Background: Social media, particularly Twitter, has played an increasing role in networking and the dissemination of neurosurgical research. Despite extensive study on financial conflicts of interest (FCOI) influencing medical research, little is known about the function of conflicts of interest on social media and the influence they may have. In this study, we sought to evaluate the FCOI of physicians followed on Twitter by the top three neurosurgical journals. Materials and Methods: We analysed the FCOI of United States (US) physicians followed by the top three neurosurgical journals (Journal of Neurosurgery, World Neurosurgery, Neurosurgery) on Twitter. We determined the FCOIs of each physician using the Open Payments Search Tool located at https://openpaymentsdata.cms.gov and summed the data between 2014 and 2021. Results: We examined 2651 Twitter accounts followed by the top three neurosurgical journals on Twitter and determined 705 (26.6%) belonged to US physicians. Of the 705 US physicians, 577 (81.8%) received general payments between 2014 and 2021. After excluding US physicians currently in residency or fellowship (n = 157), this percentage increased to 93.2% (n = 511/548). In total, nearly $70 million in general payments were made between 2014 and 2021. Conclusion: These findings raise questions regarding the interaction between neurosurgical journals and the medical community on Twitter. This study may serve as the basis for
Introduction: Decompensated cirrhosis is a common presentation in patients requiring inpatient care. According to 2012 guidelines from AASLD, paracentesis should be performed in patients admitted to the hospital with ascites regardless of the reason for admission. This retrospective study hypothesizes that evening admission will be positively associated with delay in paracentesis (defined as 12-hour paracentesis delay) and non-optimal treatment choice of paracentesis being done after antibiotic administration. Methods: 138 patients admitted with ascites secondary to cirrhosis between March 2017 and February 2021 were included. Variables studied included hospital admission of day (7 AM to 6:59 PM) versus evening (7 PM to 6:59 AM), paracentesis delay (Y/N), and whether paracentesis was performed before antibiotic administration, after antibiotic administration, or not performed. IBM SPSS Statistics Version 28 and Stata SE Version 17 were used for the analyses. P-values were two-tailed with alpha level for significance at p, 0.05. Results: We found that of all patients, 39% had paracentesis after antibiotic administration, 43% did not have paracentesis at all and 37% had delayed paracentesis. During evening admission, fewer patients were likely to have paracentesis before antibiotic administration (p50.096). In analyses comparing paracentesis after antibiotic administration with paracenteses before antibiotic administration, evening admission was significantly associated with an increased relative risk for paracentesis after antibiotic administration (p 0.046). Also, when combining the groups of paracenteses after antibiotic administration with paracentesis not done, evening admission was associated with the lowest frequency of paracentesis before antibiotic administration (p50.03). Conclusion:The benefits of early paracentesis outweigh the risks of infection or bleeding associated with the procedure. Performing paracentesis has a greater diagnostic yield if done prior to antibiotic administration, as even a 6-hour delay can decrease infection detection rate. We found that overall, fewer patients with ascites received paracentesis, and evening admission was associated with suboptimal management with paracentesis done after antibiotic administration. Based on the above findings, there is room for improvement in educating all clinicians, particularly those working during the evening shift, on the importance of performing paracentesis prior to antibiotic administration.
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