Adapting two American Decision Aids for Mild Traumatic Brain Injury to the Canadian Context Using the Nominal Group Technique.

BACKGROUND: Decision aids are patient-focused tools that have the potential to reduce the overuse of head computed tomography (CT) scans. OBJECTIVE: The objective of this study was to create a consensus among Canadian mild traumatic brain injury and emergency medicine experts on modifications required to adapt two American decision aids about head CT use for adult and paediatric mild traumatic brain injury to the Canadian context. METHODS: We invited 21 Canadian stakeholders and the two authors of the American decision aids to a Nominal Group Technique consensus meeting to generate suggestions for adapting the decision aids. This method encourages idea generation and sharing between team members. Each idea was discussed and then prioritised using a voting system. We collected data using videotaping, writing material and online collaborative writing tools. The modifications proposed were analysed using a qualitative thematic content analysis. RESULTS: Twenty-one participants took part in the meeting, including researchers and clinician researchers (n = 9; 43%), patient partners (n = 3; 14%) and decision makers (n = 2; 10%). A total of 84 ideas were generated. Participants highlighted the need to clarify the purpose of the decision aids, the nature of the problem being addressed and the target population. The tools require sociocultural adaptations, better identification of their target population, better description of head CT utility, advantages and related risks, modification of the visual and written representation of the risk of brain injury and head CT use, and locally adapted, patient follow-up plans. CONCLUSIONS: This study based on a Nominal Group Technique identified several adaptations for two American decision aids about head CT use for mild traumatic brain injury to support their use in Canada's different healthcare, social, cultural and legal context. These adaptations concerned the target users of the decision aids, the information presented, and how the benefits and risks were communicated in the decision aids. Future steps include prototyping the two adapted decision aids, conducting formative evaluations with actual emergency department patients and clinicians, and measuring the impact of the adapted tools on CT scan use.

A mild traumatic brain injury (also called concussion) can happen when the brain moves around in the skull after an impact to the head. A concussion is not a brain bleed and you cannot see a concussion. Concussions do not show up on a computed tomography (CT) scan. Brain bleeds do. Computed tomography scans are specialised X-ray machines that can detect serious brain injuries. Unfortunately, CT scan use also exposes patients to radiation and a future increased risk of cancer.Shared decision making involves health professionals and patients making decisions together based on the best available evidence, health professionals' experience, and patients' values and preferences. Shared decision making improves appropriate diagnostic test use.Two decision aids created in the USA are available to facilitate shared decision making regarding the use of head CT scans for patients with concussion. These decision aids are not fully adapted for use in Canada because the healthcare, social and legal context is different. Our study brought together patients and experts in the field of concussion and shared decision making to analyse these decision aids and propose adaptations that would increase their acceptance in Canadian emergency departments. We used a technique called the Nominal Group Technique to create a consensus about the most important changes to make to both original decision aids. The main adaptations needed for the Canadian context concerned avoiding information about cost and removing any information that does not change clinical management. This project will help us adapt two decision aids for clinical use in Canada and support appropriate CT scan use for patients with concussion.

Head CT overuse in children with a mild traumatic brain injury within two Canadian emergency departments.

BACKGROUND: The validated Pediatric Emergency Care Applied Network (PECARN) rule helps determine the relevance of a head computerized tomography (CT) for children with mild traumatic brain injury (mTBI). We sought to estimate the potential overuse of head CT within two Canadian emergency departments (EDs). METHODS: We conducted a retrospective chart review of children seen in 2016 in a paediatric Level I (site 1) and a general Level II (site 2) trauma centre. We reviewed charts to determine the appropriateness of head CT use according to the PECARN rule in a random subset of children presenting with head trauma. Simple descriptive statistics were applied. RESULTS: One thousand five hundred and forty-six eligible patients younger than 17 years consulted during the study period. Of the 203 randomly selected cases per setting, 16 (7.9%) and 24 (12%), respectively from sites 1 and 2 had a head CT performed. Based on the PECARN rule, we estimated the overuse for the younger group (<2 years) to be below 3% for both hospitals without significant difference between them. For the older group (≥2 years), the overuse rate was higher at site 2 (9.3%, 95% confidence interval [CI]: 4.8 to 17% versus 1.2%, 95% CI: 0.2 to 6.5%, P=0.03). CONCLUSION: Both EDs demonstrated overuse rates below 10% although it was higher for the older group at site 2. Such low rates can potentially be explained by the university affiliation of both hospitals and by two Canadian organizations working to raise awareness among physicians about the overuse of diagnostic tools and dangers inherent to radiation.

A Questionnaire-Based Study on the Perceptions of Canadian Seniors About Cognitive, Social, and Psychological Benefits of Digital Games.

OBJECTIVE: This study explored the perceptions of seniors who play digital games on the potential benefits of these games and on the factors associated with these perceptions. MATERIALS AND METHODS: We developed and administered a questionnaire to a sample of 590 Canadian seniors in British Columbia and Quebec that addressed demographics, digital game practices, and perceived benefits. RESULTS: Results of administering the questionnaire showed that cognitive benefits were reported more frequently than social or psychological benefits. First language and gender were associated with the benefits reported, with fewer Francophones and women reporting benefits. The most important factor found was whether or not they played online, as playing online was associated with greater perceptions of social, as well as cognitive, benefits. CONCLUSION: Social and cognitive benefits are reported by seniors from playing digital games and should be investigated through future experimental and quasi-experimental research.

Scene perception, gaze behavior, and perceptual learning in virtual environments.

More and more immersive environments are developed to provide support for learning or training purposes. Ecological validity of such environments is usually based on learning performance comparisons between virtual environments and their genuine counterparts. Little is known about learning processes occurring in immersive environments. A new technique is proposed for testing perceptual learning during virtual immersion. This methodology relies upon eye-tracking technologies to analyze gaze behavior recorded in relation to virtual objects' features and tasks' requirements. It is proposed that perceptual learning mechanisms engaged could be detected through eye movements. In this study, nine subjects performed perceptual learning tasks in virtual immersion. Results obtained indicated that perceptual learning influences gaze behavior dynamics. More precisely, analysis revealed that fixation number and variability in fixation duration varied with perceptual learning level. Such findings could contribute in shedding light on learning mechanisms as well as providing additional support for validating virtual learning environments.

Prevalence of metabolic alterations predictive of cardiovascular disease risk in the Québec population.

BACKGROUND: It is well established that cardiovascular diseases (CVD) are the most important cause of morbidity and mortality in North America and in industrialized countries. Furthermore, the presence of CVD risk factors is widespread in Canada, and two-thirds of adult Canadians present at least one traditional risk factor for CVD. OBJECTIVE: To quantify the prevalence of metabolic alterations predictive of an increased risk of CVD in a representative sample of the Québec population. METHODS: A representative sample of the Québec population was obtained through the Québec Health Survey 1990. The cohort of 1844 subjects (907 men and 937 women), aged from 18 to 74 years, completed the evaluation, which consisted of interviews, validated questionnaires for personal and family history of CVD risk factors, and a physical examination. Anthropometric measurements, blood pressure, fasting plasma lipoprotein-lipid levels as well as fasting glucose and insulin concentrations were obtained. RESULTS: Thirty one per cent of the Québec population had a normal body weight defined by body mass index (BMI) less than 25 kg/m2 with a healthy metabolic profile (glycemia less than 6.1 mmol/L, total cholesterol less than 5.2 mmol/L, low density lipoprotein-cholesterol less than 3.4 mmol/L, triglycerides less than 2.3 mmol/L and high density lipoprotein-cholesterol greater than 0.90 mmol/L). On the other hand, 28% of the population was treated for known metabolic chronic diseases (CVD, diabetes, dyslipidemias and hypertension), whereas the remaining 33% of the Québec population (BMI greater than 25 kg/m2) were characterized by an altered metabolic profile predictive of an increased CVD risk. Furthermore, 75% of men and 70% of women with an altered metabolic profile presented at least two CVD risk factors. Overall, women tended to display a significantly healthier metabolic risk profile than men (P<0.05). CONCLUSIONS: According to our results, only 31% of the Québec population is nonobese without major alterations in their metabolic risk profile. Indeed, 61% of Quebecers are either characterized by chronic diseases or by an altered metabolic profile increasing their risk for the development of CVD and type 2 diabetes. Such a high prevalence should be a source of concern justifying the development of simple screening tools for early identification of the asymptomatic carriers of this cluster of metabolic abnormalities.