Utility of social media and crowd-intelligence data for pharmacovigilance: a scoping review

The Value of Social Media Analysis for Adverse Events Detection and Pharmacovigilance: Scoping Review

BACKGROUND

Adverse drug events pose an enormous public health burden, leading to hospitalization, disability, and death. Even the adverse events (AEs) categorized as nonserious can severely impact on patient's quality of life, adherence, and persistence. Monitoring medication safety is challenging. Web-based patient reports on social media may be a useful supplementary source of real-world data. Despite the growth of sophisticated techniques for identifying AEs using social media data, a consensus has not been reached as to the value of social media in relation to more traditional data sources.

OBJECTIVE

This study aims to evaluate and characterize the utility of social media analysis in adverse drug event detection and pharmacovigilance as compared with other data sources (such as spontaneous reporting systems and the clinical literature).

METHODS

In this scoping review, we searched 11 bibliographical databases and Google Scholar, followed by handsearching and forward and backward citation searching. Each record was screened by 2 independent reviewers at both the title and abstract stage and the full-text screening stage. Studies were included if they used any type of social media (such as Twitter or patient forums) to detect AEs associated with any drug medication and compared the results ascertained from social media to any other data source. Study information was collated using a piloted data extraction sheet. Data were extracted on the AEs and drugs searched for and included; the methods used (such as machine learning); social media data source; volume of data analyzed; limitations of the methodology; availability of data and code; comparison data source and comparison methods; results, including the volume of AEs, and how the AEs found compared with other data sources in their seriousness, frequencies, and expectedness or novelty (new vs known knowledge); and conclusions.

RESULTS

Of the 6538 unique records screened, 73 publications representing 60 studies with a wide variety of extraction methods met our inclusion criteria. The most common social media platforms used were Twitter and online health forums. The most common comparator data source was spontaneous reporting systems, although other comparisons were also made, such as with scientific literature and product labels. Although similar patterns of AE reporting tended to be identified, the frequencies were lower in social media. Social media data were found to be useful in identifying new or unexpected AEs and in identifying AEs in a timelier manner.

CONCLUSIONS

There is a large body of research comparing AEs from social media to other sources. Most studies advocate the use of social media as an adjunct to traditional data sources. Some studies also indicate the value of social media in understanding patient perspectives such as the impact of AEs, which could be better explored.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/47068.

Leveraging patient experience data to guide medicines development, regulation, access decisions and clinical care in the EU

Patient experience data (PED), provided by patients/their carers without interpretation by clinicians, directly capture what matters more to patients on their medical condition, treatment and impact of healthcare. PED can be collected through different methodologies and these need to be robust and validated for its intended use. Medicine regulators are increasingly encouraging stakeholders to generate, collect and submit PED to support both scientific advice in development programs and regulatory decisions on the approval and use of these medicines. This article reviews the existing definitions and types of PED and demonstrate the potential for use in different settings of medicines' life cycle, focusing on Patient-Reported Outcomes (PRO) and Patient Preferences (PP). Furthermore, it addresses some challenges and opportunities, alluding to important regulatory guidance that has been published, methodological aspects and digitalization, highlighting the lack of guidance as a key hurdle to achieve more systematic inclusion of PED in regulatory submissions. In addition, the article discusses opportunities at European and global level that could be implemented to leverage PED use. New digital tools that allow patients to collect PED in real time could also contribute to these advances, but it is equally important not to overlook the challenges they entail. The numerous and relevant initiatives being developed by various stakeholders in this field, including regulators, show their confidence in PED's value and create an ideal moment to address challenges and consolidate PED use across medicines' life cycle.

Social Media as Pharmacovigilance: The Potential for Patient Reports to Inform Clinical Research on Glucagon-Like Peptide 1 (GLP-1) Receptor Agonists for Substance Use Disorders

The surge in popularity of semaglutide (Ozempic, Wegovy, Rybelsus) and other glucagon-like-peptide 1 (GLP-1) receptor agonists has been accompanied by widespread reports of unintended reductions in alcohol use (and other addictive behaviors) during treatment. With clinical trials of GLP-1 receptor agonists for substance use only recently under way, anecdotal reports (including via social media) are now a primary reason for interest in potential effects of GLP-1 receptor agonists on alcohol use in patient populations. The nature and volume of these reports raises the prospect that social media data can potentially be leveraged to inform the study of novel addiction treatments and the prioritization of behavioral or neurobiological targets for mechanistic research. This approach, which aligns with recent efforts to apply social media data to pharmacovigilance, may be particularly relevant for drug repurposing efforts. This possibility is illustrated by a thematic analysis of anonymous online reports concerning changes in alcohol use or alcohol-related effects during treatment with GLP-1 receptor agonists. These reports not only support the rationale for clinical trials but also point to potential neurobehavioral mechanisms (e.g., satiety, craving/preoccupation, aversion, altered subjective response) that might inform hypotheses for human laboratory and neuroscience studies. Refined methods for capturing patient reports of incidental medication effects on addictive behaviors at large scale could potentially lead to novel, pharmacovigilance-based approaches to identify candidate therapies for drug repurposing efforts.

Using natural language processing to characterize and predict homeopathic product-associated adverse events in consumer reviews: comparison to reports to FDA Adverse Event Reporting System (FAERS)

OBJECTIVE

Apply natural language processing (NLP) to Amazon consumer reviews to identify adverse events (AEs) associated with unapproved over the counter (OTC) homeopathic drugs and compare findings with reports to the US Food and Drug Administration Adverse Event Reporting System (FAERS).

MATERIALS AND METHODS

Data were extracted from publicly available Amazon reviews and analyzed using JMP 16 Pro Text Explorer. Topic modeling identified themes. Sentiment analysis (SA) explored consumer perceptions. A machine learning model optimized prediction of AEs in reviews. Reports for the same time interval and product class were obtained from the FAERS public dashboard and analyzed.

RESULTS

Homeopathic cough/cold products were the largest category common to both data sources (Amazon = 616, FAERS = 445) and were analyzed further. Oral symptoms and unpleasant taste were described in both datasets. Amazon reviews describing an AE had lower Amazon ratings (X2 = 224.28, P < .0001). The optimal model for predicting AEs was Neural Boosted 5-fold combining topic modeling and Amazon ratings as predictors (mean AUC = 0.927).

DISCUSSION

Topic modeling and SA of Amazon reviews provided information about consumers' perceptions and opinions of homeopathic OTC cough and cold products. Amazon ratings appear to be a good indicator of the presence or absence of AEs, and identified events were similar to FAERS.

CONCLUSION

Amazon reviews may complement traditional data sources to identify AEs associated with unapproved OTC homeopathic products. This study is the first to use NLP in this context and lays the groundwork for future larger scale efforts.

GLP-1 Receptor Agonists and Related Mental Health Issues; Insights from a Range of Social Media Platforms Using a Mixed-Methods Approach

The emergence of glucagon-like peptide-1 receptor agonists (GLP-1 RAs; semaglutide and others) now promises effective, non-invasive treatment of obesity for individuals with and without diabetes. Social media platforms' users started promoting semaglutide/Ozempic as a weight-loss treatment, and the associated increase in demand has contributed to an ongoing worldwide shortage of the drug associated with levels of non-prescribed semaglutide intake. Furthermore, recent reports emphasized some GLP-1 RA-associated risks of triggering depression and suicidal thoughts. Consistent with the above, we aimed to assess the possible impact of GLP-1 RAs on mental health as being perceived and discussed in popular open platforms with the help of a mixed-methods approach. Reddit posts yielded 12,136 comments, YouTube videos 14,515, and TikTok videos 17,059, respectively. Out of these posts/entries, most represented matches related to sleep-related issues, including insomnia (n = 620 matches); anxiety (n = 353); depression (n = 204); and mental health issues in general (n = 165). After the initiation of GLP-1 RAs, losing weight was associated with either a marked improvement or, in some cases, a deterioration, in mood; increase/decrease in anxiety/insomnia; and better control of a range of addictive behaviors. The challenges of accessing these medications were a hot topic as well. To the best of our knowledge, this is the first study documenting if and how GLP-1 RAs are perceived as affecting mood, mental health, and behaviors. Establishing a clear cause-and-effect link between metabolic diseases, depression and medications is difficult because of their possible reciprocal relationship, shared underlying mechanisms and individual differences. Further research is needed to better understand the safety profile of these molecules and their putative impact on behavioral and non-behavioral addictions.

Estimating Patient Satisfaction Through a Language Processing Model: Model Development and Evaluation

BACKGROUND

Measuring patient satisfaction is a crucial aspect of medical care. Advanced natural language processing (NLP) techniques enable the extraction and analysis of high-level insights from textual data; nonetheless, data obtained from patients are often limited.

OBJECTIVE

This study aimed to create a model that quantifies patient satisfaction based on diverse patient-written textual data.

METHODS

We constructed a neural network-based NLP model for this cross-sectional study using the textual content from disease blogs written in Japanese on the Internet between 1994 and 2020. We extracted approximately 20 million sentences from 56,357 patient-authored disease blogs and constructed a model to predict the patient satisfaction index (PSI) using a regression approach. After evaluating the model's effectiveness, PSI was predicted before and after cancer notification to examine the emotional impact of cancer diagnoses on 48 patients with breast cancer.

RESULTS

We assessed the correlation between the predicted and actual PSI values, labeled by humans, using the test set of 169 sentences. The model successfully quantified patient satisfaction by detecting nuances in sentences with excellent effectiveness (Spearman correlation coefficient [ρ]=0.832; root-mean-squared error [RMSE]=0.166; P<.001). Furthermore, the PSI was significantly lower in the cancer notification period than in the preceding control period (-0.057 and -0.012, respectively; 2-tailed t47=5.392, P<.001), indicating that the model quantifies the psychological and emotional changes associated with the cancer diagnosis notification.

CONCLUSIONS

Our model demonstrates the ability to quantify patient dissatisfaction and identify significant emotional changes during the disease course. This approach may also help detect issues in routine medical practice.

Strategies and interventions to strengthen pharmacovigilance systems in low-income and middle-income countries: a scoping review

OBJECTIVES

The slow progress of pharmacovigilance (PV) in low-income and middle-income countries (LMIC) raises questions about core challenges on the growth of PV, and the appropriateness of strategies used so far to develop PV. Therefore, this scoping review aims to describe strategies and interventions to strengthen PV in LMIC and to propose recommendations for future investments in PV capacity building.

INCLUSION CRITERIA

Publications included were primary studies, articles, policy and guideline papers, describing interventions to strengthen PV in LMIC.

METHODS

The review was conducted following the Joanna Briggs Institute (JBI) guidelines on conducting scoping reviews. Literature searches were performed in MEDLINE, EMBASE, Web of Science, PDQ-evidence, CINAHL and other relevant websites from January 1990 to January 2021. Two reviewers independently screened titles, abstracts and full texts. One reviewer performed data extraction and descriptive analysis, which were reviewed by two other reviewers.

RESULTS

10 922 unique titles were screened and 152 were eligible for full text review. Of these, 57 and an additional 13 reports from grey literature fulfilled eligibility criteria for inclusion in the review. These were grouped into two categories: (1) Interventions aimed at increasing PV knowledge and adverse drug reactions (ADR) reporting (45 papers), primarily education of healthcare professionals (HCP), alone or in combination with other interventions such as mobile and electronic reporting and (2) Interventions aimed at strengthening various components of the national PV system (25 papers), describing strategies or mixed interventions implemented at the national level, targeting different components of the national PV system.

CONCLUSIONS

Results of this review suggest that educating HCP on ADR reporting is the most common approach to build PV capacity in LMIC. Though important, education alone is insufficient and should ideally be organised within the holistic framework of strengthening national PV systems, with a focus on also building capacity for advanced activities such as signal detection.

The Role of Social Media for Identifying Adverse Drug Events Data in Pharmacovigilance: Protocol for a Scoping Review

BACKGROUND

Adverse drug events (ADEs) are a considerable public health burden resulting in disability, hospitalization, and death. Even those ADEs deemed nonserious can severely impact a patient's quality of life and adherence to intervention. Monitoring medication safety, however, is challenging. Social media may be a useful adjunct for obtaining real-world data on ADEs. While many studies have been undertaken to detect adverse events on social media, a consensus has not yet been reached as to the value of social media in pharmacovigilance or its role in pharmacovigilance in relation to more traditional data sources.

OBJECTIVE

The aim of the study is to evaluate and characterize the use of social media in ADE detection and pharmacovigilance as compared to other data sources.

METHODS

A scoping review will be undertaken. We will search 11 bibliographical databases as well as Google Scholar, hand-searching, and forward and backward citation searching. Records will be screened in Covidence by 2 independent reviewers at both title and abstract stage as well as full text. Studies will be included if they used any type of social media (such as Twitter or patient forums) to detect any type of adverse event associated with any type of medication and then compared the results from social media to any other data source (such as spontaneous reporting systems or clinical literature). Data will be extracted using a data extraction sheet piloted by the authors. Important data on the types of methods used (such as machine learning), any limitations of the methods used, types of adverse events and drugs searched for and included, availability of data and code, details of the comparison data source, and the results and conclusions will be extracted.

RESULTS

We will present descriptive summary statistics as well as identify any patterns in the types and timing of ADEs detected, including but not limited to the similarities and differences in what is reported, gaps in the evidence, and the methods used to extract ADEs from social media data. We will also summarize how the data from social media compares to conventional data sources. The literature will be organized by the data source for comparison. Where possible, we will analyze the impact of the types of adverse events, the social media platform used, and the methods used.

CONCLUSIONS

This scoping review will provide a valuable summary of a large body of research and important information for pharmacovigilance as well as suggest future directions of further research in this area. Through the comparisons with other data sources, we will be able to conclude the added value of social media in monitoring adverse events of medications, in terms of type of adverse events and timing.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/47068.

Barriers to opioid use disorder treatment: A comparison of self-reported information from social media with barriers found in literature

Introduction

Medications such as buprenorphine and methadone are effective for treating opioid use disorder (OUD), but many patients face barriers related to treatment and access. We analyzed two sources of data-social media and published literature-to categorize and quantify such barriers.

Methods

In this mixed methods study, we analyzed social media (Reddit) posts from three OUD-related forums (subreddits): r/suboxone, r/Methadone, and r/naltrexone. We applied natural language processing to identify posts relevant to treatment barriers, categorized them into insurance- and non-insurance-related, and manually subcategorized them into fine-grained topics. For comparison, we used substance use-, OUD- and barrier-related keywords to identify relevant articles from PubMed published between 2006 and 2022. We searched publications for language expressing fear of barriers, and hesitation or disinterest in medication treatment because of barriers, paying particular attention to the affected population groups described.

Results

On social media, the top three insurance-related barriers included having no insurance (22.5%), insurance not covering OUD treatment (24.7%), and general difficulties of using insurance for OUD treatment (38.2%); while the top two non-insurance-related barriers included stigma (47.6%), and financial difficulties (26.2%). For published literature, stigma was the most prominently reported barrier, occurring in 78.9% of the publications reviewed, followed by financial and/or logistical issues to receiving medication treatment (73.7%), gender-specific barriers (36.8%), and fear (31.5%).

Conclusion

The stigma associated with OUD and/or seeking treatment and insurance/cost are the two most common types of barriers reported in the two sources combined. Harm reduction efforts addressing barriers to recovery may benefit from leveraging multiple data sources.

Using GPT-3 to Build a Lexicon of Drugs of Abuse Synonyms for Social Media Pharmacovigilance

Drug abuse is a serious problem in the United States, with over 90,000 drug overdose deaths nationally in 2020. A key step in combating drug abuse is detecting, monitoring, and characterizing its trends over time and location, also known as pharmacovigilance. While federal reporting systems accomplish this to a degree, they often have high latency and incomplete coverage. Social-media-based pharmacovigilance has zero latency, is easily accessible and unfiltered, and benefits from drug users being willing to share their experiences online pseudo-anonymously. However, unlike highly structured official data sources, social media text is rife with misspellings and slang, making automated analysis difficult. Generative Pretrained Transformer 3 (GPT-3) is a large autoregressive language model specialized for few-shot learning that was trained on text from the entire internet. We demonstrate that GPT-3 can be used to generate slang and common misspellings of terms for drugs of abuse. We repeatedly queried GPT-3 for synonyms of drugs of abuse and filtered the generated terms using automated Google searches and cross-references to known drug names. When generated terms for alprazolam were manually labeled, we found that our method produced 269 synonyms for alprazolam, 221 of which were new discoveries not included in an existing drug lexicon for social media. We repeated this process for 98 drugs of abuse, of which 22 are widely-discussed drugs of abuse, building a lexicon of colloquial drug synonyms that can be used for pharmacovigilance on social media.

Social media and internet search data to inform drug utilization: A systematic scoping review

Introduction

Drug utilization is currently assessed through traditional data sources such as big electronic medical records (EMRs) databases, surveys, and medication sales. Social media and internet data have been reported to provide more accessible and more timely access to medications' utilization.

Objective

This review aims at providing evidence comparing web data on drug utilization to other sources before the COVID-19 pandemic.

Methods

We searched Medline, EMBASE, Web of Science, and Scopus until November 25th, 2019, using a predefined search strategy. Two independent reviewers conducted screening and data extraction.

Results

Of 6,563 (64%) deduplicated publications retrieved, 14 (0.2%) were included. All studies showed positive associations between drug utilization information from web and comparison data using very different methods. A total of nine (64%) studies found positive linear correlations in drug utilization between web and comparison data. Five studies reported association using other methods: One study reported similar drug popularity rankings using both data sources. Two studies developed prediction models for future drug consumption, including both web and comparison data, and two studies conducted ecological analyses but did not quantitatively compare data sources. According to the STROBE, RECORD, and RECORD-PE checklists, overall reporting quality was mediocre. Many items were left blank as they were out of scope for the type of study investigated.

Conclusion

Our results demonstrate the potential of web data for assessing drug utilization, although the field is still in a nascent period of investigation. Ultimately, social media and internet search data could be used to get a quick preliminary quantification of drug use in real time. Additional studies on the topic should use more standardized methodologies on different sets of drugs in order to confirm these findings. In addition, currently available checklists for study quality of reporting would need to be adapted to these new sources of scientific information.

Ethical and Methodological Considerations of Twitter Data for Public Health Research: Systematic Review

BACKGROUND

Much research is being carried out using publicly available Twitter data in the field of public health, but the types of research questions that these data are being used to answer and the extent to which these projects require ethical oversight are not clear.

OBJECTIVE

This review describes the current state of public health research using Twitter data in terms of methods and research questions, geographic focus, and ethical considerations including obtaining informed consent from Twitter handlers.

METHODS

We implemented a systematic review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of articles published between January 2006 and October 31, 2019, using Twitter data in secondary analyses for public health research, which were found using standardized search criteria on SocINDEX, PsycINFO, and PubMed. Studies were excluded when using Twitter for primary data collection, such as for study recruitment or as part of a dissemination intervention.

RESULTS

We identified 367 articles that met eligibility criteria. Infectious disease (n=80, 22%) and substance use (n=66, 18%) were the most common topics for these studies, and sentiment mining (n=227, 62%), surveillance (n=224, 61%), and thematic exploration (n=217, 59%) were the most common methodologies employed. Approximately one-third of articles had a global or worldwide geographic focus; another one-third focused on the United States. The majority (n=222, 60%) of articles used a native Twitter application programming interface, and a significant amount of the remainder (n=102, 28%) used a third-party application programming interface. Only one-third (n=119, 32%) of studies sought ethical approval from an institutional review board, while 17% of them (n=62) included identifying information on Twitter users or tweets and 36% of them (n=131) attempted to anonymize identifiers. Most studies (n=272, 79%) included a discussion on the validity of the measures and reliability of coding (70% for interreliability of human coding and 70% for computer algorithm checks), but less attention was paid to the sampling frame, and what underlying population the sample represented.

CONCLUSIONS

Twitter data may be useful in public health research, given its access to publicly available information. However, studies should exercise greater caution in considering the data sources, accession method, and external validity of the sampling frame. Further, an ethical framework is necessary to help guide future research in this area, especially when individual, identifiable Twitter users and tweets are shared and discussed.

TRIAL REGISTRATION

PROSPERO CRD42020148170; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=148170.

Spontaneously generated online patient experience data - how and why is it being used in health research: an umbrella scoping review

PURPOSE

Social media has led to fundamental changes in the way that people look for and share health related information. There is increasing interest in using this spontaneously generated patient experience data as a data source for health research. The aim was to summarise the state of the art regarding how and why SGOPE data has been used in health research. We determined the sites and platforms used as data sources, the purposes of the studies, the tools and methods being used, and any identified research gaps.

METHODS

A scoping umbrella review was conducted looking at review papers from 2015 to Jan 2021 that studied the use of SGOPE data for health research. Using keyword searches we identified 1759 papers from which we included 58 relevant studies in our review.

RESULTS

Data was used from many individual general or health specific platforms, although Twitter was the most widely used data source. The most frequent purposes were surveillance based, tracking infectious disease, adverse event identification and mental health triaging. Despite the developments in machine learning the reviews included lots of small qualitative studies. Most NLP used supervised methods for sentiment analysis and classification. Very early days, methods need development. Methods not being explained. Disciplinary differences - accuracy tweaks vs application. There is little evidence of any work that either compares the results in both methods on the same data set or brings the ideas together.

CONCLUSION

Tools, methods, and techniques are still at an early stage of development, but strong consensus exists that this data source will become very important to patient centred health research.

Knowledge-based approaches to drug discovery for rare diseases

The conventional drug discovery pipeline has proven to be unsustainable for rare diseases. Herein, we discuss recent advances in biomedical knowledge mining applied to discovering therapeutics for rare diseases. We summarize current chemogenomics data of relevance to rare diseases and provide a perspective on the effectiveness of machine learning (ML) and biomedical knowledge graph mining in rare disease drug discovery. We illustrate the power of these methodologies using a chordoma case study. We expect that a broader application of knowledge graph mining and artificial intelligence (AI) approaches will expedite the discovery of viable drug candidates against both rare and common diseases.

Using a Machine Learning Approach to Monitor COVID-19 Vaccine Adverse Events (VAE) from Twitter Data

Social media can be used to monitor the adverse effects of vaccines. The goal of this project is to develop a machine learning and natural language processing approach to identify COVID-19 vaccine adverse events (VAE) from Twitter data. Based on COVID-19 vaccine-related tweets (1 December 2020-1 August 2021), we built a machine learning-based pipeline to identify tweets containing personal experiences with COVID-19 vaccinations and to extract and normalize VAE-related entities, including dose(s); vaccine types (Pfizer, Moderna, and Johnson & Johnson); and symptom(s) from tweets. We further analyzed the extracted VAE data based on the location, time, and frequency. We found that the four most populous states (California, Texas, Florida, and New York) in the US witnessed the most VAE discussions on Twitter. The frequency of Twitter discussions of VAE coincided with the progress of the COVID-19 vaccinations. Sore to touch, fatigue, and headache are the three most common adverse effects of all three COVID-19 vaccines in the US. Our findings demonstrate the feasibility of using social media data to monitor VAEs. To the best of our knowledge, this is the first study to identify COVID-19 vaccine adverse event signals from social media. It can be an excellent supplement to the existing vaccine pharmacovigilance systems.

Social Media Analytics for Pharmacovigilance of Antiepileptic Drugs

Epilepsy is a common neurological disorder worldwide and antiepileptic drug (AED) therapy is the cornerstone of its treatment. It has a laudable aim of achieving seizure freedom with minimal, if any, adverse drug reactions (ADRs). Too often, AED treatment is a long-lasting journey, in which ADRs have a crucial role in its administration. Therefore, from a pharmacovigilance perspective, detecting the ADRs of AEDs is a task of utmost importance. Typically, this task is accomplished by analyzing relevant data from spontaneous reporting systems. Despite their wide adoption for pharmacovigilance activities, the passiveness and high underreporting ratio associated with spontaneous reporting systems have encouraged the consideration of other data sources such as electronic health databases and pharmaceutical databases. Social media is the most recent alternative data source with many promising potentials to overcome the shortcomings of traditional data sources. Although in the literature some attempts have investigated the validity and utility of social media for ADR detection of different groups of drugs, none of them was dedicated to the ADRs of AEDs. Hence, this paper presents a novel investigation of the validity and utility of social media as an alternative data source for the detection of AED ADRs. To this end, a dataset of consumer reviews from two online health communities has been collected. The dataset is preprocessed; the unigram, bigram, and trigram are generated; and the ADRs of each AED are extracted with the aid of consumer health vocabulary and ADR lexicon. Three widely used measures, namely, proportional reporting ratio, reporting odds ratio, and information component, are used to measure the association between each ADR and AED. The resulting list of signaled ADRs for each AED is validated against a widely used ADR database, called Side Effect Resource, in terms of the precision of ADR detection. The validation results indicate the validity of online health community data for the detection of AED ADRs. Furthermore, the lists of signaled AED ADRs are analyzed to answer questions related to the common ADRs of AEDs and the similarities between AEDs in terms of their signaled ADRs. The consistency of the drawn answers with the existing pharmaceutical knowledge suggests the utility of the data from online health communities for AED-related knowledge discovery tasks.

Simulation in disaster nursing education: A scoping review

OBJECTIVES

Disasters are gradually increasing in type and frequency throughout the globe. Simulation is being used in disaster nursing teaching and training. The aim of this scoping review was to systematically map the extent and application of simulation in disaster nursing education.

DESIGN, DATA SOURCES AND METHODS

A scoping review was conducted using the model of Arksey and O'Malley as the methodological framework, extended by Levac. The following databases were systematically searched to identify relevant literature: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsychINFO from the launch of the databases to June 14, 2020, with a supplemental search on October 12, 2020. Two researchers independently screened the relevant articles selected and extracted the data.

RESULTS

Twenty-four studies were included in the scoping review. The research purpose varied widely. The 24 included studies examined nine disaster simulation scenarios. Eight types of simulation methods were identified, of which simulated patients and a mixed-simulation approach were the main methods. Only two studies used a randomized controlled trial design, and none of the rest studies were set up with control groups. Only 10 studies reported validated questionnaires with reliability tests being used. Debriefing was performed in 19 studies, and in 4 of those studies, the debriefing was structured. The reported outcomes were concentrated in Kirkpatrick's levels 1 (participants' satisfaction with the training experience) and 2 (whether participants actually benefited from the training).

CONCLUSION

This review found that simulation was well-recognised in disaster nursing education and training. However, insufficient designs and methods indicated that there was a lack of strong evidence, and high-level research on the application of simulation is needed in the field of disaster care.

Spontaneously Generated Online Patient Experience of Modafinil: A Qualitative and NLP Analysis

Objective: To compare the findings from a qualitative and a natural language processing (NLP) based analysis of online patient experience posts on patient experience of the effectiveness and impact of the drug Modafinil.

Methods: Posts (n = 260) from 5 online social media platforms where posts were publicly available formed the dataset/corpus. Three platforms asked posters to give a numerical rating of Modafinil. Thematic analysis: data was coded and themes generated. Data were categorized into PreModafinil, Acquisition, Dosage, and PostModafinil and compared to identify each poster's own view of whether taking Modafinil was linked to an identifiable outcome. We classified this as positive, mixed, negative, or neutral and compared this with numerical ratings. NLP: Corpus text was speech tagged and keywords and key terms extracted. We identified the following entities: drug names, condition names, symptoms, actions, and side-effects. We searched for simple relationships, collocations, and co-occurrences of entities. To identify causal text, we split the corpus into PreModafinil and PostModafinil and used n-gram analysis. To evaluate sentiment, we calculated the polarity of each post between −1 (negative) and +1 (positive). NLP results were mapped to qualitative results.

Results: Posters had used Modafinil for 33 different primary conditions. Eight themes were identified: the reason for taking (condition or symptom), impact of symptoms, acquisition, dosage, side effects, other interventions tried or compared to, effectiveness of Modafinil, and quality of life outcomes. Posters reported perceived effectiveness as follows: 68% positive, 12% mixed, 18% negative. Our classification was consistent with poster ratings. Of the most frequent 100 keywords/keyterms identified by term extraction 88/100 keywords and 84/100 keyterms mapped directly to the eight themes. Seven keyterms indicated negation and temporal states. Sentiment was as follows 72% positive sentiment 4% neutral 24% negative. Matching of sentiment between the qualitative and NLP methods was accurate in 64.2% of posts. If we allow for one category difference matching was accurate in 85% of posts.

Conclusions: User generated patient experience is a rich resource for evaluating real world effectiveness, understanding patient perspectives, and identifying research gaps. Both methods successfully identified the entities and topics contained in the posts. In contrast to current evidence, posters with a wide range of other conditions found Modafinil effective. Perceived causality and effectiveness were identified by both methods demonstrating the potential to augment existing knowledge.

Prospective Evaluation of Adverse Event Recognition Systems in Twitter: Results from the Web-RADR Project

Introduction

A large number of studies on systems to detect and sometimes normalize adverse events (AEs) in social media have been published, but evidence of their practical utility is scarce. This raises the question of the transferability of such systems to new settings.

Objectives

The aims of this study were to develop an AE recognition system, prospectively evaluate its performance on an external benchmark dataset and identify potential factors influencing the transferability of AE recognition systems.

Methods

A pipeline based on dictionary lookups and logistic regression classifiers was developed using a proprietary dataset of 196,533 Tweets manually annotated for AE relations and prospectively evaluated the system on the publicly available WEB-RADR reference dataset, exploring different aspects affecting transferability.

Results

Our system achieved 0.53 precision, 0.52 recall and 0.52 F1-score on the development test set; however, when applied to the WEB-RADR reference dataset, system performance dropped to 0.38 precision, 0.20 recall and 0.26 F1-score. Similarly, a previously published method aiming at automatically detecting adverse event posts reported 0.5 precision, 0.92 recall and 0.65 F1-score on thus another dataset, while performance on the WEB-RADR reference dataset was reduced to 0.37 precision, 0.63 recall and 0.46 F1-score. We identified four potential factors leading to poor transferability: overfitting, selection bias, label bias and prevalence.

Conclusion

We warn the community about a potentially large discrepancy between the expected performance of automated AE recognition systems based on published results and the actual observed performance on independent data. This study highlights the difficulty of implementing an all-purpose system for automatic adverse event recognition in Twitter, which could explain the lack of such systems in practical pharmacovigilance settings. Our recommendation is to use benchmark independent datasets, such as the WEB-RADR reference, to investigate the transferability of the adverse event recognition systems and ultimately enforce rigorous comparisons across studies on the task.

Electronic supplementary material

The online version of this article (10.1007/s40264-020-00942-3) contains supplementary material, which is available to authorized users.

DeepADEMiner: a deep learning pharmacovigilance pipeline for extraction and normalization of adverse drug event mentions on Twitter

Objective

Research on pharmacovigilance from social media data has focused on mining adverse drug events (ADEs) using annotated datasets, with publications generally focusing on 1 of 3 tasks: ADE classification, named entity recognition for identifying the span of ADE mentions, and ADE mention normalization to standardized terminologies. While the common goal of such systems is to detect ADE signals that can be used to inform public policy, it has been impeded largely by limited end-to-end solutions for large-scale analysis of social media reports for different drugs.

Materials and Methods

We present a dataset for training and evaluation of ADE pipelines where the ADE distribution is closer to the average ‘natural balance’ with ADEs present in about 7% of the tweets. The deep learning architecture involves an ADE extraction pipeline with individual components for all 3 tasks.

Results

The system presented achieved state-of-the-art performance on comparable datasets and scored a classification performance of F₁ = 0.63, span extraction performance of F₁ = 0.44 and an end-to-end entity resolution performance of F₁ = 0.34 on the presented dataset.

Discussion

The performance of the models continues to highlight multiple challenges when deploying pharmacovigilance systems that use social media data. We discuss the implications of such models in the downstream tasks of signal detection and suggest future enhancements.

Conclusion

Mining ADEs from Twitter posts using a pipeline architecture requires the different components to be trained and tuned based on input data imbalance in order to ensure optimal performance on the end-to-end resolution task.

Crowdsourcing Research for Social Insights into Smart Cities Applications and Services

The evolution in knowledge management and crowdsourcing research provides new data-processing capabilities. The availability of both structured and unstructured open data formats offers unforeseen opportunities for analytics processing and advanced decision-making. However, social sciences research is facing advanced, complicated social challenges and problems. The focus of this study is to analyze the contribution of crowdsourcing techniques to the promotion of advanced social sciences research, exploiting open data available from the geographical positioning system (GPS) to analyze human behavior. In our study, we present the conceptual design of a device that, with the help of a global positioning system-data collection device (GPS-DCD), associates behavioral aspects of human life with place. The main contribution of this study is to integrate research in computer science and information systems with that in social science. The prototype system summarized in this work, proves the capacity of crowdsourcing and big data research to facilitate aggregation of microcontent related to human behavior toward improved quality of life and well-being in modern smart cities. Various ethical issues are also discussed to promote the scientific debate on this matter. Our study shows the capacity of emerging technologies to deal with social challenges. This kind of research will gain increased momentum in the future due to the availability of big data and new business models for social platforms.

The Use of Social Media in Detecting Drug Safety-Related New Black Box Warnings, Labeling Changes, or Withdrawals: Scoping Review

Background

Social media has become a new source for obtaining real-world data on adverse drug reactions. Many studies have investigated the use of social media to detect early signals of adverse drug reactions. However, the trustworthiness of signals derived from social media is questionable. To confirm this, a confirmatory study with a positive control (eg, new black box warnings, labeling changes, or withdrawals) is required.

Objective

This study aimed to evaluate the use of social media in detecting new black box warnings, labeling changes, or withdrawals in advance.

Methods

This scoping review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. A researcher searched PubMed and EMBASE in January 2021. Original studies analyzing black box warnings, labeling changes, or withdrawals from social media were selected, and the results of the studies were summarized.

Results

A total of 14 studies were included in this scoping review. Most studies (8/14, 57.1%%) collected data from a single source, and 10 (71.4%) used specialized health care social networks and forums. The analytical methods used in these studies varied considerably. Three studies (21.4%) manually annotated posts, while 5 (35.7%) adopted machine learning algorithms. Nine studies (64.2%) concluded that social media could detect signals 3 months to 9 years before action from regulatory authorities. Most of these studies (8/9, 88.9%) were conducted on specialized health care social networks and forums. On the contrary, 5 (35.7%) studies yielded modest or negative results. Of these, 2 (40%) used generic social networking sites, 2 (40%) used specialized health care networks and forums, and 1 (20%) used both generic social networking sites and specialized health care social networks and forums. The most recently published study recommends not using social media for pharmacovigilance. Several challenges remain in using social media for pharmacovigilance regarding coverage, data quality, and analytic processing.

Conclusions

Social media, along with conventional pharmacovigilance measures, can be used to detect signals associated with new black box warnings, labeling changes, or withdrawals. Several challenges remain; however, social media will be useful for signal detection of frequently mentioned drugs in specialized health care social networks and forums. Further studies are required to advance natural language processing and mine real-world data on social media.

[Utilizing social media data in post-market safety surveillance]

Post-marketing surveillance is the principal means to ensure drug use safety. The spontaneous report is the essential method of post-marketing surveillance for drug safety. Often, most spontaneous reports come from medical staff and sometimes come from patients who use the drug. The posts published by individuals on social media platforms that contain drugs and related adverse reaction content have gradually been seen as a new data source similar to spontaneous reports from drug users in recent years. Those user-generated posts potentially provide researchers and regulators with new opportunities to conduct post-marketing surveillance for drug safety from patients' perspectives mostly rather than medical professionals and can afford the possibility theoretically to discover drug-related safety issues earlier than traditional methods. Social media data as a new data source for safety signal detection and signal reinforcement have the unique advantages, such as population coverage, type of drugs, type of adverse reactions, data timeliness and quantity. Most of the social media data used in post-marketing surveillance research for drug safety are still text data in English, and even multiple languages are used by different people worldwide on several social media platforms. Unfortunately, there is still a controversy in the academic circles whether social media data can be used as reliable data sources for routine post-marketing surveillance for drug safety. A couple of obstacles of data, methods and ethics must be overcome before leveraging social media data for post-marketing surveillance. The number of Chinese social media users is large, and the social media data in the Chinese language is rapidly snowballing, which can be employed as the potential data source for post-marketing surveillance for drug safety. However, due to the Chinese language's specific characteristics, the text's diversity is different from the English text, and there is not enough accepted corpus in medical scenarios. Besides, the lack of domestic laws and regulations on privacy and security protection of social media data poses more challenges for applying Chinese social media data for post-market surveillance. The significance of social media data to post-marketing surveillance for drug safety is undoubtedly significant. It will be an essential development direction for future research to overcome the challenges of using social media data by developing new technologies and establishing new mechanisms.

Adverse Events in Twitter-Development of a Benchmark Reference Dataset: Results from IMI WEB-RADR

Introduction and Objective

Social media has been suggested as a source for safety information, supplementing existing safety surveillance data sources. This article summarises the activities undertaken, and the associated challenges, to create a benchmark reference dataset that can be used to evaluate the performance of automated methods and systems for adverse event recognition.

Methods

A retrospective analysis of public English-language Twitter posts (Tweets) was performed. We sampled 57,473 Tweets out of 5,645,336 Tweets created between 1 March, 2012 and 1 March, 2015 that mentioned at least one of six medicinal products of interest (insulin glargine, levetiracetam, methylphenidate, sorafenib, terbinafine, zolpidem). Products, adverse events, indications, product-event combinations, and product-indication combinations were extracted and coded by two independent teams of safety reviewers.

Results

The benchmark reference dataset consisted of 1056 positive controls (“adverse event Tweets”) and 56,417 negative controls (“non-adverse event Tweets”). The 1056 adverse event Tweets contained 1396 product-event combinations referring to personal adverse event experiences, comprising 292 different MedDRA^® Preferred Terms. The 1171 product-event combinations (83.9%) were confined to four MedDRA^® System Organ Classes. The 195 Tweets (18.5%) contained indication information, comprising 25 different Preferred Terms.

Conclusions

A manually curated benchmark reference dataset based on Twitter data has been created and is made available to the research community to evaluate the performance of automated methods and systems for adverse event recognition in unstructured free-text information.

Electronic supplementary material

The online version of this article (10.1007/s40264-020-00912-9) contains supplementary material, which is available to authorized users.

The Use of Social Media for Health Research Purposes: Scoping Review

BACKGROUND

As social media are increasingly used worldwide, more and more scientists are relying on them for their health-related projects. However, social media features, methodologies, and ethical issues are unclear so far because, to our knowledge, there has been no overview of this relatively young field of research.

OBJECTIVE

This scoping review aimed to provide an evidence map of the different uses of social media for health research purposes, their fields of application, and their analysis methods.

METHODS

We followed the scoping review methodologies developed by Arksey and O'Malley and the Joanna Briggs Institute. After developing search strategies based on keywords (eg, social media, health research), comprehensive searches were conducted in the PubMed/MEDLINE and Web of Science databases. We limited the search strategies to documents written in English and published between January 1, 2005, and April 9, 2020. After removing duplicates, articles were screened at the title and abstract level and at the full text level by two independent reviewers. One reviewer extracted data, which were descriptively analyzed to map the available evidence.

RESULTS

After screening 1237 titles and abstracts and 407 full texts, 268 unique papers were included, dating from 2009 to 2020 with an average annual growth rate of 32.71% for the 2009-2019 period. Studies mainly came from the Americas (173/268, 64.6%, including 151 from the United States). Articles used machine learning or data mining techniques (60/268) to analyze the data, discussed opportunities and limitations of the use of social media for research (59/268), assessed the feasibility of recruitment strategies (45/268), or discussed ethical issues (16/268). Communicable (eg, influenza, 40/268) and then chronic (eg, cancer, 24/268) diseases were the two main areas of interest.

CONCLUSIONS

Since their early days, social media have been recognized as resources with high potential for health research purposes, yet the field is still suffering from strong heterogeneity in the methodologies used, which prevents the research from being compared and generalized. For the field to be fully recognized as a valid, complementary approach to more traditional health research study designs, there is now a need for more guidance by types of applications of social media for health research, both from a methodological and an ethical perspective.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2020-040671.

Machine learning-integrated omics for the risk and safety assessment of nanomaterials

With the advancement in nanotechnology, we are experiencing transformation in world order with deep insemination of nanoproducts from basic necessities to advanced electronics, health care products and medicines. Therefore, nanoproducts, however, can have negative side effects and must be strictly monitored to avoid negative outcomes. Future toxicity and safety challenges regarding nanomaterial incorporation into consumer products, including rapid addition of nanomaterials with diverse functionalities and attributes, highlight the limitations of traditional safety evaluation tools. Currently, artificial intelligence and machine learning algorithms are envisioned for enhancing and improving the nano-bio-interaction simulation and modeling, and they extend to the post-marketing surveillance of nanomaterials in the real world. Thus, hyphenation of machine learning with biology and nanomaterials could provide exclusive insights into the perturbations of delicate biological functions after integration with nanomaterials. In this review, we discuss the potential of combining integrative omics with machine learning in profiling nanomaterial safety and risk assessment and provide guidance for regulatory authorities as well.

Scoping review protocol on the use of social media for health research purposes

INTRODUCTION

More than one-third of the world population uses at least one form of social media. Since their advent in 2005, health-oriented research based on social media data has largely increased as discussions about health issues are broadly shared online and generate a large amount of health-related data. The objective of this scoping review is to provide an evidence map of the various uses of social media for health research purposes, their fields of applications and their analysis methods.

METHODS AND ANALYSIS

This scoping review will follow the Arksey and O'Malley methodological framework (2005) as well as the Joanna Briggs Institute Reviewer's manual. Relevant publications will be first searched on the PudMed/MEDLINE database and then on Web of Science. We will focus on literature published between January 2005 and April 2020. All articles related to the use of social media or networks for health-oriented research purposes will be included. A first search will be conducted with some keywords in order to identify relevant articles. After identifying the research strategy, a two-part study selection process will be systematically applied by two reviewers. The first part consists of screening titles and abstracts found, thanks to the search strategy, to define the eligibility of each article. In the second part, the full texts will be screened and only relevant articles will be kept. Data will finally be extracted, collated and charted to summarise all the relevant methods, outcomes and key findings in the articles.

ETHICS AND DISSEMINATION

This scoping review will provide an extensive overview of the use of social media for health research purposes. Opportunities as well as future ethical, methodological and technical challenges will also be discussed based on our findings to define a new research agenda. Results will be disseminated through a peer-reviewed publication.

Comparison of Safety Profiles of the New and Old Formulations of Levothyroxine in a First Global Introduction in France

BACKGROUND

Levothyroxine sodium marketed in France was reformulated following a French National Agency for Medicines and Health Products Safety request for a more stringent potency specification. Despite previously established purity and bioequivalence of the new and old formulations, reports of adverse events substantially increased following reformulation. This analysis evaluated the nature and relevance of the medically confirmed safety reports.

METHODS

Spontaneous and solicited individual case safety reports in France were retrieved from 26 March 2015 to 30 June 2016 (old formulation) and 26 March 2017 to 30 June 2018 (new formulation). Rates of reports and adverse events were calculated for the overall patient population and for at-risk subgroups. Adverse events delineated by thyroid-stimulating hormone levels were evaluated.

RESULTS

A total of 295 and 42 775 reports for the old formulation and new formulation, respectively, were retrieved, with 149 and 5503 medically confirmed. The most common medically confirmed adverse events were consistent with the known safety profile of levothyroxine, with generally comparable rates between both formulations (range of differences, 1.8-4.1%). Most cases were not serious (old formulation, 65.8%; new formulation, 78.7%). Reporting rates were similar or higher for the old formulation within subgroups of at-risk patients. Nature/distributions of adverse events by thyroid-stimulating hormone levels as determined by both the marketing authorization holder of levothyroxine and the French National Agency for Medicines and Health Products Safety were similar.

CONCLUSIONS

The new formulation safety profile aligns with the established profile of the old formulation of levothyroxine. The benefit-risk profile is unchanged, such that the benefits of using the new formulation in the approved indications outweigh the risks associated with the treatment.

Applications of artificial intelligence in drug development using real-world data

The US Food and Drug Administration (FDA) has been actively promoting the use of real-world data (RWD) in drug development. RWD can generate important real-world evidence reflecting the real-world clinical environment where the treatments are used. Meanwhile, artificial intelligence (AI), especially machine- and deep-learning (ML/DL) methods, have been increasingly used across many stages of the drug development process. Advancements in AI have also provided new strategies to analyze large, multidimensional RWD. Thus, we conducted a rapid review of articles from the past 20 years, to provide an overview of the drug development studies that use both AI and RWD. We found that the most popular applications were adverse event detection, trial recruitment, and drug repurposing. Here, we also discuss current research gaps and future opportunities.

Social media analytics in nutrition research: a rapid review of current usage in investigation of dietary behaviours

OBJECTIVE

Social media analytics (SMA) has a track record in business research. The utilisation in nutrition research is unknown, despite social media being populated with real-time eating behaviours. This rapid review aimed to explore the use of SMA in nutrition research with the investigation of dietary behaviours.

DESIGN

The review was conducted according to rapid review guidelines by WHO and the National Collaborating Centre for Methods and Tools. Five databases of peer-reviewed, English language studies were searched using the keywords 'social media' in combination with 'data analytics' and 'food' or 'nutrition' and screened for those with general population health using SMA on public domain, social media data between 2014 and 2020.

RESULTS

The review identified 34 studies involving SMA in the investigation of dietary behaviours. Nutrition topics included population nutrition health investigations, alcohol consumption, dieting and eating out of the home behaviours. All studies involved content analysis with evidence of surveillance and engagement. Twitter was predominant with data sets in tens of millions. SMA tools were observed in data discovery, collection and preparation, but less so in data analysis. Approximately, a third of the studies involved interdisciplinary collaborations with health representation and only two studies involved nutrition disciplines. Less than a quarter of studies obtained formal human ethics approval.

CONCLUSIONS

SMA in nutrition research with the investigation of dietary behaviours is emerging, nevertheless, if consideration is taken with technological capabilities and ethical integrity, the future shows promise at a broad population census level and as a scoping tool or complementary, triangulation instrument.

A Comparative View of Reported Adverse Effects of Statins in Social Media, Regulatory Data, Drug Information Databases and Systematic Reviews

INTRODUCTION

There are few studies assessing how data on adverse drug events from consumers on social media compare with other sources.

AIM

The aim of this study was to assess the consistency of adverse event data of statin medications from social media as compared with other sources.

METHODS

We collected data on the adverse events of statins from Twitter, the US FDA Adverse Event Reporting System (FAERS), the UK Medicines and Healthcare products Regulatory Agency (MHRA), drug information databases (DIDs) and systematic reviews. We manually annotated 12,649 tweets collected between June 2013 and August 2018. We collected 45,447 reports from FAERS, 10,415 from MHRA, identified 17 systematic reviews with relevant data and extracted data from Facts and Comparisons^® and Clinical Pharmacology^®. We compared the proportion, relative frequencies and rank of each category of adverse event from each source using MedDRA^® primary System Organ Class codes.

RESULTS

Compared with other sources, patients on social media are proportionally far more likely to complain about musculoskeletal symptoms than other adverse events. Most adverse events showed a high level of agreement between Twitter and regulatory data. DIDs tend to demonstrate similar patterns but not as strongly. Systematic reviews tend to examine pre-specified adverse events or those reported by trial investigators.

CONCLUSIONS

Combining the data from multiple sources, albeit challenging, may provide a broader safety profile of any medication. Systematically collected social media reports may be able to contribute information on the most pertinent adverse effects to patients.

Social Media Text Mining Framework for Drug Abuse: Development and Validation Study With an Opioid Crisis Case Analysis

Background

Social media are considered promising and viable sources of data for gaining insights into various disease conditions and patients’ attitudes, behaviors, and medications. They can be used to recognize communication and behavioral themes of problematic use of prescription drugs. However, mining and analyzing social media data have challenges and limitations related to topic deduction and data quality. As a result, we need a structured approach to analyze social media content related to drug abuse in a manner that can mitigate the challenges and limitations surrounding the use of such data.

Objective

This study aimed to develop and evaluate a framework for mining and analyzing social media content related to drug abuse. The framework is designed to mitigate challenges and limitations related to topic deduction and data quality in social media data analytics for drug abuse.

Methods

The proposed framework started with defining different terms related to the keywords, categories, and characteristics of the topic of interest. We then used the Crimson Hexagon platform to collect data based on a search query informed by a drug abuse ontology developed using the identified terms. We subsequently preprocessed the data and examined the quality using an evaluation matrix. Finally, a suitable data analysis approach could be used to analyze the collected data.

Results

The framework was evaluated using the opioid epidemic as a drug abuse case analysis. We demonstrated the applicability of the proposed framework to identify public concerns toward the opioid epidemic and the most discussed topics on social media related to opioids. The results from the case analysis showed that the framework could improve the discovery and identification of topics in social media domains characterized by a plethora of highly diverse terms and lack of a commonly available dictionary or language by the community, such as in the case of opioid and drug abuse.

Conclusions

The proposed framework addressed the challenges related to topic detection and data quality. We demonstrated the applicability of the proposed framework to identify the common concerns toward the opioid epidemic and the most discussed topics on social media related to opioids.

Diabetes-Related Topics in an Online Forum for Caregivers of Individuals Living With Alzheimer Disease and Related Dementias: Qualitative Inquiry

BACKGROUND

Diabetes and Alzheimer disease and related dementias (ADRD) are the seventh and sixth leading causes of death in the United States, respectively, and they coexist in many older adults. Caring for a loved one with both ADRD and diabetes is challenging and burdensome.

OBJECTIVE

This study aims to explore diabetes-related topics in the Alzheimer's Association ALZConnected caregiver forum by family caregivers of persons living with ADRD.

METHODS

User posts on the Alzheimer's Association ALZConnected caregiver forum were extracted. A total of 528 posts related to diabetes were included in the analysis. Of the users who generated the 528 posts, approximately 96.1% (275/286) were relatives of the care recipient with ADRD (eg, child, grandchild, spouse, sibling, or unspecified relative). Two researchers analyzed the data independently using thematic analysis. Any divergence was discussed among the research team, and an agreement was reached with a senior researcher's input as deemed necessary.

RESULTS

Thematic analysis revealed 7 key themes. The results showed that comorbidities of ADRD were common topics of discussions among family caregivers. Diabetes management in ADRD challenged family caregivers. Family caregivers might neglect their own health care because of the caring burden, and they reported poor health outcomes and reduced quality of life. The online forum provided a platform for family caregivers to seek support in their attempts to learn more about how to manage the ADRD of their care recipients and seek support for managing their own lives as caregivers.

CONCLUSIONS

The ALZConnected forum provided a platform for caregivers to seek informational and emotional support for caring for persons living with ADRD and diabetes. The overwhelming burdens with these two health conditions were apparent for both caregivers and care recipients based on discussions from the online forum. Studies are urgently needed to provide practical guidelines and interventions for diabetes management in individuals with diabetes and ADRD. Future studies to explore delivering diabetes management interventions through online communities in caregivers and their care recipients with ADRD and diabetes are warranted.

Use of Social Media for Pharmacovigilance Activities: Key Findings and Recommendations from the Vigi4Med Project

The large-scale use of social media by the population has gained the attention of stakeholders and researchers in various fields. In the domain of pharmacovigilance, this new resource was initially considered as an opportunity to overcome underreporting and monitor the safety of drugs in real time in close connection with patients. Research is still required to overcome technical challenges related to data extraction, annotation, and filtering, and there is not yet a clear consensus concerning the systematic exploration and use of social media in pharmacovigilance. Although the literature has mainly considered signal detection, the potential value of social media to support other pharmacovigilance activities should also be explored. The objective of this paper is to present the main findings and subsequent recommendations from the French research project Vigi4Med, which evaluated the use of social media, mainly web forums, for pharmacovigilance activities. This project included an analysis of the existing literature, which contributed to the recommendations presented herein. The recommendations are categorized into three categories: ethical (related to privacy, confidentiality, and follow-up), qualitative (related to the quality of the information), and quantitative (related to statistical analysis). We argue that the progress in information technology and the societal need to consider patients' experiences should motivate future research on social media surveillance for the reinforcement of classical pharmacovigilance.

Digital Health Strategies to Fight COVID-19 Worldwide: Challenges, Recommendations, and a Call for Papers

The coronavirus disease (COVID-19) pandemic has created an urgent need for coordinated mechanisms to respond to the outbreak across health sectors, and digital health solutions have been identified as promising approaches to address this challenge. This editorial discusses the current situation regarding digital health solutions to fight COVID-19 as well as the challenges and ethical hurdles to broad and long-term implementation of these solutions. To decrease the risk of infection, telemedicine has been used as a successful health care model in both emergency and primary care. Official communication plans should promote facile and diverse channels to inform people about the pandemic and to avoid rumors and reduce threats to public health. Social media platforms such as Twitter and Google Trends analyses are highly beneficial to model pandemic trends as well as to monitor the evolution of patients' symptoms or public reaction to the pandemic over time. However, acceptability of digital solutions may face challenges due to potential conflicts with users' cultural, moral, and religious backgrounds. Digital tools can provide collective public health benefits; however, they may be intrusive and can erode individual freedoms or leave vulnerable populations behind. The COVID-19 pandemic has demonstrated the strong potential of various digital health solutions that have been tested during the crisis. More concerted measures should be implemented to ensure that future digital health initiatives will have a greater impact on the epidemic and meet the most strategic needs to ease the life of people who are at the forefront of the crisis.

Consumer understanding of the scope of FDA's prescription drug regulatory oversight: A nationally representative survey

PURPOSE

Misperceptions of how the US Food and Drug Administration (FDA) regulates prescription drugs may affect how consumers assess the safety and efficacy of prescription drugs. The study objective was to survey the public on their knowledge of FDA oversight regarding prescription drug approval and advertising.

METHODS

In 2017, we conducted a nationally representative mail-push-to-web survey with 1,744 US adults.

RESULTS

Although most respondents (86%) knew that FDA approves prescription drugs, we found misperceptions about what that approval means. In addition, few respondents understood FDA oversight of prescription drug advertising, with approximately half of respondents reporting that they did not know whether FDA approved these ads or components of the ads, and several mis-reporting that FDA approves these ads (31%) or components of the ads (22%-41%).

CONCLUSIONS

Enhanced collaboration and communication with the public by key stakeholders in this space could increase public understanding of the roles and responsibilities of FDA.

Public Opinions on Using Social Media Content to Identify Users With Depression and Target Mental Health Care Advertising: Mixed Methods Survey

BACKGROUND

Depression is a common disorder that still remains underdiagnosed and undertreated in the UK National Health Service. Charities and voluntary organizations offer mental health services, but they are still struggling to promote these services to the individuals who need them. By analyzing social media (SM) content using machine learning techniques, it may be possible to identify which SM users are currently experiencing low mood, thus enabling the targeted advertising of mental health services to the individuals who would benefit from them.

OBJECTIVE

This study aimed to understand SM users' opinions of analysis of SM content for depression and targeted advertising on SM for mental health services.

METHODS

A Web-based, mixed methods, cross-sectional survey was administered to SM users aged 16 years or older within the United Kingdom. It asked participants about their demographics, their usage of SM, and their history of depression and presented structured and open-ended questions on views of SM content being analyzed for depression and views on receiving targeted advertising for mental health services.

RESULTS

A total of 183 participants completed the survey, and 114 (62.3%) of them had previously experienced depression. Participants indicated that they posted less during low moods, and they believed that their SM content would not reflect their depression. They could see the possible benefits of identifying depression from SM content but did not believe that the risks to privacy outweighed these benefits. A majority of the participants would not provide consent for such analysis to be conducted on their data and considered it to be intrusive and exposing.

CONCLUSIONS

In a climate of distrust of SM platforms' usage of personal data, participants in this survey did not perceive that the benefits of targeting advertisements for mental health services to individuals analyzed as having depression would outweigh the risks to privacy. Future work in this area should proceed with caution and should engage stakeholders at all stages to maximize the transparency and trustworthiness of such research endeavors.

Artificial Intelligence for Drug Toxicity and Safety

Interventional pharmacology is one of medicine's most potent weapons against disease. These drugs, however, can result in damaging side effects and must be closely monitored. Pharmacovigilance is the field of science that monitors, detects, and prevents adverse drug reactions (ADRs). Safety efforts begin during the development process, using in vivo and in vitro studies, continue through clinical trials, and extend to postmarketing surveillance of ADRs in real-world populations. Future toxicity and safety challenges, including increased polypharmacy and patient diversity, stress the limits of these traditional tools. Massive amounts of newly available data present an opportunity for using artificial intelligence (AI) and machine learning to improve drug safety science. Here, we explore recent advances as applied to preclinical drug safety and postmarketing surveillance with a specific focus on machine and deep learning (DL) approaches.

Pedagogical Demonstration of Twitter Data Analysis: A Case Study of World AIDS Day, 2014

As a pedagogical demonstration of Twitter data analysis, a case study of HIV/AIDS-related tweets around World AIDS Day, 2014, was presented. This study examined if Twitter users from countries with various income levels responded differently to World AIDS Day. The performance of support vector machine (SVM) models as classifiers of relevant tweets was evaluated. A manual coding of 1,826 randomly sampled HIV/AIDS-related original tweets from November 30 through December 2, 2014 was completed. Logistic regression was applied to analyze the association between the World Bank-designated income level of users’ self-reported countries and Twitter contents. To identify the optimal SVM model, 1278 (70%) of the 1826 sampled tweets were randomly selected as the training set, and 548 (30%) served as the test set. Another 180 tweets were separately sampled and coded as the held-out dataset. Compared with tweets from low-income countries, tweets from the Organization for Economic Cooperation and Development countries had 60% lower odds to mention epidemiology (adjusted odds ratio, aOR = 0.404; 95% CI: 0.166, 0.981) and three times the odds to mention compassion/support (aOR = 3.080; 95% CI: 1.179, 8.047). Tweets from lower-middle-income countries had 79% lower odds than tweets from low-income countries to mention HIV-affected sub-populations (aOR = 0.213; 95% CI: 0.068, 0.664). The optimal SVM model was able to identify relevant tweets from the held-out dataset of 180 tweets with an accuracy (F1 score) of 0.72. This study demonstrated how students can be taught to analyze Twitter data using manual coding, regression models, and SVM models.

Monitoring Twitter Conversations for Targeted Recruitment in Cancer Trials in Los Angeles County: Protocol for a Mixed-Methods Pilot Study

BACKGROUND

Insufficient recruitment of participants remains a critical roadblock to successful clinical research, particularly clinical trials. Social media provide new ways for connecting potential participants with research opportunities. Researchers suggest that the social network Twitter may serve as a rich avenue for exploring how patients communicate about their health issues and increasing enrollment in cancer clinical trials. However, there is a lack of evidence that Twitter offers practical utility and impact.

OBJECTIVE

This pilot study aimed to examine the feasibility and impact of using Twitter monitoring data (ie, user activity and their conversations about cancer-related conditions and concerns expressed by Twitter users in Los Angeles County) as a tool for enhancing clinical trial recruitment at a comprehensive cancer center.

METHODS

We will conduct a mixed-methods interrupted time series study design with a before-and-after social media recruitment intervention. On the basis of a preliminary analysis of eligible trials, we plan to onboard at least 84 clinical trials across 6 disease categories: breast cancer, colon cancer, kidney cancer, lymphoma, non-small cell lung cancer, and prostate cancer that are open to accrual at the University of Southern California (USC) Norris Comprehensive Cancer Center. We will monitor messages about these 6 cancer conditions posted by Twitter users in Los Angeles County. Recruitment for the trials will occur through the Twitter account (@USCTrials). Primary study outcomes-feasibility and acceptance of the social media intervention among targeted Twitter users and the study teams of the onboarded trials-will be assessed using qualitative interviews and the 4-point Likert scale and by calculating the proportion of targeted Twitter users who engaged with outreach messages. Second, impact of the social media intervention will be measured by calculating the proportion of enrollees in trials. The enrollment rate will be compared between the active intervention period and the prior 10 months as historical control for each disease trial group. This study has been funded by the National Center for Advancing Translational Science through a Clinical and Translational Science Award. Study approval was obtained from the clinical investigations committee at USC Norris and the institutional review board at USC.

RESULTS

Recruitment on Twitter started in February 2018. Data collection will be completed in November 2018.

CONCLUSIONS

This pilot project will provide preliminary data and practical insight into the application of publicly available Twitter data to identify and recruit clinical trial participants across 6 cancer disease types. We will shed light on the acceptance of the social media intervention among Twitter users and study team members of the onboarded trials. If successful, the findings will inform a multisite randomized controlled trial to determine the efficacy of the social media intervention across different locations and populations.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03408561; https://clinicaltrials.gov/ct2/show/NCT03408561 (Archived by WebCite at http://www.webcitation.org/72LihauzW).

REGISTERED REPORT IDENTIFIER

RR1-10.2196/9762.