Ottawa Public Health

Canadian Blood Services implemented a re-entry programme in 2014. Donors deferred because of false-reactive or indeterminate screening tests can provide a specimen for re-entry testing 6 months after their initial test, and resume donating if they test negative for all infectious markers. We evaluated the impact of the programme on donor return and retention, and assessed factors associated with reactive results upon re-entry testing. Using extracted data from our donor database, we followed up donors who tested false-reactive for hepatitis B virus (HBV), human immunodeficiency virus (HIV) and hepatitis C virus (HCV), from the implementation of the programme on 3 February 2014 until 30 June 2025 (n = 8094). We characterized the donors reaching each step of the programme by sex, age, donation status and infection marker. We employed logistic regression to identify important predictors of obtaining reactive results upon re-entry testing. Overall, 17.3% of donors eligible for re-entry testing successfully returned and donated. Re-entry testing participation rates were 35.5%, with repeat and older donors more likely to participate. Among re-entry tested donors, 59.2% tested negative. Most donors continued to donate for multiple years upon re-entry. Upon return, 13.1% tested false reactive on a subsequent donation. False-reactives upon re-entry testing were more likely for first-time donors and less likely when a different assay was employed than for the initially false-reactive. The implementation of a donor re-entry programme has resulted in donor retention and increases in the blood supply. Sending reminder notifications to eligible donors could increase participation.

Introduction L’environnement bâti favorise l’activité physique en offrant des possibilités d’être actif dans sa vie quotidienne. Les expériences naturelles sont précieuses pour évaluer la manière dont les modifications à l’environnement bâti dans le monde réel affectent l’activité physique et sont essentielles pour guider les politiques visant à améliorer l’activité physique à l’échelle de la population. Cette étude visait à synthétiser les données probantes issues d’expériences naturelles ayant porté sur les répercussions des modifications à l’environnement bâti sur l’activité physique au Canada. Méthodologie Des recherches ont été effectuées dans MEDLINE, Embase, PsycINFO, ProQuest Public Health et SportDISCUS, de la création au 27 novembre 2024. Toutes les évaluations d’expériences naturelles incluant un groupe de comparaison ou un point de référence dans le passé et évaluant les changements dans l’activité physique associés à des modifications à l’environnement bâti étaient admissibles. Une synthèse narrative résume les données probantes, en présentant leur degré de certitude. Résultats Les résultats des 25 expériences naturelles sélectionnées révèlent des effets positifs, avec un degré de certitude faible à modéré, de l’augmentation du potentiel piétonnier, des nouvelles infrastructures cyclables et piétonnes, des programmes de vélos en libre-service (location de vélos) et des nouveaux sentiers. On observe en revanche avec un degré de certitude de très faible à faible une absence d’effets notables pour le service rapide par bus, l’amélioration des bâtiments scolaires et des cours de récréation et l’aménagement des zones scolaires. Certaines données probantes suggèrent que les parcs canins où les chiens peuvent circuler sans laisse ont des effets négatifs sur l’activité physique des enfants dans les parcs, et que les améliorations apportées aux cours de garderies ont des effets sur l’activité physique d’intensité modérée à vigoureuse. Conclusion Peu d’études canadiennes ont évalué les répercussions des modifications à l’environnement bâti sur l’activité physique, la plupart d’entre elles ayant été publiées dans la dernière décennie. Les études futures devraient inclure des échantillons plus importants et plus diversifiés ainsi que toutes les régions, contrôler pour les facteurs de confusion, notamment les variations saisonnières de l’activité physique en plein air, utiliser des groupes témoins bien appariés et intégrer des mesures objectives de l’activité physique.

The Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials (CRTs), published in 2012, is the first and remains the only international ethics guidance document specific to CRTs. However, the stepped-wedge CRT design raises complex ethical issues for which guidance may be lacking. The overarching objective of this review is to inform the forthcoming update of the Ottawa Statement; specific objectives are to characterize the types of interventions and data collection procedures in stepped-wedge CRTs (SW-CRTs), and to examine adherence to key ethical design, conduct, and reporting recommendations. Primary reports of SW-CRTs evaluating health interventions published 2016-2022 in English were reviewed. Two reviewers extracted data from each trial independently; discrepancies were resolved through consensus. Among 160 SW-CRTs, most evaluated multilevel interventions (78, 49%), and uncommonly involved therapeutic patient interventions (19, 12%). Few (10, 6%) exclusively used routinely collected data sources for outcome assessment. Sixty-four trials (40%) provided explicit justifications for using cluster randomization and the stepped-wedge design. Most (157, 98%) included a statement about research ethics committee (REC) review, of which 148 (94%) reported approval. A statement about consent was reported in 145 (91%), with 113 (78%) pertaining to patients only, 10 (7%) to health-care providers only, and 22 (15%) to both. Among 135 trials reporting on patient consent, consent was not obtained in 55 (41%). Justifications for not obtaining consent were provided in 42 (76%). The updated Ottawa Statement should provide guidance about when people should be considered research participants and when their consent is required, justifications for using a stepped-wedge design, the need for REC review, and the burden of data collection procedures in SW-CRTs. We reviewed 160 SW-CRTs published between 2016 and 2022. These trials often evaluate multifaceted interventions delivered at the cluster or professional level rather than individual level, and most had to rely on at least some form of primary data collection. Although almost all SW-CRTs reported ethics review, fewer than half explained why they used the SW-CRT design, and a substantial minority did not include a statement about whether participant informed consent was obtained. Rarely did consent statement pertain to health-care providers; most statements pertained to patients. Among the SW-CRTs that had consent statements pertaining to patients, almost half reported not obtaining or waiving consent from them, and many of these did not report clear reasons for this. Our findings highlight the need for clearer guidance in the forthcoming update to the Ottawa Statement on the Ethical Design and Conduct of CRTs.

The Canadian CT Head Rule (CCTHR) is validated in adults who hit their head and experience loss of consciousness, amnesia, or disorientation. There is less evidence to guide brain imaging when the fall history is unclear. This is a secondary analysis of a prospective study on adults aged ≥ 65 who presented to 11 emergency departments across Canada and the United States after a ground level fall. We reported the prevalence of adjudicated clinically important intracranial bleeding within 42 days of the emergency department visit among (a) patients who hit their head and met the application criteria for the CCTHR (experienced loss of consciousness, amnesia, or disorientation), (b) patients who hit their head and did not meet the CCTHR application criteria, (c) patients with an unclear history of the CCTHR application criteria, (d) patients with an unclear head injury history, and (e) patients with no head injury. 4303 participants were analyzed. The prevalence of clinically important intracranial bleeding in the subgroups was (a) patients who fulfilled the CCTHR application criteria, 7.7% (54/703, 95% confidence interval [CI]: 5.9%-9.9%), (b) patients who hit their head but did not meet CCTHR application criteria, 2.5% (30/1204, 95% CI: 1.8%-3.5%), (c) patients with head injury but an unclear history of the CCTHR application criteria, 7.6% (19/251, 95% CI: 4.9%-12.0%), (d) patients with an unclear history of head injury, 4.6% (23/502, 95% CI: 3.2%-6.8%), and (e) patients who did not hit their head, 0.8% (13/1643, 95% CI: 0.5%-1.3%). Older adults presenting after a fall with an unclear history of head injury, or an unclear history of head injury-associated loss of consciousness, amnesia, or disorientation have an elevated risk for clinically important intracranial bleeding that merits emergency brain imaging.

IntroductionMedication-related problems at transitions of care are common and can lead to patient harm. Comparing results of studies that look at medication reconciliation and medication safety at transitions of care can be difficult as the outcomes reported in these studies are heterogeneous. Moreover, the outcomes measured often lack the patient’s perspective. A core outcome set (COS) is a list of outcomes which should be measured and reported in studies in order to avoid heterogeneity between trials, measure outcomes relevant to stakeholders and ensure all trials report usable information. This study aims to develop a COS for medicines safety at transitions of care, through updating an existing systematic review and evaluating the perspectives of patients, carers and healthcare professionals.MethodsThis study is registered with the Core Outcome Measures in Effective Trials (COMET) initiative and the project will be conducted following the COS-STAR (Core Outcome Set-Standards for Reporting) guidelines for the design and reporting of COSs. A four-step process will be followed: (1) updating an existing systematic literature review; (2) semistructured interviews with patients and their caregivers; (3) Delphi survey preparation involving a project steering group to compile a list of potential outcomes; (4) a three-round Delphi consensus exercise involving patients, clinicians and policymakers to refine the final core list of outcomes.AnalysisThis will be the first COS for medicines safety at transitions of care and will address an unmet need in providing an essential measurement approach that incorporates patients’, carers’ and healthcare professionals’ views. The findings apply to both quality improvement and research, ensuring the relevance and translation of future research findings.Ethics and disseminationEthical approval for the qualitative surveys and Delphi technique has been granted by the Irish College of General Practitioners Research Ethics Committee (Record ID: 2182). The findings of this project will be disseminated through peer-reviewed publications, conference presentations and registration with the COMET Initiative. Members of the Delphi panel will receive summaries of the outputs, and findings will also be shared with the patient and public involvement groups involved in the study through lay summaries. Engagement with professional societies, healthcare organisations and patient groups will ensure that the COS is widely accessible and adopted into future practice.