Importance of early recognition and management of delusional parasitosis.

Delusional parasitosis (DP) is a psychiatric condition characterized by an individual's persistent belief that she or he is infested with pathogens when no such infestation is medically present. Family education on safety is needed before discharge due to the high risk of self-injury when patients try to rid themselves of the parasite. We present the case of a woman who presented twice with self-inflicted injury with a foreign body to the head to eliminate supposed tapeworms in her brain; she declined antipsychotic medication and psychiatric referral after the first emergency department visit only to come back with a more serious injury requiring a frontoparietal craniotomy. This clinical situation underscores the importance of psychiatric assessment to ascertain a patient's risk to themselves. Neuroimaging should be considered in the evaluation of elderly patients presenting with new-onset psychiatric complaints.

Enjeux de la pratique en évaluation d'impact sur la santé : observations sur l'expérimentation de cette démarche au Québec.

INTRODUCTION: The Quebec Government Policy of Prevention in Health incited several regional Public health departments (PHD) to initiate health impact assessment (HIA) as a way to strengthen collaboration with municipal decision makers and improve their projects of urban planning projects. This article presents the main HIA implementation issues encountered in the last two years and the solutions applied or envisaged. METHOD: The documentation of the issues is based on the observations of HIA experts drawn from working sessions with practitioners from different regional PHDs and from the activities of a community of practice. RESULTS: Five issues have been identified : appropriation of the HIA process and new skills, support and collaboration of municipal partners, intersectoral work, access to expertise and evidence as well as HIA funding. DISCUSSION: A common implementation framework offering different tools, a scientific support and a vibrant community of practice will help to develop skills of practitioners and capacities of their respective organizations. These solid foundations will increase the credibility and relevance of HIA for municipal partners. CONCLUSION: An in-depth evaluation will be carried out at the end of the experiment to examine the relevance, feasibility and acceptability of HIA and to better understand the conditions necessary for a successful integration of this practice in various contexts. It will make it possible to assess whether the services and instrumentation made available to practitioners are useful or how they can be improved.

A Comparative Analysis of Health Impact Assessment Implementation Models in the Regions of Montérégie (Québec, Canada) and Nouvelle-Aquitaine (France).

Many countries have introduced health impact assessment (HIA) at the national, regional, or local levels. In France and in Québec, there is increasing interest in using HIA to inform decision-makers and influence policies, programs, and projects. This paper aims to compare HIA implementation models in two regions: Nouvelle-Aquitaine (France) and Montérégie (Québec, Canada) using a case study methodology. The objective is to gain a better understanding of the similarities and differences in the approaches used to achieve the operationalization of HIA. The methodological approach involves four steps: (1) design of an analytical framework based on the literature; (2) exchanges within the research team and review of documents concerning the two implementation strategies under study; (3) development of the case studies based on the proposed framework; and (4) cross-comparison analysis of the case studies. The findings show that the two regions share certain similarities, including the strong commitment and political will of the public health organizations involved and a well-established culture of engaging in intersectoral action with municipal partners. Differences mainly concern their different approaches to implementing HIAs in accordance with the regional policies and the organizational and administrative contexts in place. This study identifies potential avenues for supporting the practice of HIA at the municipal level.

A review of methods to assess the economic impact of distributed medical education (DME) in Canada.

BACKGROUND: Canadian distributed medical education (DME) increased substantially in the last decade, resulting in positive economic impacts to local communities. A reliable and simple method to estimate economic contributions is essential to provide managers with information on the extent of these impacts. This review paper fills a gap in the literature by answering the question: What are the most applicable quantitative methods to assess the economic impact of Canadian DME programs? METHODS: The literature is reviewed to identify economic assessment methods. These are evaluated and compared based on the benefits, challenges, data needs, outputs and potential for use in the DME context. RESULTS: We identified five economic impact methods used in similar contexts. Two of these methods have the potential for Canadian DME programs: the Canadian Input-Output (I-O) model and the Simplified American Council on Education (ACE) method. CONCLUSION: Choice of a method is contingent on the ability to measure the salient economic impacts, and provide an output that facilitates sustainable decision making. This paper thus fills a gap by identifying methods applicable to DME. These methods will assist stakeholders to calculate economic impacts, resulting in both the advancement and sustainability of these programs over short-and long-term time frames.

Impacts of online and group perinatal education: a mixed methods study protocol for the optimization of perinatal health services.

BACKGROUND: Prenatal education is a core component of perinatal care and services provided by health institutions. Whereas group prenatal education is the most common educational model, some health institutions have opted to implement online prenatal education to address accessibility issues as well as the evolving needs of future parents. Various studies have shown that prenatal education can be effective in acquisition of knowledge on labour and delivery, reducing psychological distress and maximising father's involvement. However, these results may depend on educational material, organization, format and content. Furthermore, the effectiveness of online prenatal education compared to group prenatal education remains unclear in the literature. This project aims to evaluate the impacts of group prenatal education and online prenatal education on health determinants and users' health status, as well as on networks of perinatal educational services maintained with community-based partners. METHODS: This multipronged mixed methods study uses a collaborative research approach to integrate and mobilize knowledge throughout the process. It consists of: 1) a prospective cohort study with quantitative data collection and qualitative interviews with future and new parents; and 2) a multiple case study integrating documentary sources and interviews with stakeholders involved in the implementation of perinatal information service networks and collaborations with community partners. Perinatal health indicators and determinants will be compared between prenatal education groups (group prenatal education and online prenatal education) and standard care without these prenatal education services (control group). DISCUSSION: This study will provide knowledge about the impact of online prenatal education as a new technological service delivery model compared to traditional group prenatal education. Indicators related to the complementarity of these interventions and those available in community settings will refine our understanding of regional perinatal services networks. Results will assist decision-making regarding service organization and delivery models of prenatal education services. PROTOCOL VERSION: Version 1 (February 9 2018).

Validation of the New Interpretation of Gerasimov's Nasal Projection Method for Forensic Facial Approximation Using CT Data(.).

The most common method to predict nasal projection for forensic facial approximation is Gerasimov's two-tangent method. Ullrich H, Stephan CN (J Forensic Sci, 2011; 56: 470) argued that the method has not being properly implemented and a revised interpretation was proposed. The aim of this study was to compare the accuracy of both versions using a sample of 66 postmortem cranial CT data. The true nasal tip was defined using pronasale and nasal spine line, as it was not originally specified by Gerasimov. The original guidelines were found to be highly inaccurate with the position of the nasal tip being overestimated by c. 2 cm. Despite the revised interpretation consistently resulting in smaller distance from true nasal tip, the method was not statistically accurate (p > 0.05) in positioning the tip of the nose (absolute distance >5 mm). These results support that Gerasimov's method was not properly performed, and Ullrich H, Stephan CN (J Forensic Sci, 2011; 56: 470) interpretation should be used instead.

Predicting success of endoscopic third ventriculostomy: validation of the ETV Success Score in a mixed population of adult and pediatric patients.

OBJECT: Endoscopic third ventriculostomy (ETV) has become the first line of treatment in obstructive hydrocephalus. The Toronto group (Kulkarni et al.) developed the ETV Success Score (ETVSS) to predict the clinical response following ETV based on age, previous shunt, and cause of hydrocephalus in a pediatric population. However, the use of the ETVSS has not been validated for a population comprising adults. The objective of this study was to validate the ETVSS in a "closed-skull" population, including patients 2 years of age and older. METHODS: In this retrospective observational study, medical charts of all consecutive cases of ETV performed in two university hospitals were reviewed. The primary outcome, the success of ETV, was defined as the absence of reoperation or death attributable to hydrocephalus at 6 months. The ETVSS was calculated for all patients. Discriminative properties along with calibration of the ETVSS were established for the study population. The secondary outcome is the reoperation-free survival. RESULTS: This study included 168 primary ETVs. The mean age was 40 years (range 3-85 years). ETV was successful at 6 months in 126 patients (75%) compared with a mean ETVSS of 82.4%. The area under the receiver operating characteristic curve was 0.61, revealing insufficient discrimination from the ETVSS in this population. In contrast, calibration of the ETVSS was excellent (calibration slope = 1.01), although the expected low numbers were obtained for scores < 70. Decision curve analyses demonstrate that ETVSS is marginally beneficial in clinical decision-making, a reduction of 4 and 2 avoidable ETVs per 100 cases if the threshold used on the ETVSS is set at 70 and 60, respectively. However, the use of the ETVSS showed inferior net benefit when compared with the strategy of not recommending ETV at all as a surgical option for thresholds set at 80 and 90. In this cohort, neither age nor previous shunt were significantly associated with unsuccessful ETV. However, better outcomes were achieved in patients with aqueductal stenosis, tectal compressions, and other tumor-associated hydrocephalus than in cases secondary to myelomeningocele, infection, or hemorrhage (p = 0.03). CONCLUSIONS: The ETVSS did not show adequate discrimination but demonstrated excellent calibration in this population of patients 2 years and older. According to decision-curve analyses, the ETVSS is marginally useful in clinical scenarios in which 60% or 70% success rates are the thresholds for preferring ETV to CSF shunt. Previous history of CSF shunt and age were not associated with worse outcomes, whereas posthemorrhagic and postinfectious causes of the hydrocephalus were significantly associated with reduced success rates following ETV.