What do neurology information seekers really want?

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, wherewhy, and how of neurology information quest.

https://pixabay.com/en/questions-who-what-how-why-where-1328465/

 

We asked these question specifically to guide a major Neurochecklists upgrade. 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 what really matters to people when they go foraging for neurology. What do they really want, and how do they go about satisfying their need?

Search Key. GotCredit on Flickr. https://www.flickr.com/photos/gotcredit/32943606783/

 

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.

Q&A. opensource.com on Flickr. https://www.flickr.com/photos/opensourceway/5556249000

 

Who searches for neurology information?

More than 50% of our responders were consultant neurologists, and about 15% were medical consultantsNeurology 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

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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 enhanced Neurochecklists. Watch out for our next blog post to find out the changes we will be launching soon. Neurology seekers, watch this space!

By AnsonloboOwn work, CC BY-SA 4.0, Link

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.

Neurochecklists image

  neurochecklists

 

So what is so remarkable about neurology anyway?

There is an astounding variety of reasons why a patient may be referred to a neurologist. The neurologist is easily identified as a brain doctor, and the patient may, after all, just have some tingling in the feet or some flickering of the muscles. Many patients may only have heard of prominent neurologists such as Oliver Sacks.

9.13.09 Oliver Sacks By Luigi Novi
9.13.09 Oliver Sacks By Luigi Novi

 

Or perhaps that man Sigmund Freud-or was he a psychoanalyst?

"Sigmund Freud LIFE" by Max Halberstadt - http://politiken.dk/kultur/boger/faglitteratur_boger/ECE1851485/psykoanalysen-har-stadig-noget-at-sige-i-noejagtigt-betitlet-bog/. Licensed under Public Domain via Commons - https://commons.wikimedia.org/wiki/File:Sigmund_Freud_LIFE.jpg#/media/File:Sigmund_Freud_LIFE.jpg
“Sigmund Freud LIFE” by Max Halberstadt – http://politiken.dk/kultur/boger/faglitteratur_boger/ECE1851485/psykoanalysen-har-stadig-noget-at-sige-i-noejagtigt-betitlet-bog/. Licensed under Public Domain via Commons – https://commons.wikimedia.org/wiki/File:Sigmund_Freud_LIFE.jpg#/media/File:Sigmund_Freud_LIFE.jpg

 

Apart from the fact that both are bearded, there is absolutely nothing similar to the practice of Sacks and Freud. You may refer to my post on the 100 all-time most influential neurologists for a flavour of the diverse and prominent neurologists.

By Joaquín Sorolla (1863 - 1923) ([1]) [Public domain or Public domain], via Wikimedia Commons
Santiago Ramon y Cajal By Joaquín Sorolla (1863 – 1923) ([1]) [Public domain or Public domain], via Wikimedia Commons

And this is what baffles patients; their inability to pigeon-hole a neurologist. Most medical specialists are easily identified by the restricted range of patients they see but neurology has a bewildering diversity of specialties. A cardiologist or a nephrologist comes with a clear label on the box, but the neurologist deals with conditions that extend from the top of the head to the tips of the toes.

"Components of the Nervous System" by Jenna Fair - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Components_of_the_Nervous_System.png#/media/File:Components_of_the_Nervous_System.png
“Components of the Nervous System” by Jenna Fair – Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons – https://commons.wikimedia.org/wiki/File:Components_of_the_Nervous_System.png#/media/File:Components_of_the_Nervous_System.png

 

Neurological conditions are broadly defined as either affecting the central nervous system (brain and spinal cord) or the peripheral nervous system. Each of these then has several subspecialties that are mind-boggling.

Charis Tsevis Wired Nerves for Harrison & star. Flikr. https://www.flickr.com/photos/tsevis/8043450564
Charis Tsevis on Flikr. Wired Nerves for Harrison & Star. https://www.flickr.com/photos/tsevis/8043450564

 

The peripheral nervous system for instance consists of a diversity of motor and sensory nerves, and these communicate with organs, muscles and tissues all over the body. And there is an overwhelming array of things that can go wrong at each point of the nervous system, resulting in a myriad of nervous system diseases.

 

Gontzal García del Caño on Flikr. Spinal cord and spinal nerves. https://www.flickr.com/photos/euskalanato/2056232391
Gontzal García del Caño on Flikr. Spinal cord and spinal nerves. https://www.flickr.com/photos/euskalanato/2056232391

 

Peripheral nerve dysfunction may therefore give rise to disorders of the anterior horn cell, the nerve root, the ganglion, the neuromuscular junction, muscles, small and large nerve fibers. Each of these are further subclassified, a reflection of the diversity of neurological disorders. Take a look for example at the complex neuromuscular junction below, and you will appreciate the literally countless things that may go amiss.

"Synapse diag4". Licensed under CC BY-SA 3.0 via Commons - https://commons.wikimedia.org/wiki/File:Synapse_diag4.png#/media/File:Synapse_diag4.png
“Synapse diag4”. Licensed under CC BY-SA 3.0 via Commons – https://commons.wikimedia.org/wiki/File:Synapse_diag4.png#/media/File:Synapse_diag4.png

 

The diversity of neurological problems was brought home to me when I took up the task of compiling a database of neurology checklists. I blame Atul Gawande‘s Checklist Manifesto for this excursion on my part. The process was like opening up a can of worms; below is the broad range of major neurological disease categories I found:

  • Epilepsy
  • Disorders of Cranial Nerves
  • Disorders of Cognition
  • Disorders of Consciousness
  • Neurological Infections
  • Neurological Toxicity
  • Sleep disorders
  • Developmental Disorders
  • Parkinsonism
  • Other movement Disorders
  • Neuro-inflammatory Disorders
  • Headache Disorders
  • Metabolic disorders
  • Autoimmune Disorders
  • Anterior Horn Cell disorders
  • Radicular disorders
  • Plexus Disorders
  • Peripheral Nerve Disorders
  • Neuromuscular Junction (NMJ) disorders
  • Muscle Disorders
  • Spinal Cord Disorders
  • Nervous System Tumours
  • Stroke
  • Other Vascular Disorders

Neurology also has significant overlaps with other specialties, and neurologists often have to deal with:

  • Disorders of Allied Neurological Specialties
  • Neurological Disorders and General Medicine

What is so remarkable about neurology? It encompasses an unimaginable diversity of diseases. Many such as as migraine, Parkinson’s disease (PD) and peripheral neuropathy are common. For a taste of the diversity of these common diseases, see my previous blogs on neurology guidelines and neurology review articles. Many neurological diseases are however rare and complicated; for a flavour of the rarer diseases, take a look at my previous blog post on the most esoteric neurological conditions.

Typhoon at English Wikipedia [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons
Typhoon at English Wikipedia [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)%5D, via Wikimedia Commons

These are the remarkable things neurologist try to sort out. But how do they do it? How do they go about teasing out what is what? What is in the neurological toolbox? The key is the neurological consultation, an assessment so alien, using tools so scary, that it takes many patients aback: watch out for my future blog on The 20 Bizarre Things Neurologists Do To Their Patients.