Browsing by Author "Fiest, Kirsten M."
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Item Open Access A scoping review of methods to measure and evaluate citizen engagement in health research(2022-12-10) Shahid, Anmol; Lalani, Inara N.; Rosgen, Brianna K.; Sept, Bonnie G.; Longmore, Shelly; Parsons Leigh, Jeanna; Stelfox, Henry T.; Fiest, Kirsten M.Abstract Background Citizen engagement, or partnering with interested members of the public in health research, is becoming more common. While ongoing assessment of citizen engagement practices is considered important to its success, there is little clarity around aspects of citizen engagement that are important to assess (i.e., what to look for) and methods to assess (i.e., how to measure and/ or evaluate) citizen engagement in health research. Methods In this scoping review, we included peer-reviewed literature that focused primarily on method(s) to measure and/or evaluate citizen engagement in health research. Independently and in duplicate, we completed title and abstract screening and full-text screening and extracted data including document characteristics, citizen engagement definitions and goals, and methods to measure or evaluate citizen engagement (including characteristics of these methods). Results Our search yielded 16,762 records of which 33 records (31 peer-reviewed articles, one government report, one conference proceeding) met our inclusion criteria. Studies discussed engaging citizens (i.e., patients [n = 16], members of the public [n = 7], service users/consumers [n = 4], individuals from specific disease groups [n = 3]) in research processes. Reported methods of citizen engagement measurement and evaluation included frameworks, discussion-based methods (i.e., focus groups, interviews), survey-based methods (e.g., audits, questionnaires), and other methods (e.g., observation, prioritization tasks). Methods to measure and evaluate citizen engagement commonly focused on collecting perceptions of citizens and researchers on aspects of citizen engagement including empowerment, impact, respect, support, and value. Discussion and conclusion We found that methods to measure and/or evaluate citizen engagement in health research vary widely but share some similarities in aspect of citizen engagement considered important to measure or evaluate. These aspects could be used to devise a more standardized, modifiable, and widely applicable framework for measuring and evaluating citizen engagement in research. Patient or public contribution Two citizen team members were involved as equal partners in study design and interpretation of its findings. Systematic review registration Open Science Framework (10.17605/OSF.IO/HZCBR).Item Open Access A scoping review of perceptions from healthcare professionals on antipsychotic prescribing practices in acute care settings(2022-10-21) Jaworska, Natalia; Moss, Stephana J.; Krewulak, Karla D.; Stelfox, Zara; Niven, Daniel J.; Ismail, Zahinoor; Burry, Lisa D.; Fiest, Kirsten M.Abstract Background Antipsychotic medications are frequently prescribed in acute care for clinical indications other than primary psychiatric disorders such as delirium. Unfortunately, they are commonly continued at hospital discharge and at follow-ups thereafter. The objective of this scoping review was to characterize antipsychotic medication prescribing practices, to describe healthcare professional perceptions on antipsychotic prescribing and deprescribing practices, and to report on antipsychotic deprescribing strategies within acute care. Methods We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science databases from inception date to July 3, 2021 for published primary research studies reporting on antipsychotic medication prescribing and deprescribing practices, and perceptions on those practices within acute care. We included all study designs excluding protocols, editorials, opinion pieces, and systematic or scoping reviews. Two reviewers screened and abstracted data independently and in duplicate. The protocol was registered on Open Science Framework prior to data abstraction (10.17605/OSF.IO/W635Z). Results Of 4528 studies screened, we included 80 studies. Healthcare professionals across all acute care settings (intensive care, inpatient, emergency department) perceived prescribing haloperidol (n = 36/36, 100%) most frequently, while measured prescribing practices reported common quetiapine prescribing (n = 26/36, 76%). Indications for antipsychotic prescribing were delirium (n = 48/69, 70%) and agitation (n = 20/69, 29%). Quetiapine (n = 18/18, 100%) was most frequently prescribed at hospital discharge. Three studies reported in-hospital antipsychotic deprescribing strategies focused on pharmacist-driven deprescribing authority, handoff tools, and educational sessions. Conclusions Perceived antipsychotic prescribing practices differed from measured prescribing practices in acute care settings. Few in-hospital deprescribing strategies were described. Ongoing evaluation of antipsychotic deprescribing strategies are needed to evaluate their efficacy and risk.Item Open Access Assessing Nociception by fMRI of the Human Spinal Cord: A Systematic Review(SAGE PUBLICATIONS LTD, 2015) Kolesar, Tiffany A.; Fiest, Kirsten M.; Smith, Stephen D.; Kornelsen, JenniferOBJECTIVE: To assess the use of fMRI of the spinal cord in measuring noxious stimulation. METHODS: The Scopus, Medline, EMBASE, and Web of Science databases were searched, along with the reference lists of included articles. Two independent reviewers screened abstracts, full-text articles, and extracted data. Original research was included if fMRI of the human spinal cord was used to measure responses to noxious stimulation. RESULTS: Of the 192 abstracts screened, 19 met the search criteria and were divided according to their focus: investigating pain responses (n = 6), methodology (n = 6), spinal cord injury (n = 2), or cognition-pain interactions (n = 5). All but one study appear to have observed activity in ipsilateral and dorsal gray matter regions in response to noxious stimuli, although contralateral or ventral activity was also widely observed. CONCLUSIONS: Although nociception can be investigated using spinal fMRI, establishing reliability, standardizing methodology, and reporting of results will greatly advance this field.Item Open Access Clinical practice guideline recommendations for diagnosis and management of anxiety and depression in hospitalized adults with delirium: a systematic review(2023-09-25) Poulin, Therese G.; Jaworska, Natalia; Stelfox, Henry T.; Fiest, Kirsten M.; Moss, Stephana J.Abstract Background Delirium commonly occurs in hospitalized adults. Psychiatric disorders such as anxiety, depression, and post-traumatic stress disorder (PTSD) can co-occur with delirium, and can be recognized and managed by clinicians using recommendations found in methodological guiding statements called Clinical Practice Guidelines (CPGs). The specific aims of this review were to: [1] synthesize CPG recommendations for the diagnosis and management of anxiety, depression, and PTSD in adults with delirium in acute care; and [2] identify recent published literature in addition to those identified and reported in a 2017 review on delirium CPG recommendations and quality. Methods MEDLINE, EMBASE, CINAHL, PsycINFO, and 21 sites on the Canadian Agency for Drugs and Technologies listed in the Health Grey Matters Lite tool were searched from inception to February 12, 2021. Selected CPGs focused on delirium in acute care, were endorsed by an international scientific society or governmental organization, and contained at least one recommendation for the diagnosis or management of delirium. Two reviewers independently extracted data in duplicate and independently assessed CPG quality using the AGREE-II tool. Narrative synthesis of CPG recommendations was conducted. Results Title and abstract screening was completed on 7611 records. Full-text review was performed on 197 CPGs. The final review included 27 CPGs of which 7 (26%) provided recommendations for anxiety (4/7, 57%), depression (5/7, 71%), and PTSD (1/7, 14%) in delirium. Twenty CPGs provided recommendations for delirium only (e.g., assess patient regularly, avoid use of benzodiazepines). Recommendations for the diagnosis of psychiatric disorders with delirium included using evidence-based diagnostic criteria and standardized screening tools. Recommendations for the management of psychiatric disorders with delirium included pharmacological (e.g., anxiolytics, antidepressants) and non-pharmacological interventions (e.g., promoting patient orientation using clocks). Guideline quality varied: the lowest was Applicability (mean = 36%); the highest Clarity of Presentation (mean = 76%). Conclusions There are few available evidence-based CPGs to facilitate appropriate diagnosis and management of anxiety, depression, and PTSD in patients with delirium in acute care. Future guideline developers should incorporate evidence-based recommendations on the diagnosis and management of these psychiatric disorders in delirium. Systematic review registration Registration number: PROSPERO (CRD42021237056)Item Open Access Co-development of a transitions in care bundle for patient transitions from the intensive care unit: a mixed-methods analysis of a stakeholder consensus meeting(2022-01-02) Rosgen, Brianna K.; Plotnikoff, Kara M.; Krewulak, Karla D.; Shahid, Anmol; Hernandez, Laura; Sept, Bonnie G.; Morrissey, Jeanna; Robertson, Kristin; Fraser, Nancy; Niven, Daniel J.; Straus, Sharon E.; Leigh, Jeanna P.; Stelfox, Henry T.; Fiest, Kirsten M.Abstract Background Intensive care unit (ICU) patients undergoing transitions in care are at increased risk of adverse events and gaps in medical care. We evaluated existing patient- and family-centered transitions in care tools and identified facilitators, barriers, and implementation considerations for the application of a transitions in care bundle in critically ill adults (i.e., a collection of evidence-based patient- and family-centred tools to improve outcomes during and after transitions from the intensive care unit [ICU] to hospital ward or community). Methods We conducted a concurrent mixed methods (quan + QUAL) study, including stakeholders with experience in ICU transitions in care (i.e., patient/family partners, researchers, decision-makers, providers, and other knowledge-users). First, participants scored existing transitions in care tools using the modified Appraisal of Guidelines, Research and Evaluation (AGREE-II) framework. Transitions in care tools were discussed by stakeholders and either accepted, accepted with modifications, or rejected if consensus was achieved (≥70% agreement). We summarized quantitative results using frequencies and medians. Second, we conducted a qualitative analysis of participant discussions using grounded theory principles to elicit factors influencing AGREE-II scores, and to identify barriers, facilitators, and implementation considerations for the application of a transitions in care bundle. Results Twenty-nine stakeholders attended. Of 18 transitions in care tools evaluated, seven (39%) tools were accepted with modifications, one (6%) tool was rejected, and consensus was not reached for ten (55%) tools. Qualitative analysis found that participants’ AGREE-II rankings were influenced by: 1) language (e.g., inclusive, balance of jargon and lay language); 2) if the tool was comprehensive (i.e., could stand alone); 3) if the tool could be individualized for each patient; 4) impact to clinical workflow; and 5) how the tool was presented (e.g., brochure, video). Participants discussed implementation considerations for a patient- and family-centered transitions in care bundle: 1) delivery (e.g., tool format and timing); 2) continuity (e.g., follow-up after ICU discharge); and 3) continuous evaluation and improvement (e.g., frequency of tool use). Participants discussed existing facilitators (e.g., collaboration and co-design) and barriers (e.g., health system capacity) that would impact application of a transitions in care bundle. Conclusions Findings will inform future research to develop a transitions in care bundle for transitions from the ICU, co-designed with patients, families, providers, researchers, decision-makers, and knowledge-users.Item Open Access Delirium severity and patient health outcomes: a systematic review and meta-analysis(2018-04-25) Rosgen, Brianna; Krewulak, Karla D.; Ely, E. Wesley; Stelfox, Henry Thomas; Fiest, Kirsten M.Item Open Access Exploring the influence of behavioural, normative and control beliefs on intentions to adhere to public health guidelines during the COVID-19 pandemic: a qualitative interview based study(2023-03-10) Parsons Leigh, Jeanna; Moss, Stephana J.; Mizen, Sara J.; FitzGerald, Emily A.; Brundin-Mather, Rebecca; de Grood, Chloe; Dodds, Alexandra; Stelfox, Henry T.; Fiest, Kirsten M.Abstract Background Perceived severity and susceptibility of disease are predictors of individual behaviour during health crises. Little is known about how individual beliefs influence intentions to adhere to public health guidelines during periods of health crises, and how access to and consumption of information influence these intentions. This study investigated behavioural beliefs, normative beliefs, and control beliefs, and their influence on behavioural intentions to adhere to public health guidelines during the COVID-19 pandemic. Methods Participants were recruited from a related COVID-19 study conducted by our team, and through snowball sampling in subsequent. Using a maximum variation sampling technique, we recruited a diverse group of participants representing six major regions in Canada. Participants took part in one-on-one semi-structured interviews from February 2021 to May 2021. Data were analyzed independently in duplicate by thematic analysis. The Theory of Planned Behaviour (TPB) was the conceptual framework used to organize dominant themes. Results We conducted a total of 60 individual interviews (137 eligible individuals contacted, 43.8% response rate) and identified six themes organized according to the three constructs of behavioural, normative and control beliefs as described in the TPB: (1) Behavioural: My “New Normal,” Individual Rights and Perceived Pandemic Severity, Fatigue with COVID-19, (2) Normative: COVID-19 Collective, (3) Control: Practicality of Public Health Guidelines, and (6) Conflicting Public Health Messages. Most (n = 43, 71.7%) participants perceived individuals in their geographic community to be following public health guidelines adequately. Several participants (n = 15, 25.0%) commented on the unequal impact of restrictions based on socioeconomic factors (i.e., class, race, age). Conclusion Individual perceptions of risk, loss of control, access to resources (i.e., childcare), and societal expectations, shaped intentions to engage in disease preventative behaviours (i.e., social distancing) during the COVID-19 pandemic.Item Open Access Impact of restricted family presence during the COVID-19 pandemic on critically ill patients, families, and critical care clinicians: a qualitative systematic review(2024-08-15) Krewulak, Karla D.; Jaworska, Natalia; Lee, Laurie; Louis, Julia S.; Dmitrieva, Olesya; Leia, Madison P.; Doig, Christopher; Niven, Daniel J.; Parhar, Ken K. S.; Rochwerg, Bram; West, Andrew; Stelfox, Henry T.; Leigh, Jeanna P.; Fiest, Kirsten M.Abstract Background We aimed to synthesize the qualitative evidence on the impacts of COVID-19-related restricted family presence policies from the perspective of patients, families, and healthcare professionals from neonatal (NICU), pediatric (PICU), or adult ICUs. Methods We searched MEDLINE, EMBASE, Cochrane Databases of Reviews and Clinical Trials, CINAHL, Scopus, PsycINFO, and Web of Science. Two researchers independently reviewed titles/abstracts and full-text articles for inclusion. Thematic analysis was completed following appraising article quality and assessing confidence in the individual review findings using standardized tools. Results We synthesized 54 findings from 184 studies, revealing the impacts of these policies in children and adults on: (1) Family integrated care and patient and family-centered care (e.g., disruption to breastfeeding/kangaroo care, dehumanizing of patients); (2) Patients, families, and healthcare professionals (e.g., negative mental health consequences, moral distress); (3) Support systems (e.g., loss of support from friends/families); and (4) Relationships (e.g., loss of essential bonding with infant, struggle to develop trust). Strategies to mitigate these impacts are reported. Conclusion This review highlights the multifaceted impacts of restricted visitation policies across distinct care settings and strategies to mitigate the harmful effects of these policies and guide the creation of compassionate family presence policies in future health crises. Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=290263 .Item Open Access Incorporating and evaluating citizen engagement in health research: a scoping review protocol(2021-09-28) Shahid, Anmol; Rosgen, Brianna K.; Krewulak, Karla D.; Lorenzetti, Diane L.; Foster, Nadine; Sept, Bonnie G.; Leigh, Jeanna P.; Stelfox, Henry T.; Fiest, Kirsten M.Abstract Background Citizen engagement in research is an emerging practice that involves members of the general public in research processes such as priority setting, planning, decision-making, research conduct, implementation, evaluation, and dissemination. Engaging citizens in research, particularly health research, increases the relevance of study findings, minimizes waste by facilitating stewardship over resources, and builds public trust in the research. While several existing frameworks guide the application of citizen engagement principles to health research, it is unclear how citizen engagement can be utilized to maximize benefits and minimize risks and challenges in health research. To address the gaps in knowledge around citizen engagement in health research, we propose a scoping review to synthesize the state of knowledge on methods to incorporate and evaluate citizen engagement in research. A protocol is presented in this manuscript. Methods The methodology for our scoping review is guided by Arksey and O’ Malley’s framework for scoping reviews, and additional recommendations by Levac and colleagues. We will include peer-reviewed and gray literature that report on citizen engagement in health research (including biomedical, clinical, health systems and services, and social, cultural, environmental and population health) and report method(s) to conduct, measure, or evaluate citizen engagement. We will systematically search electronic databases (MEDLINE, EMBASE, CINAHL, JSTOR, PsycINFO, Scopus, and Science Direct) from inception onwards and search relevant organizations’ websites for additional studies, frameworks, and reports on citizen engagement. Title and abstract and full-text citations will be screened independently and in duplicate. Data will be extracted independently and in duplicate, including document characteristics, citizen engagement definitions and goals, and outcomes of citizen engagement (e.g., barriers, facilitators). Discussion This review will synthesize the definitions, goals, methods, outcomes, and significance of citizen engagement in health research, as well as any potential barriers, facilitators, and challenges outlined in existing literature. The findings will provide an evidence-based foundation for developing new or improved guidance for citizen engagement in health research. Overall, we anticipate that our scoping review will be a preliminary step to meaningful engagement of citizens in research and strengthen the relationship between the scientific community and the public through transparency and collaboration. Systematic review registration Open Science Framework https://osf.io/hzcbr .Item Open Access Interventions to improve well-being among children and youth aged 6–17 years during the COVID-19 pandemic: a systematic review(2023-04-03) Moss, Stephana J.; Mizen, Sara J.; Stelfox, Maia; Mather, Rebecca B.; FitzGerald, Emily A.; Tutelman, Perri; Racine, Nicole; Birnie, Kathryn A.; Fiest, Kirsten M.; Stelfox, Henry T.; Parsons Leigh, JeannaAbstract Background The COVID-19 pandemic is an example of a global infectious disease outbreak that poses a threat to the well-being of children and youth (e.g., physical infection, psychological impacts). The consequences of challenges faced during COVID-19 may be longstanding and newly developed interventions are being deployed. We present a narrative synthesis of available evidence from the first 2 years of the COVID-19 pandemic on the feasibility, accessibility, and effects of interventions to improve well-being among children and youth to inform the development and refinement of interventions relevant to post-pandemic recovery. Methods Six databases were searched from inception to August 2022. A total of 5484 records were screened, 39 were reviewed in full text, and 19 studies were included. The definition of well-being and the five domains of well-being as defined by the Partnership for Maternal, Newborn & Child Health and the World Health Organization in collaboration with the United Nations H6 + Technical Working Group on Adolescent Health and Well-Being were used. Results Nineteen studies (74% randomized controlled trials) from 10 countries were identified, involving a total of 7492 children and youth (age range: 8.2–17.2 years; 27.8–75.2% males) and 954 parents that occurred during the COVID-19 pandemic (March 2020 to March 2021). Nearly all interventions (n = 18, 95%) targeted health and nutrition, followed by connectedness (n = 6, 32%), while fewer studies targeted agency and resilience (n = 5, 23%), learning and competence (n = 2, 11%), or safety and support (n = 1, 3%). Five interventions (26%) were self-guided while 13 interventions (68%) were guided synchronous by a trained professional, all of which targeted physical and mental health subdomains within health and nutrition; one intervention (5%) was unclear. Conclusions Studies deploying synchronous interventions most often reported improved well-being among children and youth largely in the domain of health and nutrition, specifically physical and mental health. Targeted approaches will be crucial to reach sub-groups of children and youth who are most at risk of negative well-being outcomes. Further research is needed to determine how interventions that best supported children and youth early in the pandemic are different from interventions that are required now as we enter into the post-pandemic phase.Item Open Access Patient discharge from intensive care: an updated scoping review to identify tools and practices to inform high-quality care(2021-12-17) Plotnikoff, Kara M.; Krewulak, Karla D.; Hernández, Laura; Spence, Krista; Foster, Nadine; Longmore, Shelly; Straus, Sharon E.; Niven, Daniel J.; Parsons Leigh, Jeanna; Stelfox, Henry T.; Fiest, Kirsten M.Abstract Background Critically ill patients require complex care and experience unique needs during and after their stay in the intensive care unit (ICU). Discharging or transferring a patient from the ICU to a hospital ward or back to community care (under the care of a general practitioner) includes several elements that may shape patient outcomes and overall experiences. The aim of this study was to answer the question: what elements facilitate a successful, high-quality discharge from the ICU? Methods This scoping review is an update to a review published in 2015. We searched MEDLINE, EMBASE, CINAHL, and Cochrane databases from 2013-December 3, 2020 including adult, pediatric, and neonatal populations without language restrictions. Data were abstracted using different phases of care framework models, themes, facilitators, and barriers to the ICU discharge process. Results We included 314 articles from 11,461 unique citations. Two-hundred and fifty-eight (82.2%) articles were primary research articles, mostly cohort (118/314, 37.6%) or qualitative (51/314, 16.2%) studies. Common discharge themes across all articles included adverse events, readmission, and mortality after discharge (116/314, 36.9%) and patient and family needs and experiences during discharge (112/314, 35.7%). Common discharge facilitators were discharge education for patients and families (82, 26.1%), successful provider-provider communication (77/314, 24.5%), and organizational tools to facilitate discharge (50/314, 15.9%). Barriers to a successful discharge included patient demographic and clinical characteristics (89/314, 22.3%), healthcare provider workload (21/314, 6.7%), and the impact of current discharge practices on flow and performance (49/314, 15.6%). We identified 47 discharge tools that could be used or adapted to facilitate an ICU discharge. Conclusions Several factors contribute to a successful ICU discharge, with facilitators and barriers present at the patient and family, health care provider, and organizational level. Successful provider-patient and provider-provider communication, and educating and engaging patients and families about the discharge process were important factors in a successful ICU discharge.Item Open Access Protocol for co-producing a framework and integrated resource platform for engaging patients in laboratory-based research(2024-02-12) Lalu, Manoj M.; Richards, Dawn; Foster, Madison; French, Brittany; Crawley, Angela M.; Fiest, Kirsten M.; Hendrick, Kathryn; Macala, Kimberly F.; Mendelson, Asher A.; Messner, Pat; Nicholls, Stuart G.; Presseau, Justin; Séguin, Cheryle A.; Sullivan, Patrick; Thébaud, Bernard; Fergusson, Dean A.Abstract Background Patient engagement in research is the meaningful and collaborative interaction between patients and researchers throughout the research process. Patient engagement can help to ensure patient-oriented values and perspectives are incorporated into the development, conduct, and dissemination of research. While patient engagement is increasingly prevalent in clinical research, it remains relatively unrealized in preclinical laboratory research. This may reflect the nature of preclinical research, in which routine interactions or engagement with patients may be less common. Our team of patient partners and researchers has previously identified few published examples of patient engagement in preclinical laboratory research, as well as a paucity of guidance on this topic. Here we propose the development of a process framework to facilitate patient engagement in preclinical laboratory research. Methods Our team, inclusive of researchers and patient partners, will develop a comprehensive, empirically-derived, and stakeholder-informed process framework for ‘patient engagement in preclinical laboratory research.’ First, our team will create a ‘deliberative knowledge space’ to conduct semi-structured discussions that will inform a draft framework for preclinical patient engagement. Over the course of several sessions, we will identify actions, activities, barriers, and enablers (e.g. considerations and motivations for patient engagement in preclinical laboratory research, define roles of key players). The resulting draft process framework will be further populated with examples and refined through an international consensus-building Delphi survey with patients, researchers, and other collaborator organizations. We will then conduct pilot field tests to evaluate the framework with preclinical laboratory research groups paired with patient partners. These results will be used to create a refined framework enriched with real-world examples and considerations. All resources developed will be made available through an online repository. Discussion Our proposed process framework will provide guidance, best practices, and standardized procedures to promote patient engagement in preclinical laboratory research. Supporting and facilitating patient engagement in this setting presents an exciting new opportunity to help realize the important impact that patients can make.Item Open Access Public awareness and knowledge of sepsis: a cross-sectional survey of adults in Canada(2022-11-03) Parsons Leigh, Jeanna; Brundin-Mather, Rebecca; Moss, Stephana J.; Nickel, Angie; Parolini, Ariana; Walsh, Deirdre; Bigham, Blair L.; Carter, Alix J. E.; Fox-Robichaud, Alison; Fiest, Kirsten M.Abstract Background Sepsis is a life-threatening complication of the body’s response to infection. The financial, medical, and psychological costs of sepsis to individuals and to the healthcare system are high. Most sepsis cases originate in the community, making public awareness of sepsis essential to early diagnosis and treatment. There has been no comprehensive examination of adult’s sepsis knowledge in Canada. Methods We administered an online structured survey to English- or French-literate adults in Canada. The questionnaire comprised 28 questions in three domains: awareness, knowledge, and information access. Sampling was stratified by age, sex, and geography and weighted to 2016 census data. We used descriptive statistics to summarize responses; demographic differences were tested using the Rao–Scott correction for weighted chi-squared tests and associations using multiple variable regression. Results Sixty-one percent of 3200 adults sampled had heard of sepsis. Awareness differed by respondent’s residential region, sex, education, and ethnic group (p < 0.001, all). The odds of having heard of sepsis were higher for females, older adults, respondents with some or completed college/university education, and respondents who self-identified as Black, White, or of mixed ethnicity (p < 0.01, all). Respondent’s knowledge of sepsis definitions, symptoms, risk factors, and prevention measures was generally low (53.0%, 31.5%, 16.5%, and 36.3%, respectively). Only 25% of respondents recognized vaccination as a preventive strategy. The strongest predictors of sepsis knowledge were previous exposure to sepsis, healthcare employment, female sex, and a college/university education (p < 0.001, all). Respondents most frequently reported hearing about sepsis through television (27.7%) and preferred to learn about sepsis from healthcare providers (53.1%). Conclusions Sepsis can quickly cause life-altering physical and psychological effects and 39% of adults sampled in Canada have not heard of it. Critically, a minority (32%) knew about signs, risk factors, and strategies to lower risk. Education initiatives should focus messaging on infection prevention, employ broad media strategies, and use primary healthcare providers to disseminate evidence-based information. Future work could explore whether efforts to raise public awareness of sepsis might be bolstered or hindered by current discourse around COVID-19, particularly those centered on vaccination.Item Open Access Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review(2021-09-25) Moss, Stephana J.; Krewulak, Karla D.; Stelfox, Henry T.; Ahmed, Sofia B.; Anglin, Melanie C.; Bagshaw, Sean M.; Burns, Karen E. A.; Cook, Deborah J.; Doig, Christopher J.; Fox-Robichaud, Alison; Fowler, Robert; Hernández, Laura; Kho, Michelle E.; Kredentser, Maia; Makuk, Kira; Murthy, Srinivas; Niven, Daniel J.; Olafson, Kendiss; Parhar, Ken K. S.; Patten, Scott B.; Rewa, Oleksa G.; Rochwerg, Bram; Sept, Bonnie; Soo, Andrea; Spence, Krista; Spence, Sean; Straus, Sharon; West, Andrew; Parsons Leigh, Jeanna; Fiest, Kirsten M.Abstract Background Restricted visitation policies in acute care settings because of the COVID-19 pandemic have negative consequences. The objective of this scoping review is to identify impacts of restricted visitation policies in acute care settings, and describe perspectives and mitigation approaches among patients, families, and healthcare professionals. Methods We searched Medline, Embase, PsycINFO, Healthstar, CINAHL, Cochrane Central Register of Controlled Trials on January 01/2021, unrestricted, for published primary research records reporting any study design. We included secondary (e.g., reviews) and non-research records (e.g., commentaries), and performed manual searches in web-based resources. We excluded records that did not report primary data. Two reviewers independently abstracted data in duplicate. Results Of 7810 citations, we included 155 records. Sixty-six records (43%) were primary research; 29 (44%) case reports or case series, and 26 (39%) cohort studies; 21 (14%) were literature reviews and 8 (5%) were expert recommendations; 54 (35%) were commentary, editorial, or opinion pieces. Restricted visitation policies impacted coping and daily function (n = 31, 20%) and mental health outcomes (n = 29, 19%) of patients, families, and healthcare professionals. Participants described a need for coping and support (n = 107, 69%), connection and communication (n = 107, 69%), and awareness of state of well-being (n = 101, 65%). Eighty-seven approaches to mitigate impact of restricted visitation were identified, targeting families (n = 61, 70%), patients (n = 51, 59%), and healthcare professionals (n = 40, 46%). Conclusions Patients, families, and healthcare professionals were impacted by restricted visitation polices in acute care settings during COVID-19. The consequences of this approach on patients and families are understudied and warrant evaluation of approaches to mitigate their impact. Future pandemic policy development should include the perspectives of patients, families, and healthcare professionals. Trial registration: The review was registered on PROSPERO (CRD42020221662) and a protocol peer-reviewed prior to data extraction.Item Open Access Sex-based analysis of treatment responses in animal models of sepsis: a preclinical systematic review protocol(2023-03-21) Zhang, MengQi; Fergusson, Dean A.; Sharma, Rahul; Khoo, Ciel; Mendelson, Asher A.; McDonald, Braedon; Macala, Kimberly F.; Sharma, Neha; Gill, Sean E.; Fiest, Kirsten M.; Lehmann, Christian; Shorr, Risa; Jahandideh, Forough; Bourque, Stephane L.; Liaw, Patricia C.; Fox-Robichaud, Alison; Lalu, Manoj M.Abstract Background The importance of investigating sex- and gender-dependent differences has been recently emphasized by major funding agencies. Notably, the influence of biological sex on clinical outcomes in sepsis is unclear, and observational studies suffer from the effect of confounding factors. The controlled experimental environment afforded by preclinical studies allows for clarification and mechanistic evaluation of sex-dependent differences. We propose a systematic review to assess the impact of biological sex on baseline responses to disease induction as well as treatment responses in animal models of sepsis. Given the lack of guidance surrounding sex-based analyses in preclinical systematic reviews, careful consideration of various factors is needed to understand how best to conduct analyses and communicate findings. Methods MEDLINE and Embase will be searched (2011-present) to identify preclinical studies of sepsis in which any intervention was administered and sex-stratified data reported. The primary outcome will be mortality. Secondary outcomes will include organ dysfunction, bacterial load, and IL-6 levels. Study selection will be conducted independently and in duplicate by two reviewers. Data extraction will be conducted by one reviewer and audited by a second independent reviewer. Data extracted from included studies will be pooled, and meta-analysis will be conducted using random effects modeling. Primary analyses will be stratified by animal age and will assess the impact of sex at the following time points: pre-intervention, in response to treatment, and post-intervention. Risk of bias will be assessed using the SYRCLE’s risk-of-bias tool. Illustrative examples of potential methods to analyze sex-based differences are provided in this protocol. Discussion Our systematic review will summarize the current state of knowledge on sex-dependent differences in sepsis. This will identify current knowledge gaps that future studies can address. Finally, this review will provide a framework for sex-based analysis in future preclinical systematic reviews. Systematic review registration PROSPERO CRD42022367726.Item Open Access Social factors associated with self-reported changes in mental health symptoms among youth in the COVID-19 pandemic: a cross-sectional survey(2024-02-28) Moss, Stephana J.; Stelfox, Maia; McArthur, Eric; Sriskandarajah, Cynthia; Ahmed, Sofia B.; Birnie, Kathryn; Halperin, Donna M.; Halperin, Scott A.; Harley, Micaela; Hu, Jia; Kamstra, Josh N.; Leppan, Laura; Nickel, Angie; Racine, Nicole; Russell, Kristine; Smith, Stacie; Solis, May; Tutelman, Perri R.; Stelfox, Henry T.; Fiest, Kirsten M.; Parsons Leigh, JeannaAbstract Background Children and youth experienced marked impacts on day-to-day life in the COVID-19 pandemic that were associated with poorer familial and friend relationships, and greater mental health challenges. Few studies provide self-report data on mental health symptoms from children and youth themselves. We sought to examine the associations between social factors and child and youth self-reported symptoms of worsened mood, anxiety, and irritability during the COVID-19 pandemic. Methods A nationally representative cross-sectional survey was administered online to collect self-report data across 10 Canadian provinces among children (11–14 years) and youth (15–18 years), April–May 2022. Age-appropriate questions were based on The Partnership for Maternal, Newborn & Child Health and the World Health Organization of the United Nations H6 + Technical Working Group on Adolescent Health and Well-Being consensus framework and the Coronavirus Health and Impact Survey. Associations between a priori defined social factors (e.g., relationship quality) and respondent self-reported mental health were evaluated using ordinal logistic regression models adjusted for age, sex, and geographic location. Results We analyzed data from 483 (51.7%) children (11–14 years; 227, 47.0% girls) and 450 (48.3%) youth (15–18 years; 204, 45.3% girls). The parents of most children and youth had resided in Canada for over 20 years (678, 72.7%). Over one-quarter of children and youth self-identified as Black, Indigenous, or a Person of Color (134, 27.7%; 134, 29.8%, respectively). Over one-third of children and youth self-reported symptoms of worsened mood (149, 30.9%; 125, 27.8%, respectively), anxiety (181, 37.5%; 167, 37.1%, respectively), or irritability (160, 33.1%; 160, 35.6%, respectively) during, compared to pre-pandemic. In descending order of odds ratios (OR), for children and youth, worsened familial relationships (during compared to pre-pandemic) was associated with the self-reported symptoms of worsened mood (child: OR 4.22, 95%CI 2.51–6.88; youth: OR 6.65 95%CI 3.98–11.23), anxiety (child: OR 4.24, 95%CI2.69–6.75; youth: OR 5.28, 95%CI 3.17–8.86), and irritability (child: OR 2.83, 95%CI 1.76–4.56; youth: OR 6.46, 95%CI 3.88–10.90). Conclusions Self-reported data from a nationally representative sample of children and youth suggest strong associations between social factors and mental health during the COVID-19 pandemic. Interventions targeting child and youth familial relationships may positively impact child and youth mental health.Item Open Access Study protocol: development and pilot testing of the Critical Care Pain Observation Tool for families (CPOT-Fam)(2022-07-16) Shahid, Anmol; Owen, Victoria S.; Sept, Bonnie G.; Longmore, Shelly; Soo, Andrea; Brundin-Mather, Rebecca; Krewulak, Karla D.; Moss, Stephana J.; Plotnikoff, Kara M.; Gélinas, Céline; Fiest, Kirsten M.; Stelfox, Henry T.Abstract Background Patients in the intensive care unit (ICU) often have limited ability to communicate making it more difficult to identify and effectively treat their pain. Family caregivers or close friends of critically ill patients may be able to identify signs of pain before the clinical care team and could potentially assist in routine pain assessments. This study will adapt the Critical Care Pain Observation Tool (CPOT) for use by family members to create the CPOT-Fam and compare family CPOT-Fam assessments with nurse-provided CPOT assessments for a given patient. Methods This study will be executed in two phases: 1) Development of the CPOT-Fam — A working group of patient partners, ICU clinicians, and researchers will adapt the CPOT for use by family caregivers (creating the CPOT-Fam) and produce an accompanying educational module to deliver information on pain and how to use the tool. The CPOT-Fam will undergo preclinical testing with participants (i.e., members of the public and family caregivers of critically ill adults), who will complete the educational module and provide CPOT-Fam scores on sample cases. Feedback on the CPOT-Fam will be collected. 2) Pilot testing the CPOT — Fam family caregivers of critically ill adults will complete the educational module and provide information on the following: (1) demographics, (2) anxiety, (3) caregiving self-efficacy, and (4) satisfaction with care in the ICU. Family caregivers will then provide a proxy assessment of their critically ill loved one’s pain through the CPOT-Fam and also provide a subjective (i.e., questionnaire-based including open-ended responses) account of their loved one’s pain status. A comparison (i.e., agreement) will be made between family caregiver provided CPOT-Fam scores and ICU nurse-provided CPOT scores (collected from the provincial health information system), calculated independently and blinded to one another. Feasibility and acceptability of the CPOT-Fam will be determined. Discussion The results of this work will produce a family caregiver CPOT (i.e., CPOT-Fam), determine feasibility and acceptability of the CPOT-Fam, and compare pain assessments conducted by family caregivers and ICU nurses. The results will inform whether a larger study to determine a role for family caregivers in ICU pain assessment using the CPOT-Fam is warranted.Item Open Access Systematic review and assessment of validated case definitions for depression in administrative data(BMC, 2014) Fiest, Kirsten M.; Jette, Nathalie; Quan, Hude; St Germaine-Smith, Christine; Metcalfe, Amy; Patten, Scott B.; Beck, Cynthia A.Background: Administrative data are increasingly used to conduct research on depression and inform health services and health policy. Depression surveillance using administrative data is an alternative to surveys, which can be more resource-intensive. The objectives of this study were to: (1) systematically review the literature on validated case definitions to identify depression using International Classification of Disease and Related Health Problems (ICD) codes in administrative data and (2) identify individuals with and without depression in administrative data and develop an enhanced case definition to identify persons with depression in ICD-coded hospital data. Methods: (1) Systematic review: We identified validation studies using ICD codes to indicate depression in administrative data up to January 2013. (2) Validation: All depression case definitions from the literature and an additional three ICD-9-CM and three ICD-10 enhanced definitions were tested in an inpatient database. The diagnostic accuracy of all case definitions was calculated [sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV)]. Results: (1) Systematic review: Of 2,014 abstracts identified, 36 underwent full-text review and three met eligibility criteria. These depression studies used ICD-9 and ICD-10 case definitions. (2) Validation: 4,008 randomly selected medical charts were reviewed to assess the performance of new and previously published depression-related ICD case definitions. All newly tested case definitions resulted in Sp >99%, PPV >89% and NPV >91%. Sensitivities were low (28-35%), but higher than for case definitions identified in the literature (1.1-29.6%). Conclusions: Validating ICD-coded data for depression is important due to variation in coding practices across jurisdictions. The most suitable case definitions for detecting depression in administrative data vary depending on the context. For surveillance purposes, the most inclusive ICD-9 & ICD-10 case definitions resulted in PPVs of 89.7% and 89.5%, respectively. In cases where diagnostic certainty is required, the least inclusive ICD-9 and -10 case definitions are recommended, resulting in PPVs of 92.0% and 91.1%. All proposed case definitions resulted in suboptimal levels of sensitivity (ranging from 28.9%-35.6%). The addition of outpatient data (such as pharmacy records) for depression surveillance is recommended and should result in improved measures of validity.Item Open Access Systematic Review and Meta-analysis of Interventions for Depression and Anxiety in Persons With Rheumatoid Arthritis(LIPPINCOTT WILLIAMS & WILKINS, 2017) Fiest, Kirsten M.; Hitchon, Carol A.; Bernstein, Charles N.; Peschken, Christine A.; Walker, John R.; Graff, Lesley A.; Zarychanski, Ryan; Abou-Setta, Ahmed; Patten, Scott B.; Sareen, Jitender; Bolton, James; Marrie, Ruth AnnBackground Psychiatric comorbidities, such as depression and anxiety, are very common in persons with rheumatoid arthritis (RA) and can lead to adverse outcomes. By appropriately treating these comorbidities, disease-specific outcomes and quality of life may be improved. Objective The aim of this study was to systematically review the literature from controlled trials of treatments for depression and anxiety in persons with RA. Methods We searched multiple online databases from inception until March 25, 2015, without restrictions on language, date, or location of publication. We included controlled trials conducted in persons with RA and depression or anxiety. Two independent reviewers extracted information including trial and participant characteristics. The standardized mean differences (SMDs) of depression or anxiety scores at postassessment were pooled between treatment and comparison groups, stratified by active versus inactive comparators. Results From 1291 unique abstracts, we included 8 RA trials of depression interventions (6 pharmacological, 1 psychological, 1 both). Pharmacological interventions for depression with inactive comparators (n = 3 trials, 143 participants) did not reduce depressive symptoms (SMD, -0.21; 95% confidence interval [CI], -1.27 to 0.85), although interventions with active comparators (n = 3 trials, 190 participants) did improve depressive symptoms (SMD, -0.79; 95% CI, -1.34 to -0.25). The single psychological trial of depression treatment in RA did not improve depressive symptoms (SMD, -0.44; 95% CI, -0.96 to 0.08). Seven of the trials had an unclear risk of bias. Conclusions Few trials examining interventions for depression or anxiety in adults with RA exist, and the level of evidence is low to moderate because of the risk of bias and small number of trials.Item Open Access Systematic review of interventions for depression and anxiety in persons with inflammatory bowel disease(BMC, 2016) Fiest, Kirsten M.; Bernstein, Charles N.; Walker, John R.; Graff, Lesley A.; Hitchon, Carol A.; Peschken, Christine A.; Zarychanski, Ryan; Abou-Setta, Ahmed; Patten, Scott B.; Sareen, Jitender; Bolton, James; Singer, Alexander; Marrie, Ruth AnnBackground Depression and anxiety are common in inflammatory bowel disease (IBD) and can affect disease outcomes, including quality of life and success of disease treatment. Successful management of psychiatric comorbidities may improve outcomes, though the effectiveness of existing treatments in IBD is unknown. Methods We searched multiple online databases from inception until March 25, 2015, without restrictions on language, date, or location of publication. We included controlled clinical trials conducted in persons with IBD and depression or anxiety. Two independent reviewers reviewed all abstracts and full-text articles and extracted information including trial and participant characteristics. We also assessed the risk of bias. Results Of 768 unique abstracts, we included one trial of pharmacological anxiety treatment in IBD (48 participants), which found an improvement in anxiety symptoms (p < 0.001). There was a high risk of bias in this trial. We found no controlled clinical trials on the treatment of depression in persons with IBD and depression and no controlled clinical trials reporting on psychological interventions for anxiety or depression in IBD. Conclusions Only one trial examined an intervention for anxiety in adults with IBD and no trials studied depression in adults with IBD. The level of evidence is low because of the risk of bias and limited evidence.