Ottawa Hospital

Background International guidelines recommend sterile water for endoscopic irrigation despite limited evidence. Single-use plastic sterile water bottles generate substantial costs, greenhouse gas emissions, and microplastics. We sought to estimate whether replacing sterile water with potable tap water for endoscopic irrigation affected clinical outcomes. Methods This quasi-experimental study involved an interrupted time series design at a multi-campus tertiary care academic health system (The Ottawa Hospital, Canada). All adults undergoing esophagogastroduodenoscopy, colonoscopy, flexible sigmoidoscopy, enteroscopy, ileoscopy, or pouchoscopy between February 2024 and August 2025 were included. A system-wide switch to tap water took place on February 10, 2025. The primary outcome was a composite of emergency department visits, unplanned admissions, or deaths within 7 days post-procedure. Infectious complications within 30 days constituted secondary endpoints. Data were obtained from validated institutional databases. Segmented regression modeled the weekly outcome proportion to estimate the step change post-implementation, with a non-inferiority margin of <0.5% absolute risk increase. Findings A total of 29,522 procedures were performed on 29,423 patients (18,863 pre-implementation; 10,560 post-implementation). Patient and procedural characteristics were comparable. The weekly proportion experiencing the primary outcome was 1.6% in both phases. The post-implementation step change was −0.40% (95% confidence interval [CI] −1.16 to 0.35), with the upper boundary of the 95% CI below the pre-specified non-inferiority margin of 0.5%. Results were similar for infectious complications (step change −0.23%, 95% CI −0.75 to 0.29). Interpretation Potable tap water was non-inferior to sterile water for endoscopic irrigation with respect to clinical outcomes. These findings provide an evidence base for revising current guideline recommendations that mandate sterile water for endoscopic irrigation. Funding This project was supported by the 2024 Canadian Society of Colorectal Surgeons Research Operating Grant.

Virtual reality (VR) may offer training advantages over mannequin-based high-fidelity simulation (HFS), but data are lacking. We sought to investigate whether VR is noninferior to HFS in teaching nontechnical skills to anesthesiology trainees. We conducted a sequential randomized controlled noninferiority trial to compare two simulation crisis management scenarios in 31 anesthesiology trainees. Scenario #1 was delivered either as a VR or as HFS. After 3 weeks, all participants underwent scenario #2, delivered only as HFS. We set a noninferiority margin of 0.6 for the overall improvement on the Ottawa Global Rating Scale (O-GRS), a crisis resource management scale, in scenario #2 between the two groups. As secondary outcomes, we compared changes in the Anaesthetists’ Non-technical Skills (ANTS) scale and the Managing Emergencies in Paediatric Anaesthesia Global Rating Scale (MEPA-GRS) between the two groups. We also evaluated the VR module using the VR Sickness Questionnaire (VRSQ), the System Usability Scale (SUS), the Technology Acceptance Model, and a feedback survey. During scenario #2, VR was noninferior to HFS regarding the overall O-GRS improvement (mean difference [upper bound 97.5 NCT05041049 ); first submitted 10 September 2021.

Objectives: Alcohol withdrawal is a potentially life-threatening condition commonly managed using the Clinical Institute Withdrawal Assessment-Alcohol Revised (CIWA-Ar) protocol. The objective of our study is to examine quality of care outcomes for patients with alcohol-related diagnoses treated with the CIWA-Ar protocol at a large tertiary care hospital. We specifically aim to describe opportunities for further risk stratification for inpatients with withdrawal to help clinical teams identify the appropriate level of care (eg, ward versus higher-acuity unit) for these patients, and to identify current quality gaps in the care of patients with alcohol-related diagnoses. Methods: We conducted a health records review of patients admitted to the internal medicine service at a large tertiary care academic centre from January 2022 until January 2024 with alcohol-related diagnoses. We collected data on duration and severity of CIWA-Ar scores, inpatient alcohol and benzodiazepine prescriptions, and prescriptions for relapse prevention pharmacotherapy. Results: Our cohort of 878 patients had 1281 admissions. Of these 1281 encounters, 655 were on the CIWA-Ar protocol. 35.1% of patients had lower-acuity withdrawal, defined as CIWA-Ar scores remaining <10 throughout admission. 79 patients were prescribed both benzodiazepines and managed alcohol during their admission; of these, 67.1% received concurrent prescriptions. Relapse prevention pharmacotherapy (naltrexone or acamprosate) was prescribed in 25.4% of encounters. Conclusions: We identified several key areas for improvement in the management of withdrawal. We propose an alcohol withdrawal risk stratification algorithm to help improve disposition decisions, which may have important implications for patient care, resource management, and hospital costs across Canada.

Chest X-rays are an inexpensive and widely available imaging modality for diagnosing or monitoring a variety of medical conditions. Given their abundance, healthcare providers could greatly benefit from automated systems capable of screening healthy patients and supporting the diagnosis of pathological cases. Deep learning has become central to such decision-support systems, offering accurate and efficient image classification that can improve clinical workflows and reduce radiologist workload. However, despite the rapid evolution of general-purpose neural architectures, particularly attention-based models, their application to medical imaging remains constrained by limited incorporation of medical domain knowledge. Most existing attention mechanisms optimize only task-specific losses, disregarding crucial anatomical and lesion-location priors, which can hinder generalization and interpretability. In this work, we introduce a fully automated, attention-guided classification framework that integrates medical priors through an on-the-fly segmentation of the lungs, followed by a spatially aware attention loss that directs the network’s focus toward clinically relevant regions. The method requires minimal physician input—only a single annotated X-ray indicating potential lesion areas at initialization and generalizes effectively across patients without relying on absolute bounding-box coordinates. Gradient-based activation mapping is further employed to ensure alignment between attention and lesion-specific regions. Our approach is architecture-agnostic and integrates seamlessly into end-to-end pipelines. Experiments on two medical image datasets demonstrate that the proposed segmentation-enhanced attention loss improves both classification accuracy and representation interpretability compared to the standard cross-entropy loss. The code is available at: https://github.com/rcorizzo/cxr-segmentation-attention/ .

BACKGROUND:Renizgamglogene autogedtemcel (reni-cel) is an investigational clustered regularly interspaced short palindromic repeats (CRISPR)-Cas12a gene-edited autologous hematopoietic stem-cell therapy. The therapy was designed to disrupt the BCL11A binding sites in the HBG1 and HBG2 promoters to reactivate fetal hemoglobin production for the treatment of sickle cell disease. METHODS:We conducted a phase 1-2, multicenter, open-label, single-group study involving patients with severe sickle cell disease who were 12 to 50 years of age and had had at least two severe vaso-occlusive events per year in the previous 2 years. The patients received a single infusion of reni-cel after myeloablative conditioning with busulfan. The patients were monitored for engraftment, hemoglobin-related measures, allelic editing levels, vaso-occlusive events, and adverse events over a 24-month period. The study was terminated early on the basis of the sponsor's reassessment of clinical development priorities. Results of an analysis that was not prespecified are reported. RESULTS:As of October 29, 2024, a total of 28 patients with severe sickle cell disease had been treated with reni-cel. The median duration of follow-up was 9.5 months (range, 0.7 to 25.2). Among 27 patients who had neutrophil and platelet engraftment by the data-cutoff date, neutrophil engraftment occurred after a median of 23 days (range, 14 to 29), and platelet engraftment occurred after a median of 25 days (range, 17 to 51). At month 6, among 18 patients with at least 6 months of available data, the mean (±SD) total hemoglobin level (9.8±1.7 g per deciliter at baseline) had increased to 13.8±1.9 g per deciliter, and the mean percentage of fetal hemoglobin (2.5±2.5% at baseline) had increased to 48.1±3.2%; both measures were maintained at or above these values thereafter. One patient had two severe vaso-occlusive events after infusion. Adverse events were consistent with those that occur after myeloablative busulfan-based conditioning and autologous hematopoietic stem-cell transplantation. CONCLUSIONS:Treatment with reni-cel led to normalization of the total hemoglobin level and an increase in the percentage of fetal hemoglobin, with no vaso-occlusive events occurring in 27 of 28 patients after infusion. These results support further investigation of this gene-editing approach in the treatment of severe sickle cell disease. (Funded by Editas Medicine; RUBY ClinicalTrials.gov number, NCT04853576.).