Towards Evaluating and Enhancing the Reach of Online Health Forums for Smoking Cessation.

Online pro-health social networks facilitating smoking cessation through web-assisted interventions have flourished in the past decade. In order to properly evaluate and increase the impact of this form of treatment on society, one needs to understand and be able to quantify its reach, as defined within the widely-adopted RE-AIM framework. In the online communication context, user engagement is an integral component of reach. This paper quantitatively studies the effect of engagement on the users of the Alt.Support.Stop-Smoking forum that served the needs of an online smoking cessation community for more than ten years. The paper then demonstrates how online service evaluation and planning by social network analysts can be applied towards strategic interventions targeting increased user engagement in online health forums. To this end, the challenges and opportunities are identified in the development of thread recommendation systems using core-users as a strategic resource for effective and efficient spread of healthy behaviors, in particular smoking cessation.

Administration of pamidronate helps prevent immediate postparathyroidectomy hungry bone syndrome.

BACKGROUND: Despite the use of vitamin D analogues and oral calcium supplements, hypocalcaemia following surgical parathyroidectomy is a common problem, because of the so-called hungry bone syndrome. METHODS: The aim of this audit was to determine whether the change in clinical practice by the administration of pamidronate before parathyroidectomy, in addition to standard perioperative management, could prevent severe postoperative hypocalcaemia. RESULTS: The postoperative course of 37 end-stage renal failure patients on regular dialysis referred for total parathyroidectomy were reviewed. Twenty-seven patients had been given pamidronate 24-48 h before surgery. Pamidronate reduced corrected serum calcium from 2.54 +/- 0.18 mmol/L (mean +/- SD) to 2.36 +/- 0.18 before surgery (P < 0.05). Following surgery, serum calcium in the 10 patients given standard therapy alone fell to a nadir of 2.08 mmol/L (1.75-2.19) (median (interquartile range) by the first postoperative day, and all 10 patients required additional support with multiple boluses of intravenous calcium. In the pamidronate group, the lowest median postoperative calcium was 2.3 mmol/L (2.2-2.46), P < 0.05, and only two patients required additional support with intravenous calcium, chi(2) = 27, P < 0.001). However, in the longer term the annual percentage increase in bone mineral density following parathyroidectomy was non-statistically lower in the pamidronate group compared with the controls (lumbar spine (L1-L4), 0.041 +/- 0.04 vs 0.058 +/- 0.41, P = 0.23 and femoral neck, 0.03 +/- 0.03 vs 0.107 +/- 0.1, P = 0.15, respectively). CONCLUSION: Preoperative pamidronate in combination with high doses of oral alfacalcidol and calcium supplements can prevent symptomatic postoperative hypocalcaemia, reduce the requirement for intensive monitoring of calcium, reduce patient morbidity, and reduce hospital stay from 9.2 +/- 1.9 to 5.7 +/- 2.9 days, P < 0.05. However, in the longer term pamidronate may potentially delay bone remodelling.

Parathyroid carcinoma: a report of two cases and a concise review and update of the literature.

Parathyroid carcinoma is very rare and when diagnosed can be difficult to treat as more than 50 per cent have persistent or recurrent disease. Patients generally present with profound symptoms of hypercalcaemia and a palpable neck mass. We describe a case of parathyroid carcinoma in primary hyperparathyroidism and a case in tertiary hyperparathyroidism in a renal dialysis patient. Most studies in the literature are retrospective but recent trends in presentation, treatment options and complications have been reviewed and are summarized in this paper.