Evaluation of Medical Confidentiality Breaches on Twitter Among Anesthesiology and Intensive Care Health Care Workers.

BACKGROUND: With the generalization of social network use by health care workers, we observe the emergence of breaches in medical confidentiality. Our objective was to determine, among anesthesiology and intensive care health care workers, the rate of medical confidentiality breaches among professional tweets. METHODS: We performed a retrospective analysis of public Twitter data available through the official Twitter application program interface. The profiles of anesthesiology and intensive care professionals were identified thanks to keywords in their biography. All the tweets with a photograph and all the text-only tweets containing at least one specific keyword related to anesthesiology or intensive care were extracted. We selected only the tweets with a health care-related character. Then, we analyzed 10% of the tweets with a photograph and 10% of the text-only tweets extracted and noted those presenting a breach of medical confidentiality. RESULTS: After a first screening of 12,705 accounts, we manually analyzed 431 tweets with photograph(s) and 9000 text-only tweets from 1831 accounts. We found 44 (10.2%) breaches of medical confidentiality among the photographs and 76 (0.8%) among text-only tweets. These 120 problematic tweets came from 96 profiles (96/1831; 5.2%); 3.7% of North American profiles breached medical confidentiality versus 6.3% of profiles from other areas; P = .03. When comparing the distribution of the number of followers and tweets, accounts with breach of medical confidentiality tweets had more tweets and followers than profiles without (both P < .0001). CONCLUSIONS: We found a significant proportion of tweets with breach of medical confidentiality among anesthesiology and intensive care professionals accounts.

Voriconazole for secondary prophylaxis of invasive fungal infections in allogeneic stem cell transplant recipients: results of the VOSIFI study.

BACKGROUND: Recurrence of prior invasive fungal infection (relapse rate of 30-50%) limits the success of stem cell transplantation. Secondary prophylaxis could reduce disease burden and improve survival. DESIGN AND METHODS: A prospective, open-label, multicenter trial was conducted evaluating voriconazole (4 mg/kg/12 h intravenously or 200 mg/12 h orally) as secondary antifungal prophylaxis in allogeneic stem cell transplant recipients with previous proven or probable invasive fungal infection. Voriconazole was started 48 h or more after completion of conditioning chemotherapy and was planned to be continued for 100-150 days. Patients were followed for 12 months. The primary end-point of the study was the incidence of proven or probable invasive fungal infection. RESULTS: Forty-five patients were enrolled, 41 of whom had acute leukemia. Previous invasive fungal infections were proven or probable aspergillosis (n=31), proven candidiasis (n=5) and other proven or probable infections (n=6); prior infection could not be confirmed in three patients. The median duration of voriconazole prophylaxis was 94 days. Eleven patients (24%) died within 12 months of transplantation, but only one due to systemic fungal disease. Three invasive fungal infections occurred post-transplant: two relapses (one candidemia and one fatal scedosporiosis) and one new zygomycosis in a patient with previous aspergillosis. The 1-year cumulative incidence of invasive fungal disease was 6.7±3.6%. Two patients were withdrawn from the study due to treatment-related adverse events (i.e. liver toxicity). CONCLUSIONS: Voriconazole appears to be safe and effective for secondary prophylaxis of systemic fungal infection after allogeneic stem cell transplantation. The observed incidence of 6.7% (with one attributable death) is considerably lower than the relapse rate reported in historical controls, thus suggesting that voriconazole is a promising prophylactic agent in this population.