A few months ago, Neurochecklists set out to discover how people go about searching for neurology information. We therefore carried out an online survey of neurology information users. We asked 10 critical questions about the who, what, where, why, and how of neurology information quest.
We asked these question specifically to guide a major Neurochecklistsupgrade. This knowledge is, after all, critical for a website which has set out to be the best source of clear, concise, and comprehensive neurology information. But we needed help to know whatreally matters to people when they go foraging for neurology. What do they really want, and how do they go about satisfying their need?
The response we got was heart-warming; about 190 people answered our online questions. Below are the questions along with the insights we gained from the answers.
Who searches for neurology information?
More than 50% of our responders were consultant neurologists, and about 15% were medical consultants. Neurology trainees constituted about 7%. The range of users is however quite broad, including nurses, surgeons, medical students, and patients! See the breakdown in the pie chart below:
Insight: There are diverse neurology information seekers!
How often do we forage for neurology information?
Neurology information is in high demand, with >50% of responders seeking information at least once a day, and >80% at least once a week. Below is the breakdown:
Insight: There is a huge craving for neurology information!
Where do we go when we need neurology information?
Online websites are by far the most popular source of quick neurology information, accounting for >50% of responses. This is followed by journals which account for just over 25% of responses. Very few responders access textbooks, handbooks, downloadable apps or online videos. Below is the breakdown:
Insight: Neurology source information is now mainly online
Where are we when we most crave neurology information?
In a question which allowed multiple answers, the clinic was by far the most common setting for looking up neurology information. We however also have a strong urge for neurology on the ward, and at home! Below is the breakdown:
Insight: The need for neurology information has no boundaries
Why do we access neurology information?
The most frequent reasons responders access neurology information were to answer clinical questions and for personal study. Other reasons were to aid discussions with patients, and to look for relevant references.
Insight: the checklist approach is the best solution
What devices do we use to access neurology information?
In another multiple answer question, responders most often use their phones to access online neurology information. Laptops and desktops are also favoured, but tablets much less so.
Insight: neurology information must be device-compatible
What features do we most favour in an online neurology database?
We asked what features responders most desire in an online neurology database, and the front-runners here are accuracy and currency of information, followed by conciseness, adequacy, ease of navigation, and link to references.
Insight: Neurochecklists is on the right track
We wish to extend our thanks to everybody who took part in the survey, including the many who attempted it after the closing date! We have taken all the responses on board, and we have been working night and day to provide an enhancedNeurochecklists. Watch out for our next blog post to find out the changes we will be launching soon. Neurology seekers, watch this space!
So what is this blog post about then? It is to announce that, after several months in beta version, Neurochecklists has come of age. During this time, the application went through massive expansion, refining, editing, and fine-tuning. More importantly, many of the hundreds of users sent it helpful feedback, all of which have helped to enhance the app. Most of the comments are indeed gratifying, as reflected in this screenshot which is now on the Neurochecklists landing page:
And here are few more…I just have to share!
“Interesting and convenient for everyday work…and… for continuing education”
“It’s nice and concise. A good quick reference”
“It would be helpful to all internists but more importantly, neurologists and neurology residents”
“It’s very good! It’s really practical”
“A fabulous quick reference material for neurologists and trainees”
“This is a really useful resource“
“It helps me to learn neurologysimpler and fast”
“Amazing! Good work!!!”
“Very good and very useful to neurologists in training and in practice”
“This is excellent…I love the instant access to abstracts especially useful to quote papers”
“It’s a good source of data“
“It’s a well designed and laid out site”
“Concise and therefore useful“
“I liked it. It is very useful“
“Very good portal for all relevant information”
OK, I admit it. I am posting the comments to encourage more people to register. There is a free account, but of course going Premium isn’t that painful either. And why not? Neurochecklists is packed with relevant and up-to-date information, linked to the latest references, and under constant review. It is comprehensive, concise, and handy. And it is now post-beta! And if you missed the 6 clickable opportunities above to go to the app, you may do so below. Go on then, explore it!
Anti VGKC antibody encephalitis is caused by two different antibodies called LGI1 and Caspr2. The immunology laboratory would however only test for these two if the ‘generic’ VGKC test is positive. Neurologists are understandably left scratching their heads when both tests turn out to be negative. Not any more, going by a report in Neurology titled The relevance of VGKC positivity in the absence of LGI1 and Caspr2 antibodies. The judgment is out: a positive VGCK antibody test is not significant if both LGI1 and Caspr2 are negative. What a relief.
Many acquired neurological disorders have a way of dragging genetics into their fold. Such is the case it seems with anti NMDA receptor encephalitis. This is the case with the GRIN-1 gene which codes for an NMDA receptor subunit. Mutations in this gene results in visual impairment, intellectual disability, and eye movement disorders. This is reported in Neurology by Josep Dalmauand colleagues in a paper titled Delineating the GRIN1 phenotypic spectrum. It is appropriate that the authors call this the genetic sibling of NMDA receptor encephalitis.
4. ECT for anti-NMDA receptor encephalitis
The typical treatment of autoimmune encephalitis revolves around steroids, intravenous immunoglobulins (IVIg), and plasma exchange. Neurologists, when pushed to the wall, may use heavy duty agents such as Rituximab and Cyclophosphamide. Because anti-NMDA receptor encephalitis may be associated with ovarian teratomas, neurologists may make the difficult trip across the border to consult their gynaecology colleagues. I thought these were all the treatment options for anti NMDA receptor encephalitis until I read this case report, again in Neurology, which reported an excellent response to Electroconvulsive therapy in anti-NMDA receptor encephalitis. A no-brainer then if you see neurologists exchanging pleasantries with psychiatrists: they are the ECT experts. It is just a case report for now, but well-worth thinking about when all else fails.
So what is the secret of neurochecklists? As a picture is worth a thousand words, a video clip must be worth a thousand blogs posts. Enough blogging on this subject then; here is a video glimpse at what makes neurochecklists tick-even if I say so myself!
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.
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 theirPubMed abstracts, and books to their Amazon.com page.
How can neurochecklists help neurological practice?
1. By quickly checking up a topic in the clinic or on a ward round
2. By helping the preparation of presentations or teachings
3. By making reading for examinationsand researchinga topic easier
4. By complementing the search for relevant and up-to-date references
5. Facilitating neurology discussions with patients
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
Non-Parkinsonian Movement Disorders
Anterior Horn Cell Disorders
Peripheral Nerve and Radicular Disorders
Neuromuscular Junction and Muscle Diseases
Nervous System Tumours
Spinal Cord Disorders
Autoimmune and Metabolic Disorders
Neurochecklists also addresses the range of allied neurological specialities such as:
These diseases are all reviewed from diverse perspectives:
How reliable are neurochecklists?
In developing neurochecklists, I 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.
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.
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.
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.
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.
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 promotepatient safety. It also cited Atul Gawande‘s call to Medicine to “seize the opportunity” and produce checklists for all aspects of clinical practice.
Picking up this gauntlet for neurology comes with peculiar challenges. Here are the 7 hurdles to overcome.
1. The challenge of a diverse specialty
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
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.
3. The challenge of reliable content
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.
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.
5. The challenge of varied target groups
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.
In many places however other cadres of medicine cater for people with neurological diseases. Psychiatrists, neurosurgeons, paediatricians, general 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 therapists. Medical students and researchers also require vast amounts of neurological information, often within restricted time frames.
6. The challenge of public access
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
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.
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?
We all know how important checklists are in our day-to-day lives. We cannot survive the day without a to-do list reminding us of the tasks that make our lives go round. It is clearly not an exaggeration to say we live by the checklist.
But checklists perform far more important roles than reminding us to buy the milk, or to pick junior after football practice. Checklists are central to the maintenance of safe practice in many industries. Checklists are best celebrated in aviation where they are indispensable to airlinesafety.
The Checklist Manifesto
Despite their recognised value, checklists are not applied widely enough in medicine. One person who has passionately addressed this shortcoming is Atul Gawande in his highly acclaimed book, The Checklist Manifesto. In this book, the author explored the positive impact of checklists based on his own research into surgical safety. His view of checklists is quite instructive, for example when he says:
Checklists translate knowledge into a simple, usable, and systematic form
Checklists are quick and simple tools aimed to buttress the skills of expert professionals.
Good checklists could become as important for doctors and nurses as good stethoscopes
The WHO surgical safety checklist
Gawande’s major contribution to patient safety is the development of the acclaimed WHO Surgical Safety Checklist. This simple tool is now a key component of surgical operating procedures globally.
Gawande’s own experience of using the checklist shows how important this tool is. He says:
I have yet to get through a week in surgery without the checklist’s leading us to catch something we would have missed
With the checklist in place, we have caught unrecognized drug allergies, equipment problems, confusion about medications, mistakes on labels for biopsy specimens
We have made better plans and been better prepared for patients
Beyond the operating room
Atul Gawande made the important observation that checklists have potential applications “beyond the operating room“. He said “…there are hundreds, perhaps thousands, of things doctors do that are as dangerous and prone to error as surgery“. He gave several examples of these such as the evaluation of headache, chest pain, lung nodules and breast lumps. He also pointed to the treatment of heart attacks, strokes, drug overdoses, pneumonias, kidney failures, seizures, and headache.
Addressing Gawande’s challenge
Gawande appreciates that all medical activities involve risk, uncertainty, and complexity. His simple recommendation is to commit them all to checklists. He urges the medical fraternity to seize the opportunity and do this. Apart from Anaesthesia which is probably ahead of the curve, there are only few medical checklists such as:
Gawande’s vision of a checklist-led approach to medicine, encompassing the spectrum of clinical practice, is indeed challenging. As a neurologist who is keen on patient safety, I was intrigued by this perspective, and I wondered if it was possible to commit the whole of neurology to checklists. In taking up the challenge, I imagined a neurology checklist application that is practical, comprehensive, easy to search, evidence-based, and up-to-date. After five years of collecting and distilling articles, reviews and guidelines, and after months of engagement with software developers, the dream is becoming reality. In my next blog post I will describe the outcome of the journey and discuss how simple checklists may unlock excellent neurological practice.
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.
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
StrokePad™is an electronic patient record for stroke care
FAST Test to evaluate stroke risk using the FAST mnemonic
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’.