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Neuronline review of SimulConsult by G. Fuller. Imagine the scene: you have just seen a patient with what seems likely to be an inherited or congenital syndrome who has a combination of symptoms and signs you do not recognise and in whom standard investigations have provided no clues. What do you do? Looking in the books is very time consuming and depends on how well the books are indexed; searching PubMed or online inheritance in man (OMIM) is often difficult using just symptoms and signs. Wouldn’t it be useful if you could put the clinical information into a database to narrow down the differential diagnosis?

Medical decision support software is the term used for computer programs and associated databases that help make diagnoses and advise on treatment. Because such software deals with skills that are central to the role of doctors, it tends to be the focus of hopes and fears about medical software.

by Orly Avitzur MD in the American Academy of Neurology’s publication “Neurology Today”: James D. Reggin, MD, the only child neurologist at MeritCare Health System in Fargo, ND, was called into consultation for an infant delivered 11 days earlier by C-section, now in respiratory distress and intubated, when pediatricians observed persistent hypotonia and a poor sucking reflex. Dr. Reggin noted that the infant displayed dysmorphic features as well as severe microcephaly, syndactyly, and multiple capillary hemangiomas. When he could not pinpoint a specific syndrome, he turned to SimulConsult, a computerized decision-support tool that helps neurologists arrive at difficult diagnoses by entering a list of findings.

American Academy of Neurology Neurology Today article “How Neurologists Use the Internet to Enhance Clinical Decision-Making” by Orly Avitzur MD. If C. J. Malanga, MD, PhD had his way, neurologists would be required to – not left with the option of – learning how to use the Internet… Dr. Malanga first discovered the benefits of the Internet as a child neurology fellow at Massachusetts General Hospital (MGH), trying to determine a differential diagnosis for a case posted on the weekly neuropathology conference. The case involved a 15-year-old boy who was first seen at age 5 with slurred speech and gait instability and who continued to deteriorate over the next 10 years with emerging marked dystonia, dysphagia, tics and seizures.