Text In The City

A blog about texting technology & health care
About Me

Text in the City is a text messaging service for teens attending the Mount Sinai Adolescent Health Center (MSAHC) in New York.

Follow us on Twitter at:
https://twitter.com/textinthecityNY

Contact me at:
katherine.malbon@mountsinai.org

More information about MSAHC:
http://bit.ly/crcFlr

We launched a 6 month pilot in January 2010. This has now extended in to 12 months. We hope to make it in to a full, more widely available program in 2011.

MSAHC is a free & confidential clinic serving over 10,000 young people annually, mainly from the South Bronx and East Harlem.

TTC have teamed up with Rip Road, a mobile marketing agency, to create this new trial service, allowing teens to ask confidential questions, & sign up for birth control reminders. We also offer weekly 'healthbytes' of useful and interesting health-based advice, via text.

We're keen to learn from others involved in similar projects and trials.

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Archive
2012 (2)
2011 (33)
2010 (37)
2009 (3)
 

Using Social Networks to Prevent STDs

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Those of us working in adolescent medicine and specifically reproductive and sexual health are constantly on the search to find novel and innovative ways to disseminate education on sexually transmitted diseases and pregnancy prevention. When it comes to using social networks, we are faced with a conundrum; is this an invasion of a patient's personal space? Do adolescents see their 'Facebook page' as a communication with friends and not with health professionals? Do they want to be educated at the same time as 'friending' acquaintances? 

Social networks are being used more and more as a personal 'hub' of daily activities. Gone are the days (if they ever existed) of separate email accounts, AIM, game sites or bookmarking 'favorites'. Now for many teens everything is accessed through their favored social network site. Through one 'App' they can talk to friends, play games (alone or against friends), up-date their status, get the latest news headlines and more.

So, if they are doing all this through one main 'portal', it makes sense that we, as health professionals, reach them in that space. The advantages of doing this could be huge. Tracy Clark-Flory writes an interesting piece on the potential of using social networks for this purpose http://bit.ly/H3GLhF. 

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Hanging Out with 100 others: 5 tips for Bringing Health Professionals Together with Google Hangouts

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One of the challenges of being a Pediatrician and working in a state the size of New York (53,000 sq miles in area, over 300 miles from north to south) is the inability to easily meet colleagues who live further a field to share ideas. I am involved with the New York State Chapter of the Society for Adolescent Medicine (NY SAHM).

We meet quarterly for networking and education purposes; vital for furthering the health and well being of adolescents living in the US. For logistics sake these meetings tend to happen in Manhattan during the week, making it almost impossible for those up state to attend. In our most recent meeting we overcame this challenge and brought together almost 100 folk interested in Adolescent health care by way of a new technology; the Google+ Hangout.

A Google+ Hangout enables 10 Google+ accounts to connect. ‘Hangout with extras’ allows for the showing and sharing of PowerPoint presentations or other documents. It seemed to be the answer to our conundrum, but I was soon to learn that it would take meticulous planning.

On December 6th 2011 almost 100 Adolescent Health Care Providers hooked up in a Google+ Hangout. Presenters from Manhattan and Rochester, NY (300 miles away) delivered stellar lectures on “Improving access to healthcare for GBLTQ youth”. Questions and comments on the topic were taken from three different locations; Manhattan, Rochester and Buffalo. A business meeting was shared from the Manhattan location as well as the presentation of our regional chapter award. In addition all three locations watched each other munch on the NY staple diet of ordered-in pizza, washed down with a good glass of red.

We marveled in the fact that we had achieved our challenge; we had connected the state together. It wasn’t entirely plain sailing. The odd frozen screen here and sound issue there, not to mention the anxiety of hoping it would or could work. But I came away from the evening intent on doing this again. I had learnt so much and the second time around would be even better. What struck me more was how we, as healthcare professionals, can use this technology even further afield than the confines of the state or even the country. Suddenly the vast world of global medicine has become smaller; we don’t necessarily need to travel to find out what, why and how other states, countries or continents are managing adolescent healthcare.

So, if you are inspired to have a Google+ Hangout for the good of the Nation or perhaps just a High School reunion, here are my 5 top tips for making it happen (almost) glitch free:

1. At least a day before you’re due to Hangout, make sure each participant has a Gmail account and they have signed-up for a Google+ account (you can do that here)

2. Assign one leader of the Hangout (especially if this is for a big meeting), and make that clear to all - that person should send the invitation, to which the others respond

3. If you plan to share a document or PowerPoint presentation, upload it to Google Docs beforehand (& check the format has stayed the same)

4. If this is for a meeting, make sure you have a ‘test’ Hangout a few days before the real thing

5. On the day of the Hangout, the ‘leader’ must start the Hangout and invite members.

For more tips and help on hanging out successfully, check out this page of help, on Google+.

Happy hanging out!

 

Filed under  //  Google+   Hangouts   NYSAHM   adolescent medicine   technology  
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Teens sending 7 text messages per waking hour.

U.S. Teens Triple Data Usage
Jay Donovan 

The report states that “In the third quarter of 2011, teens age 13-17 used an average of 320 MB of data per month on their phones, increasing 256 percent over last year and growing at a rate faster than any other age group”.

While this deluge of data consumption seems immense, messaging still remains the largest teen behavior in the mobile space, with the number of SMS/MMS messages reaching 3,417 per teen. Let me just say that again…3,417 texts per teen—seven messages per waking hour, according to the study. Um, WOW!


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90% of ADULTS have difficulty following routine medical advice: Frightening facts from the CDC.

So if that's the case, how on earth are adolescents able to take in advice given to them during a medical visit? How are they going to be able to negotiate the intricacies of starting a birth control method? The answer is...they often don't.

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Two-thirds of births to females less than 18yo are unintended. Although the teenage birth rate has declined since 1991 and continues on a downward trend, the US still has the highest rate compared to Canada, where the teen birth rate is a third of the US and European countries being less than one fifth of the US rate. Teen child bearing has adverse consequences for mothers and their children as well as imposing huge public sector costs.

Studies also show that birth control use in the US has increased amongst teenage adolescents (data from the National Survey of Family Growth). Still, despite this, we top the teen birth rate. 

Sadly, it comes back to education (or lack of it) in our schools. Many patients tell me that they only learnt about HIV in 'Health Ed' and only a handful can claim to have had any education or information given to them about birth control.

From the first days of working in adolescent medicine, it was very apparent that our patients could not handle the amount of information we were giving to them. I always make a point of asking a patient to repeat instructions about how to use a birth control method back to me. It never fails to amaze me just how many of them find this so difficult. I've tried numerous ways of delivering the information; diagrams, demonstrations, using different language. Whatever I try, it still is problematic. And this was how Text in the City evolved. I wanted to give these patients the ability to clarify what I had said to them; to 'just check' if they were doing it right; to see if how they were feeling since starting a method was 'normal' or not. I hope it goes some way towards doing this.

So if the CDC is reporting facts about patient education like these (see above), we need to be thinking of more innovative, cost effective ways of 'joining-the-dots' for both adult and adolescent patients and, importantly, we need to be showing that they work.

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Make your day a little easier with Doximity

This looks pretty awesome...I think. It's like a 'LinkedIn' for Physicians but with additional HIPAA compliant communication tools. It may be more useful for Physicians in private practice, but I'm going to give it a go. What's more - it's free!
Take a look:

https://www.doximity.com/tour

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Has the iPad replaced the stethoscope?

'Thirty years ago, we depended on 2,000-page texts such as Robbins Basic Pathology and Gray’s Anatomy. We lugged these around and juggled them as we did our anatomical dissections.' Dr Michael Collins.http://bit.ly/r6b8Hy

Dr Michael Collins has written a thought provoking article in the Worcester Telegram & Gazette today (see above) regarding technology and the next generation of medical students. It really got me thinking about the 'good' and 'bad' effects of the multitude of on-line resources available to us as Physicians.

Having trained in the UK and worked in India for a short while, clinical examination has always been the number one all important aspect of being a great doctor. As a medical student nothing excited me more than finding a patient with positive clinical signs (just like the text books said). I was somewhat dismayed when I came to the USA and had to go through the Licensing exams (USMLE) to find that the clinical examination was with a group of actors who had no 'real' clinical signs. The onus of the examination was on communication with the patient. Although equally important, I couldn't help feeling that this exam could be passed by any socially amiable individual.

This morning I arrived early at work to teach the Residents about male genital pathology. During the first 15 minutes we talked about the examination; how to make ourselves feel more comfortable with the examination; how to put the patient at ease; how to feel confident in what we are looking for; how to approach the examination with a system; how to use the examination as a learning situation for the patient (self-testicular examination is important in preventative health care).

As I continued to teach about male genital pathology, we kept coming back to 'clinical examination' and the importance of the examination in leading to a diagnosis.

Today we are so fortunate as Physicians to have instant access to the most current up-to-date information on line. We can access amazing 3D anatomical visuals on-line. We can instantly find out the dose, side effects and interactions of medications. Most physicians have access to the Internet during a consult and many have an iPhone or iPad at hand for instant reference. We no longer depend on our memory.

One thing does concern me though. I worry that our clinical skills will be lost among the 'downloads' and 'uploads'. I worry that medical students will be so directed towards accessing information that they will not focus on the clinical examination. Photographs of clinical signs can be found so easily in one quick google search; but there is nothing so thrilling as finding them yourself.

I will always believe that the difference between a 'good' doctor and a 'great' doctor lies in the ability to do a thorough clinical examination and put together the clinical signs to come up with a diagnosis. I then might reach for my iPhone to find out which medication to use....

As Physicians and educators we need to ensure that clinical examination skills are not lost and that medical students feel confident in their ability to examine. There should never be an excuse for leaving the stethoscope behind; listening to heart sounds is one thing an iPad cannot do.

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Adolescent health week - thanks to the NY Times.

I LOVE this - a whole week dedicated to adolescent health in the NY Times. Some truly amazing resources. What I really like is that several articles I had previously seen in the NY Times and meant to re-visit (but had forgotten) now reappear. In particular the MTV '16 and Pregnant' article...I've been a little dubious about the merits of this TV series, but following this article, I really think that it may be beneficial watching for some of our teens. I would also love to try using it as a teaching resource, as often it can be hard to get teens talking; this, I feel could spark some lively and learning conversation.

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Angry birds or a birth control counseling App? it's a hard choice...

In my day-to-day practice of counseling teens on birth control use, I often feel defeated. The information we impart to them is complex and confusing. It never surprises me to find that various methods have been used in all manor of ways (not to mention hair being washed with crushed oral contraceptives...but that's another story). We invariably see teens who complain of abnormal vaginal bleeding, only to find that they have kept the 'patch' on for 3 weeks or that pills have been 'tripled up' due to missed ones.

Additionally, birth control is not adhered to because the initial choice of method was not right for that individual. Just last week a patient came in for a pregnancy test. In her medical chart it noted that she had been prescribed the pill as a method of birth control. She told me that she had started it but because she lives in between her Mom and Dad's apartments, she forgets to take it back and forth. Added to that, neither parent was aware she was on birth control and she had it hidden at the bottom of a closet. The pill was clearly the wrong choice for this individual.

The up-take of birth control reminders via text message has proved to be highly popular amongst our adolescent population at MSAHC. This combined with extensive use of the 'chat' platform to clarify proper use of birth control has led to me designing a study using tailored text messages to support girls initiating a birth control method. It seems we need to find something to help these girls make the right choice and feel educated and supported in continuing it's use. Perhaps technology can help us with this.

I was really interested in work presented by Allison Meserve MPH, Samantha Garbers MPA and Mary Ann Chiasson DrPH, on a self-administered computerized counseling module to improve contraceptive method choice. This large randomised controlled trial included 1,983 patients (adolescents and adults) and compared a 'tailored counseling' module, a 'counseling' module and a control. The tailored counseling module was found to significantly increase women's choice of a more effective birth control method. A simple, yet effective strategy (http://bit.ly/pdUNQE).

As I take a walk through our ever crowded waiting area in the clinic, at least 95% of patients are looking at a handheld device. Many of these patients will be here for reproductive health. I can't help but think that an 'app' with a birth control 'module' could be the answer to this on-going problem of poor up-take and adherence to birth control use, or perhaps I'm being too naive and 'angry birds' will continue be the preferred option....

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Contraceptive coverage can prevent teen pregnancy

Good news! The Institute of Medicine has finally declared that contraception is an important preventative health service and should be covered by health plans under the Affordable Health Care Act. Krishna Upadhya, gives a view on why, as an Adolescent Health Care Specialist, this is so important (Washington Post).

Last week, in my work as a doctor of adolescent medicine, I had to tell three 19-year-old patients that they are pregnant. Their circumstances varied, but for all of them, pregnancy was unexpected, unplanned and unwanted. Two of the young women are already caring for very young children; the other is a college student planning a demanding career. All of them have been pregnant before.

I take my job as a physician seriously and feel strongly that it is my ethical duty to inform my patients about all of their options to prevent or manage an unplanned pregnancy. I work hard to support the decisions they make and to ensure that they have access to whatever medical services they need, even if I cannot provide them myself. As a mother, I am also deeply saddened by how often I see teens and young women who are faced with decisions about unplanned pregnancies that they cannot handle and that I know we could have easily prevented though the use of effective contraception.

To read more, go to: http://wapo.st/puG8MP

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Scientific Advances on Contraceptive for Men

This blog is largely about texting and health and as much as I love to find new and interesting facts and figures about the later, it's time to start branching out and cover things all reproductive and teenage health related, with some text and technology thrown in (of course). So here we go. Starting today with contraceptives for men....

 

Steve Owens had always left birth control to his wife, who took the pill. After all, male methods were vasectomy, which he did not want, and condoms, which he described as: “Well, condoms are condoms.”

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Kevin P. Casey for The New York Times

Steve Owens of Seattle volunteered to help test different male contraceptives and found some more to his liking than others.

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Then Mr. Owens volunteered to test potential methods that lowered his sperm count so much that “I was not viably able to produce a child,” he said. His count rebounded weeks after stopping each method, and he fathered a daughter between research studies.

“I would definitely do some kind of long-term male contraceptive,” said Mr. Owens, a 39-year-old school social worker from Seattle.

Male contraceptives are attracting growing interest from scientists, who believe they hold promise for being safe, effective and, also important, reversible.

“We have a number of irons in the fire,” said Diana L. Blithe, program director for contraceptive development for the National Institute of Child Health and Human Development. “I think men actually do want to do this.”

While male contraception has been studied before, no method met the stringent safety and effectiveness criteria that female methods do. It was also unclear whether men would use them.

Now, scientific advances are producing approaches that could pass muster. Prompted by women’s organizations, global health groups and surveys indicating that men are receptive, federal agencies are financing research. Some methods will be presented at an October conference sponsored by the Bill and Melinda Gates Foundation.

To read the full article: http://nyti.ms/qd9vS7

 

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