How will neurology checklists unlock excellent practice?

Launching neurochecklists

After 5 years of data gathering and sorting, neurochecklists launches today. This is a web-based application which covers the spectrum of neurological practice. I was prompted by Atul Gawande‘s call to physicians to develop checklist-driven medicine, as I discussed in my previous blog post, What is the value of checklists in medical practice? Conceived in libraries and coffee shops, lay-bys and terminals, neurochecklists is the culmination of a vision to commit the whole of neurology to checklists.

 

Neurochecklists image

 

What exactly is neurochecklists?

Neurochecklists is a comprehensive and easy-to-search database consisting of thousands of checklists. It is conceived as a mobile resource to aid all cadres of medical professionals. It has 18 categories, each consisting of chapters divided into topics. All checklists are brief and divided into sub-checklists as required. Users may explore topics either through the search boxes available on all webpages, or via the Index. Each checklist is fully referenced, and all articles are hyperlinked to their PubMed abstracts, and books to their Amazon.com page.

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How can neurochecklists help neurological practice?

1. By quickly checking up a topic in the clinic or on a ward round

And you haven't been to your doctor because? Alex Proimos on Flikr. https://www.flickr.com/photos/proimos/6870109454
And you haven’t been to your doctor because? Alex Proimos on Flikr. https://www.flickr.com/photos/proimos/6870109454

2. By helping the preparation of presentations or teachings

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3. By making reading for examinations and researching a topic easier

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4. By complementing the search for relevant and up-to-date references

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5. Facilitating neurology discussions with patients 

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What exactly does neurochecklists contain?

Neurochecklists is extensive, covering all the core neurological subspecialties:

  • Disorders of Cranial Nerves
  • Disorders of Cognition
  • Disorders of Consciousness
  • Neurological Infections and Toxicity
  • Epilepsy
  • Parkinsonism
  • Non-Parkinsonian Movement Disorders
  • Headache Disorders
  • Neuroinflammatory Disorders
  • Anterior Horn Cell Disorders
  • Peripheral Nerve and Radicular Disorders
  • Neuromuscular Junction and Muscle Diseases
  • Stroke
  • Nervous System Tumours
  • Spinal Cord Disorders
  • Autoimmune and Metabolic Disorders
Binaural-beat-digital-drug. Digitalbob8 on Flikr. https://www.flickr.com/photos/44568283@N02/4098316274
Binaural-beat-digital-drug. Digitalbob8 on Flikr. https://www.flickr.com/photos/44568283@N02/4098316274

Neurochecklists also addresses the range of allied neurological specialities such as:

  • Neurophysiology
  • Neurosurgery
  • Neuroradiology
  • Neuropsychiatry
  • Neuroophthalmology
  • Neurootology
  • Pain Disorders
  • General medicine
  • Surgery
  • Pregnancy

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These diseases are all reviewed from diverse perspectives:

  • Epidemiology
  • Genetics
  • Pathology
  • Clinical Features
  • Investigations 
  • Treatment
Human brain illustrated with millions of small nerves. Ars Electronica on Flikr. https://www.flickr.com/photos/arselectronica/13994747444
Human brain illustrated with millions of small nerves. Ars Electronica on Flikr. https://www.flickr.com/photos/arselectronica/13994747444

 

How reliable are neurochecklists?

In developing neurochecklistsI took into consideration the challenges of such a project as discussed in my previous blog, What are the obstacles to creating reliable neurology checklists? Neurochecklists has also gone through a beta-testing stage, and the feedback has influenced the final version. This is however the beginning of the journey to maintain and improve the database. This on-going challenge will require feedback from users which will be invaluable in advancing the app to higher levels.

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What will it cost to access neurochecklists?

Neurochecklists comes with two levels of access. There is a free version which entitles users to 15 free searches a month. There is therefore no excuse not to have a neurochecklists account! To get the maximum benefit of neurochecklists, a premium account is required, and this comes at the equivalent cost of a coffee and cake a month, and even less with an annual subscription.

 

Cake and coffee. Jeremey keith on Flikr. https://www.flickr.com/photos/adactio/4925134798
Cake and coffee. Jeremey keith on Flikr. https://www.flickr.com/photos/adactio/4925134798

 

The reason for paid subscriptions is to help offset the heavy financial cost of app development and future improvement and enhancement plans. One such plan is to develop android and ios platforms. I am however open to suggestions to make this a completely free resource.

 

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Who helped to develop neurochecklists?

Neurochecklists is the result of a collaborative effort in many ways. My wife Zainab has been invaluable in encouraging and supporting me throughout the journey. To Jafaru Dori for invaluable guidance, support and connections. To the bright young men at Studio 14, Stephen, Tobi and Timi for their great imagination and passion for the project. My gratitude to my work colleagues and the hundreds of social media friends who share so much knowledge, much of which has found its way into neurochecklists. And finally my apologies to Aminah, Safiyyah, Ja’far, and Maryam for not having their dad’s full attention for so long. Hopefully it’s been worth the while.

Feedback checklist. AJ Cann on Flikr. https://www.flickr.com/photos/ajc1/9568156463
Feedback checklist. AJ Cann on Flikr. https://www.flickr.com/photos/ajc1/9568156463

How to get to neurochecklists?

If you have so far resisted the dozen opportunities to click on neurochecklists, go on now and click on the image or text below to check it out! Don’t forget to leave your feedback.

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What are the obstacles to creating reliable neurology checklists?

This is a follow up to my previous blog post on the value of checklists in medical practice. That post explored how checklists improve clinical practice and promote patient safety. It also cited Atul Gawande‘s call to Medicine to “seize the opportunity” and produce checklists for all aspects of clinical practice.

Neurology. MV Maverick. https://www.flickr.com/photos/themvmaverick/11396461045
Neurology. MV Maverick. https://www.flickr.com/photos/themvmaverick/11396461045

 

Picking up this gauntlet for neurology comes with peculiar challenges. Here are the 7 hurdles to overcome.

1. The challenge of a diverse specialty

Legume diversity. Global Crop Diversity Trust on Flikr. https://www.flickr.com/photos/croptrust/3594324633
Legume diversity. Global Crop Diversity Trust on Flikr. https://www.flickr.com/photos/croptrust/3594324633

Neurology consists of an astonishing diversity of sub-specialities. Any neurology checklist must exhaustively cover the major neurological categories such as stroke, epilepsy, movement disorders, headache, dementia, neuromuscular diseases, sleep disorders, neuro-inflammation, nervous system tumours, and neurological infections. These topics must be thoroughly covered with emphasis on their clinical features, investigations, and treatments. A useful database must also include rare neurological diseases, of which neurology has quite a few. This is reflected in my previous blog on the most perplexing diseases that excite neurologists.

2. The challenge of multiple associated specialties

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Neurological disorders cut across many diverse allied neurological specialties. Any dependable checklist database must cover these specialised fields which include neurosurgery, neuroradiology, neuroophthalmology, neuropsychiatry, neuropaediatrics, and pain management. It must also include important diseases which straddle neurology and general medicine. These include a long list of cardiovascular, nutritional, endocrine and gastrointestinal disorders. Furthermore, neurologists often have to deal with surgical complications especially in orthopaedics and following transplant surgery. Neurologists are also frequently called upon to attend to neurological problems that are unique to pregnancy. Any practical checklist application must therefore thoroughly address these areas.

Brain Cells Created From Skin Cells in Landmark Study. Day Donaldson on Flikr. https://www.flickr.com/photos/thespeakernews/15656329862
Brain Cells Created From Skin Cells in Landmark Study. Day Donaldson on Flikr. https://www.flickr.com/photos/thespeakernews/15656329862

3. The challenge of reliable content

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It goes without saying that the most important feature of any database is reliable content which alone will engender trust and confidence. A reliable checklist must obtain its material from dependable sources. Neurology is replete with reliable textbooks and reference websites, . Neurology is also bursting at the seams with journals such as Neurology, Brain, the JNNP, and Journal of Neurology, each churning out a bewildering array of neurology guidelines, review articles, ground-breaking studies, and fascinating case reports. The challenge is to keep a regular handle on these sources, sifting through for practical and established material. As important for the user is that any checklist must be fully referenced and hyperlinked to the source material.

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4. The challenge of practical functionality

Any practical checklist database must be available on the move, easily accessible and searchable. In other words, it must be in the form of a mobile application. The app must have a reliable search functionality. More importantly for users is the requirement that the application must serves as a prompt to remember important points across the breadth of neurological practice: history taking, investigations, differential diagnosis, and treatment. For the administrator, the technology must make it easy to update and edit content, keeping the content consistently up-to-date.

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5. The challenge of varied target groups

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In developing any form of medical resource, it is a challenge to define the target audience. The primary aim of a neurology checklist application is to ease the challenges medical professionals face in accessing relevant and practical information about neurology in a timely way. This may be on a busy ward round or clinic, but also when researching a topic or preparing a presentation. The core users of a neurology application will therefore clearly be neurologists and neurology trainees.

By SpinningSpark real life identity: SHA-1 commitment ba62ca25da3fee2f8f36c101994f571c151abee7 - Created with Superliminal's Magic Cube 4D, CC BY-SA 3.0, https://en.wikipedia.org/w/index.php?curid=17492843
By SpinningSpark real life identity: SHA-1 commitment ba62ca25da3fee2f8f36c101994f571c151abee7 – Created with Superliminal’s Magic Cube 4D, CC BY-SA 3.0, https://en.wikipedia.org/w/index.php?curid=17492843

In many places however other cadres of medicine cater for people with neurological diseases. Psychiatrists, neurosurgeons, paediatriciansgeneral physicians, obstetricians, ophthalmologists, specialist and general nurses, would likely access the database. Other health care professionals may also find areas of interest such as speech therapists, physiotherapists and occupational therapistsMedical students and researchers also require vast amounts of neurological information, often within restricted time frames.

A Tangle of Different Colours 001. Christina Quinn on Flikr. https://www.flickr.com/photos/chrisser/7909899736
A Tangle of Different Colours 001. Christina Quinn on Flikr. https://www.flickr.com/photos/chrisser/7909899736

6. The challenge of public access

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Specialised medical application are never aimed at non-medically trained people. The reality however is that the general public are closely involved in their care today, seeking reliable information to address their medical concerns. It is inevitable that patients and their families will access the checklist database. For this reason the language must be simple and clear, avoiding any sort of ambiguity.

7. The challenge of resources and pricing

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A checklist application, to be most beneficial, should ideally be free to use. A Wikipedia model would be a model to adapt. But creating a checklist database, with all the features mentioned above, would surely stretch resources in terms of time and funding. There will also be great demands on resources to maintain and enhance it. A balance must be struck between beneficence and realism. Such a balance should have, as with most applications, a free version with sufficient access of some sort, and a premium version with unlimited access. The developer must also be aware that potential users have limited resources to spread round their conflicting demands. Any premium account should be affordable, perhaps not more than the equivalent cost of a cup of coffee and a cake a month.

Muffin and coffee. Phil Gyford on Flikr. https://www.flickr.com/photos/philgyford/6534958441
Muffin and coffee. Phil Gyford on Flikr. https://www.flickr.com/photos/philgyford/6534958441 

 

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Is there any neurology checklist application that has taken the above challenges into consideration? This will be revealed in my next blog post, How simple checklists unlock excellent neurological practice?

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Which are the most useful neurological applications?

It is no exaggeration to say our lives revolve around apps. These handy devices bring knowledge to our fingertips at the tap of the finger, or the click of a mouse . They promise easy access to a world of information, often digested to size. Some offer tools to simplify our practice. Neurology is, or should be, no exception.

Apple Store according to the New York Times. Wolf Gang on Flikr. https://www.flickr.com/photos/wolfgangkuhnle/4163909778
Apple Store according to the New York Times. Wolf Gang on Flikr. https://www.flickr.com/photos/wolfgangkuhnle/4163909778

 

So what are the tools out there making neurological practice easier and handier? What are these practical shortcuts making clinical work more efficient? I browsed the web to and found some useful neurology applications and have grouped them as below.

Clinical management apps

Apps that aid the clinical examination

  • Neuro Toolkit. This is only available for the iphone or ipad. A review on Neurology Times says it is ‘an up-to-date, simple and straightforward app’ that contains medical calculators and clinical scoring scales. It also received a favourable review in Neurology journal.
  • 5-minute Neurology Consult. The blurb on google play says Neurology Consult ‘provides instant access to comprehensive, clinically-oriented, must-have information on all disorders of the nervous system’.
  • Neurology a-pocket cards.
  • Neurology Exam Tools promises a flashlight and tuning fork which should lighten the neurologists tool case but it is not clear how efficiently.
  • Neuro Localizer sounds self-explanatory and is developed by neurologists.
  • Neurology pocket app with explanatory video below:

Apps oriented towards clinical scoring

Patient self-management apps

Rubik apps. Cesar Poyatos on Flikr. https://www.flickr.com/photos/cpoyatos/5791320785
Rubik apps. Cesar Poyatos on Flikr. https://www.flickr.com/photos/cpoyatos/5791320785

Disease-specific apps 

Anatomy apps

Journal apps

Allied neurological specialties apps 

Want to explore further? You may check these links out:

Watch out for Neurochecklists coming soon!

Know any useful apps I’ve missed out? Please leave a comment