons. Some of these include medico-legal barriers such as patient privacy, confidentiality, and
accountability. Others include the lack of available guidelines about the use of social networking in medicine and surgery, and the fear of adverse implications on patient care. As a result, most of these novel platforms are only exclusively available in the USA. While these obstacles slow down the use of social networking, it is evident that social networking can be developed further as a valuable tool, particularly in orthopaedic surgery. In our opinion, the most important potential of social networking is the ability to form an innovative platform which can provide a superior model of evidence-based medicine, replacing the current process of a peer-review-based model. Innovative technologies that can deliver a stronger social network can enable large groups of experts to link with each other, in order to create a more powerful way of presenting, processing and ranking information. It has the potential to allow important research findings to be classified and ranked in a similar way to YouTube and Google. By creating a network of orthopaedic surgeons, subspecialists can meet over the internet to discuss evidence-based practices, surgical techniques and novel developments in their field of surgery. When a novel research finding is presented to this network, it can be identified and ranked by a panel of experts, in order to identify the most significant research. Highly-ranked research can be presented to each and every individual in that social networking group, which gives a novel and robust approach to selecting important research information and fast-tracking it into practice. This should become an important way in which medical and surgical journals can incorporate the use of social networking, in order to transform their presence within cyberspace. References 1. No authors listed. Office for National Statistics, Statistical bulletin: Internet users, 2015. http://www.ons.gov.uk/ons/rel/rdit2/ internet-users/2015/stb-ia-2015.html (date last accessed 4 August 2015). 2. No authors listed. Office for National Statistics Internet access - households and individuals 2014. http://www.ons.gov.uk/ons/rel/ rdit2/internet-access---households-and-individuals/2014/stb-ia-2014. html (date last accessed 4 August 2015). 3. Eckler P, Worsowicz G, Rayburn JW. Social media and health care: an overview. PM & R 2010;2:1046-50. 4. Mansfield SJ, Morrison SG, Stephens HO et al. Social media and the medical profession. Med J Aust 2011;194:642-644. 5. No authors listed. Mayo Clinic: sharing Mayo Clinic (blog).. http://sharing.mayoclinic.org (date last accessed 4 August 2015). 6. No authors listed. Life in the fast lane (blog). http:// lifeinthefastlane.com (date last accessed 4 August 2015). 7. Bray D, Croxson K, Dutton W, Konsynski B. Sermo: a community-based knowledge ecosystem. SSRN http://papers.ssrn. com/sol3/papers.cfm?abstract_id=1016483 [[bibmisc]]
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Gihan De Mel Gihan.deMel@monashhealth.org Pierre Nasr pierrenasr@doctors.org.uk Vikas Khanduja Consultant Orthopaedic Surgeon vk279@cam.ac.uk
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