Delusional parasitosis as presenting symptom of occipital lobe cerebrovascular accident

Delusional parasitosis manifests as a fixed, false belief that an individual is infested by living organisms. Primary delusional parasitosis is a psychiatric disorder with the delusion as an isolated manifestation, whereas secondary delusional parasitosis is a delusion occurring secondary to a psychiatric disorder, substance use, or medical illness. A 62-year-old woman with no psychiatric history presented to the Emergency Department with two to three months of “whole body itching” and seeing small insects crawling on her skin and in her hair. Exam of her skin and scalp was notable for no appreciable lesions, rashes, excoriations, or insects. Her neurologic exam was notable for full visual fields, and no localizing deficits. A non-contrast head CT demonstrated a nonspecific heterogeneous low-attenuation lesion within the medial right occipital lobe, and a follow up MRI confirmed a right posterior cerebral artery distribution subacute infarction. She was admitted for two days, and ultimately was discharged on aspirin and atorvastatin for secondary prevention. An emergency physician should remain vigilant in his/her assessment of patients with seemingly psychiatric symptoms, in particular elderly patients with no known psychiatric illnesses. Neuroimaging should be amongst studies considered in the evaluation of elderly patients presenting with new onset psychiatric complaints.     

Improving the quality of pressure ulcer management in a skilled nursing facility

Pressure ulcers (PUs) are a serious health care problem for nursing home residents and a key quality metric for regulators. Three initiatives were introduced at a 128‐bed facility to improve PU prevention. First, a Quality Assurance and Performance Improvement project and a Root Cause Analysis were conducted to improve the facility's wound care programme. Second, a digital wound care management solution was adopted to track wound management. Third, the role of skin integrity coordinator was created as a central point of accountability for wound care‐related activities and related performance metrics. Improvements in PU prevention were tracked using Centers of Medicare and Medicaid data, specifically (a) the percentage of long‐stay high‐risk residents with PUs and (b) the percentage of short‐stay residents with PUs that are new or have worsened. PU prevalence for long‐stay high‐risk residents was 12.99% (Q4 2016), and upon implementation of these initiatives, the facility saw continued reductions in PU prevalence to 2.9% (Q4 2017), while PUs for short‐stay residents were maintained at zero throughout this period. This study highlights the power of effective management combined with real‐time data analytics, as enabled by digital wound care management, to make significant improvements in health care delivery.     

The relationship between early maladaptive schemas and interpersonal problems: A meta‐analytic review

Early maladaptive schemas (EMSs) have been hypothesized to be associated with interpersonal problems. Furthermore, a stronger contention is that EMSs impact negatively on, or cause, interpersonal problems. The aims of this meta‐analysis were (a) to assess the strength of the association between EMSs and interpersonal problems, (b) clarify which EMSs are most strongly associated with interpersonal problems, (c) examine any possible moderators on the relationship between EMSs and interpersonal problems, and (d) examine whether any empirical evidence exists supporting a causal relationship between EMSs and interpersonal problems. A comprehensive systematic literature search and meta‐analysis were conducted using the PRISMA guidelines for systematic reviews. A total of 49 empirical studies were reviewed investigating EMSs and interpersonal problems. EMSs were found to have a moderate positive association with interpersonal problems with different EMSs having small to moderate effect sizes. To date, there has been limited evidence supporting a causal effect of EMSs on interpersonal problems. Possible limitations and avenues for future research were discussed.