Stephana Julia Moss

Background: Family caregivers (i.e., family members, close friends) may be able to help assess pain in intensive care unit (ICU) patients. However, suitable methods for family caregivers to assess pain in the ICU have yet to be identified. Aim: To evaluate the feasibility and acceptability of independently collecting patient and family caregiver assessments of patient pain and to determine agreement between pain scores. Study Design: Adult patients who could communicate pain ratings and their family caregivers (creating patient–family caregiver dyads) from a single ICU in Calgary, Alberta, Canada were asked to simultaneously provide independent (unaware of the other's response) assessments of the patient's pain (beginning 4 January 2023) using: (1) a yes/no response on the presence of pain, (2) pain intensity on the Numerical Rating Scale, and (3) open text descriptions of pain. The feasibility of obtaining pain assessments from dyads was determined by the percent of dyads recruited compared to dyads approached. Acceptability was determined by calculating completion rates of dyads in this study. Cohen's kappa ( κ ) and intraclass correlation coefficients (ICC) [95% confidence intervals] were used to determine inter‐dyad agreement. Results: Of 458 patients admitted to the study ICU during the recruitment period, 45 dyads were approached for participation. Thirty‐four dyads (75.6%) consented (feasibility outcome) and completed (100%) the study (acceptability outcome). Agreement was moderate between yes/no pain responses ( κ = 0.45 [0.16–0.76]) and good between patient and family caregiver Numerical Pain Scale scores (ICC = 0.75 [0.56–0.87]). Of the 18 dyads who provided open text descriptions of the pain, 13 (72.2%) were similar for patients and family caregivers. Conclusions: Collecting independent, simultaneous pain assessments from patient–family caregiver dyads in the ICU appears feasible and acceptable, and family caregivers appear to provide good proxy reports of the patient's pain. Relevance to Clinical Practice: Family caregiver involvement in pain assessment in the ICU may have the potential to complement clinical pain assessment in select contexts, particularly for patients who are unable to communicate, although further research is needed.

International reports highlight important impacts of the COVID-19 pandemic on the wellbeing of youth. There is limited knowledge of the experiences and per

Introduction The use of digitally enabled technology is considered a promising platform to prevent morbidity and enhance youth mental health as youth are growing up in the digital world and accessing the Internet at increasingly younger age. This scoping review will identify, describe and categorise the models, frameworks and strategies that have been used to study the implementation of digital mental health interventions targeted at youth aged 15–34 years. Methods and analysis We will conduct a scoping review following the Arksey-O’Malley five-stage scoping review method and the Scoping Review Methods Manual by the Joanna Briggs Institute. Implementation methods will be operationalised according to pre-established aims: (1) process models that describe or guide the implementation process; (2) evaluation frameworks evaluating or measuring the success of implementation; and (3) implementation strategies used in isolation or combination in implementation research and practice. Primary research studies in all languages will be identified in CINAHL, Cochrane Central Register of Controlled Trials, Embase, ERIC, Education Research Complete, MEDLINE and APA PsycINFO on 6 January 2025. Two reviewers will calibrate screening criteria and the data charting form and will independently screen records and abstract data. We will use the Evidence Standards Framework for Digital Health Technologies by the National Institute for Health and Care Excellence to classify digital interventions based on functions, and a pre-established working taxonomy to synthesise conceptually distinct implementation outcomes. Convergent integrated data synthesis will be performed. Ethics and dissemination Ethical approval is not applicable as this scoping review will be conducted only on data presented in the published literature. Findings will be published and directly infused into our multidisciplinary team of academic researchers, youth partners, health professionals and knowledge users (healthcare and non-governmental organisation decision makers) to co-design and pilot test a digital psychoeducational health intervention to engage, educate and empower youth to be informed stewards of their mental health.

Mental health disorders typically emerge in early life and can be modified through prompt intervention. Mental health literacy is the multi-dimensional knowledge of mental health disorders to recognize, manage, or prevent mental health disorders. Enhancing youth mental health literacy through information communication technologies already adopted by youth may be an accessible and effective approach to address the ongoing mental health crisis. We used an interconnected, three phase process following co-design methods to determine evidence-based consensus statements to conceptualize and develop the Youth MindTrack and to inform future digital tools to support youth mental health literacy. In Phase I, a scientific team (N = 21; 24% youth) adhered to deliberative dialogue and priority setting methods to develop strategic priorities. Phase II consisted of a modified Delphi consensus process to determine evidence-based consensus statements (N = 352 (13% youth) Round 1; N = 87 (33% youth) Round 2). Semi-structured focus groups in Phase III were conducted to refine the consensus statements (N = 16, 25% youth) and design the digital mental health literacy tool (N = 24, 33% youth). Twenty-one consensus statements encompassing four domains were produced: (1) Understanding mental health (N = 4); (2) Exercising mental health (N = 6); (3) Engaging with digital support (N = 8); and (4) Evaluating digital support (N = 3). Content analysis of discussions identified 16 themes mapped to the domains of mental health literacy and user-interface, design considerations for digital tools on mental health literacy more broadly. The resulting design of the Youth MindTrack tool to support mental health literacy included four main interactive sections designed to be downloaded and completed by youth on a digital device. We determined 21 evidence-based consensus statements that underpinned the conceptualization and development of the Youth MindTrack: a downloadable digital tool to support youth mental health literacy. The data supports proceeding to pilot testing to assess the tool’s usability, acceptability, and perceived effectiveness prior to implementation, and provides evidence that an iterative and participatory research-based process with youth can help adapt health technology to their needs.

Background: Despite longstanding efforts and calls for reform, Canada’s incremental approach to healthcare changes has left the country lagging behind other OECD nations. Reform to the Canadian healthcare system is essential to develop a higher performing system. This study sought to gain a deeper understanding of the views of Canadian stakeholders on structural and process deficiencies and strategies to improve the Canadian healthcare system substantially and meaningfully. Methods: We conducted individual, ~ 45-minute, semi-structured virtual interviews from May 2022 to August 2022. Using existing contacts and snowball sampling, we targeted one man and one woman from five regions in Canada across four stakeholder groups: (1) public citizens; (2) healthcare leaders; (3) academics; and (4) political decision makers. Interviews centered on participants’ perceptions of the state of the current healthcare system, including areas where major improvements are required, and strategies to achieve suggested enhancements; Donabedian’s Model (i.e., structure, process, outcomes) was the guiding conceptual framework. Interviews were audio-recorded, transcribed verbatim, and de-identified, and inductive thematic analysis was performed independently and in duplicate according to published methods. Results: The data from 31 interviews with 13 (41.9%) public citizens, 10 (32.3%) healthcare leaders, 4 (12.9%) academics, and 4 (12.9%) political decision makers resulted in three themes related to the structure of the healthcare system (1. system reactivity; 2. linkage with the Canadian identity; and 3. political and funding structures), three themes related to healthcare processes (1. staffing shortages; 2. inefficient care; and 3. inconsistent care), and three strategies to improve short- and long-term population health outcomes (1. delineating roles and revising incentives; 2. enhanced health literacy; 3. interdisciplinary and patient-centred care). Conclusion: Canadians in our sample identified important structural and process limitations to the Canadian healthcare system. Meaningful reforms are needed and will require addressing the link between the Canadian identity and our healthcare system to facilitate effective development and implementation of strategies to improve population health outcomes.

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.

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)

Introduction On 11 March 2020, WHO declared the novel coronavirus (COVID-19) disease a global pandemic. Governments globally implemented physical distancing measures and closure of public institutions that resulted in varying implications to youth mental well-being (eg, social isolation, reduced extracurricular activities). These impacts may have detrimental short-term and long-term effects on youth mental well-being; care for youth with mental health disorders was already overstretched, underfunded and fragmented before the pandemic and youth are not often considered in mental health initiatives. There is a pressing need to partner with youth and families to target and improve youth mental well-being prior to the onset of a mental health disorder, as well as to conduct research on youth mental well-being needs related to pandemic recovery. Here we present a protocol for partnering with youth and families to codesign a user-centred digital tool for youth mental well-being. Methods and analysis We will conduct a national research study to develop a catalogue of recommendations specific to supporting youth mental well-being, and a digital tool to support youth mental well-being through three phases of work: (1) expert consultation on data related to supporting youth mental well-being existing within our Pandemic Preparedness Research Program; (2) codesign of an innovative digital tool for youth mental well-being; and (3) assessment of the tool’s usability and acceptability. Ethics and dissemination This study has been approved by the Dalhousie Research Ethics Board (2023-6538) and the Conjoint Health Research Ethics Board (23-0039). This study will complement ongoing foundational research in youth conducted by our team that involves partnering with youth and families to understand the unique implications of the pandemic on this population.