Background: The prevalence and intensity of persistent post-surgical pain (PPSP) after breast cancer surgery are uncertain. We conducted a systematic review and meta-analysis to further elucidate this issue. Methods: We searched MEDLINE, Embase, CINAHL, and PsycINFO, from inception to November 2018, for observational studies reporting persistent pain (3 months) after breast cancer surgery. We used random-effects meta-analysis and the Grading of Recommendations, Assessment, Development and Evaluations approach to rate quality of evidence. Results: We included 187 observational studies with 297 612 breast cancer patients. The prevalence of PPSP ranged from 2% to 78%, median 37% (inter-quartile range: 22e48%); the pooled prevalence was 35% (95% confidence interval [CI]: 32e39%). The pooled pain intensity was 3.9 cm on a 10 cm visual analogue scale (95% CI: 3.6e4.2 cm). Moderate-quality evidence supported the subgroup effects of PPSP prevalence for localized pain vs any pain (29% vs 44%), moderate or greater vs any pain (26% vs 44%), clinician-assessed vs patient-reported pain (23% vs 36%), and whether patients underwent sentinel lymph node biopsy vs axillary lymph node dissection (26% vs 43%). The adjusted analysis found that the prevalence of patient-reported PPSP (any severity/location) was 46% (95% CI: 36e56%), and the prevalence of patientreported moderate-to-severe PPSP at any location was 27% (95% CI: 10e43%).

Background Recent medical education literature pertaining to professional identity development fails to reflect the impact social media has on professional identity theory. Social media is transforming the field of medicine, as the web-based medium is now an avenue for professional development and socialization for medical students and residents. Research regarding identity development in social media has been primarily confined to electronic professionalism through best practice guidelines. However, this neglects other potential aspects pertinent to digital identity that have not yet been explored. Objective This study aims to define the properties and development of the digital self and its interactions with the current professional identity development theory. Methods A qualitative study was conducted using thematic analysis. A total of 17 participants who are social media education and knowledge translation experts were interviewed. The initial participants were from emergency medicine, and a snowball sampling method was used following their respective web-based semistructured interviews to enable global recruitment of other participants from interprofessional disciplines. The research team consisted of a diverse group of researchers including one current social media knowledge translation physician clinician educator, one postdoctoral researcher who is regularly engaged in social media knowledge translation, and 3 nonphysician research assistants who are not social media users. Half of the team conducted the initial coding and analysis, whereas the other 2 investigators audited the procedures followed. Results A total of 4 themes were identified that pertain to digital identity. In the first theme, origins of initial digital identity formation were found to be derived from perceived needs in professional roles (eg, as a medical student or resident). The second theme consisted of the cultivation of digital identity, in which digital identity was developed parallel to professional identity. The third theme that emerged was the management between the professional and personal components of digital identity. Participants initially preferred keeping these components completely separate; however, attempts to do so were inadequate while the integration of both components provided benefits. The fourth theme was the management of real-life identity and digital identity. Participants preferred real-life identity to be wholly represented on the web. Instances of misalignment resulted in identity conflict, compromising one of the identities. Conclusions Social media introduces new features to professional identity in the digital world. The formation of digital identity, its development, and reconciliation with other identities were features captured in our analysis. The virtual component of professional identity must not be neglected but instead further explored, as educational institutions continue to give more importance to navigating professional identity development.

Introduction There still remains a gap between those who conduct science and those who engage in educating others about health sciences through various forms of social media. Few empirical studies have sought to define useful practices for engaging in social media for academic use in the health professions. Given the increasing importance of these platforms, we sought to define good practices and potential pitfalls with help of those respected for their work in this new field. Methods We conducted a qualitative study, guided by constructivist grounded theory principles, of 17 Electronic supplementary material The online version of this article (

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Introduction: As academia begins to incorporate modern communication technologies into its scholarly structures, there are both enablers and barriers which foster academics’ uptake of these innovations. Those who are early adopters of academic social media - whether it be for education, research-related networking, or knowledge translation - may therefore be best positioned to highlight both enablers and barriers within their work environments. Methods: The authors conducted a constructivist grounded theory study to discern what prominent practitioners of academic social media (e.g. Twitter) have encountered in their careers. Participants were recruited via a snowball sampling technique and invited to participate in semi-structured interviews. Three investigators engaged in constant comparative analysis of incoming transcripts. To enhance rigour, we conducted an audit of the analysis and a participant member check. Results: Seventeen emerging influencers in the field of academic social media were recruited. After axial coding, the 30 enablers and 21 barriers to academic social media use were mapped to three spheres of influence: personal, institutional, and virtual. The investigators propose a framework that organizes these enablers and barriers around a tipping point where sustainability becomes possible. Conclusions: Multiple enablers and barriers were described to influence social media users within academic medicine. By organizing these facets into a personal, institutional, and virtual framework along a spectrum, we can begin to understand the underlying structures that potentiate the academic ecosystems in which social media and similar innovations may flourish.

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