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Background The COVID-19 public health crisis has produced an immense and quickly evolving body of evidence. This research speed and volume, along with variability in quality, could overwhelm public health decision-makers striving to make timely decisions based on the best available evidence. In response to this challenge, the National Collaborating Centre for Methods and Tools developed a Rapid Evidence Service, building on internationally accepted rapid review methodologies, to address priority COVID-19 public health questions. Results Each week, the Rapid Evidence Service team receives requests from public health decision-makers, prioritizes questions received, and frames the prioritized topics into searchable questions. We develop and conduct a comprehensive search strategy and critically appraise all relevant evidence using validated tools. We synthesize the findings into a final report that includes key messages, with a rating of the certainty of the evidence using GRADE, as well as an overview of evidence and remaining knowledge gaps. Rapid reviews are typically completed and disseminated within two weeks. From May 2020 to July 21, 2021, we have answered more than 31 distinct questions and completed 32 updates as new evidence emerged. Reviews receive an average of 213 downloads per week, with some reaching over 7700. To date reviews have been accessed and cited around the world, and a more fulsome evaluation of impact on decision-making is planned. Conclusions The development, evolution, and lessons learned from our process, presented here, provides a real-world example of how review-level evidence can be made available – rapidly and rigorously, and in response to decision-makers’ needs – during an unprecedented public health crisis.

Health Evidence provides access to quality appraisals for >10,000 evidence syntheses on the effectiveness and cost-effectiveness of public health and health promotion interventions. Maintaining Health Evidence has become increasingly resource-intensive due to the exponential growth of published literature. Innovative screening methods using artificial intelligence (AI) can potentially improve efficiency. The objectives of this project are to: (1) assess the ability of AI-assisted screening to correctly predict nonrelevant references at the title and abstract level and investigate the consistency of this performance over time, and (2) evaluate the impact of AI-assisted screening on the overall monthly manual screening set. Training and testing were conducted using the DistillerSR AI Preview & Rank feature. A set of manually screened references (n=43,273) was uploaded and used to train the AI feature and assign probability scores to each reference to predict relevance. A minimum threshold was established where the AI feature correctly identified all manually screened relevant references. The AI feature was tested on a separate set of references (n=72,686) from the May 2019 to April 2020 monthly searches. The testing set was used to determine an optimal threshold that ensured >99% of relevant references would continue to be added to Health Evidence. The performance of AI-assisted screening at the title and abstract screening level was evaluated using recall, specificity, precision, negative predictive value, and the number of references removed by AI. The number and percentage of references removed by AI-assisted screening and the change in monthly manual screening time were estimated using an implementation reference set (n=272,253) from November 2020 to 2023. The minimum threshold in the training set of references was 0.068, which correctly removed 37% (n=16,122) of nonrelevant references. Analysis of the testing set identified an optimal threshold of 0.17, which removed 51,706 (71.14%) references using AI-assisted screening. A slight decrease in recall between the 0.068 minimum threshold (99.68%) and the 0.17 optimal threshold (94.84%) was noted, resulting in four missed references included via manual screening at the full-text level. This was accompanied by an increase in specificity from 35.95% to 71.70%, doubling the proportion of references AI-assisted screening correctly predicted as not relevant. Over 3 years of implementation, the number of references requiring manual screening was reduced by 70%, reducing the time spent manually screening by an estimated 382 hours. Given the magnitude of newly published peer-reviewed evidence, the curation of evidence supports decision makers in making informed decisions. AI-assisted screening can be an important tool to supplement manual screening and reduce the number of references that require manual screening, ensuring that the continued availability of curated high-quality synthesis evidence in public health is possible.

Background Fragmented delivery of health and social services can impact access to high-quality, person-centred care. The goal of system navigation is to reduce barriers to healthcare access and improve the quality of care. However, the effectiveness of system navigation remains largely unknown. This systematic review aims to identify the effectiveness of system navigation programs linking primary care with community-based health and social services to improve patient, caregiver, and health system outcomes. Methods Building on a previous scoping review, PsychInfo, EMBASE, CINAHL, MEDLINE, and Cochrane Clinical Trials Registry were searched for intervention studies published between January 2013 and August 2020. Eligible studies included system navigation or social prescription programs for adults, based in primary care settings. Two independent reviewers completed study selection, critical appraisal, and data extraction. Results Twenty-one studies were included; studies had generally low to moderate risk of bias. System navigation models were lay person-led ( n  = 10), health professional-led ( n  = 4), team-based ( n  = 6), or self-navigation with lay support as needed ( n  = 1). Evidence from three studies (low risk of bias) suggests that team-based system navigation may result in slightly more appropriate health service utilization compared to baseline or usual care. Evidence from four studies (moderate risk of bias) suggests that either lay person-led or health professional-led system navigation models may improve patient experiences with quality of care compared to usual care. It is unclear whether system navigation models may improve patient-related outcomes (e.g., health-related quality of life, health behaviours). The evidence is very uncertain about the effect of system navigation programs on caregiver, cost-related, or social care outcomes. Conclusions There is variation in findings across system navigation models linking primary care with community-based health and social services. Team-based system navigation may result in slight improvements in health service utilization. Further research is needed to determine the effects on caregiver and cost-related outcomes.

Objectives Associations between shift work and chronic disease have been observed, but relatively little is known about how to mitigate these adverse health effects. This critical review aimed to (i) synthesize interventions that have been implemented among shift workers to reduce the chronic health effects of shift work and (ii) provide an overall evaluation of study quality. Methods MeSH terms and keywords were created and used to conduct a rigorous search of MEDLINE, CINAHL, and EMBASE for studies published on or before 13 August 2012. Study quality was assessed using a checklist adapted from Downs & Black. Results Of the 5053 articles retrieved, 44 met the inclusion and exclusion criteria. Over 2354 male and female rotating and permanent night shift workers were included, mostly from the manufacturing, healthcare, and public safety industries. Studies were grouped into four intervention types: (i) shift schedule; (ii) controlled light exposure; (iii) behavioral; and, (iv) pharmacological. Results generally support the benefits of fast-forward rotating shifts; simultaneous use of timed bright light and light-blocking glasses; and physical activity, healthy diet, and health promotion. Mixed results were observed for hypnotics. Study quality varied and numerous deficiencies were identified. Conclusions Except for hypnotics, several types of interventions reviewed had positive overall effects on chronic disease outcomes. There was substantial heterogeneity among studies with respect to study sample, interventions, and outcomes. There is a need for further high-quality, workplace-based prevention research conducted among shift workers.

Background The primary objective of this systematic review was to update our previous review on randomized controlled trials (RCTs) of exercise in cancers other than breast or prostate, evaluating: 1) the application of principles of exercise training within the exercise prescription; 2) reporting of the exercise prescription components (i.e., frequency, intensity, time, and type (FITT)); and 3) reporting of participant adherence to FITT. A secondary objective was to examine whether reporting of these interventions had improved over time. Methods MEDLINE, EMBASE, CINAHL and SPORTDiscus databases were searched from 2012 to 2020. Eligible studies were RCTs of at least 4 weeks of aerobic and/or resistance exercise that reported on physiological outcomes relating to exercise (e.g., aerobic capacity, muscular strength) in people with cancer other than breast or prostate. Results Eighty-six new studies were identified in the updated search, for a total of 107 studies included in this review. The principle of specificity was applied by 91%, progression by 32%, overload by 46%, initial values by 72%, reversibility by 7% and diminishing returns by 5%. A significant increase in the percentage of studies that appropriately reported initial values (46 to 80%, p  < 0.001) and progression (15 to 37%, p  = 0.039) was found for studies published after 2011 compared to older studies. All four FITT prescription components were fully reported in the methods in 58% of all studies, which was higher than the proportion that fully reported adherence to the FITT prescription components in the results (7% of studies). Reporting of the FITT exercise prescription components and FITT adherence did not improve in studies published after 2011 compared to older studies. Conclusion Full reporting of exercise prescription and adherence still needs improvement within exercise oncology RCTs. Some aspects of exercise intervention reporting have improved since 2011, including the reporting of the principles of progression and initial values. Enhancing the reporting of exercise prescriptions, particularly FITT adherence, may provide better context for interpreting study results and improve research to practice translation.

Background Understanding organizational mechanisms that protect the mental health of the healthcare workforce during pandemics and epidemics is critical to support decision-making related to worker health and safety. This systematic review aimed to identify organizational-level factors, strategies or interventions that support the mental health of healthcare workers during pandemics or epidemics. Methods A comprehensive search was used, including online databases, a grey literature review, and handsearching of reference lists. Studies were eligible for inclusion if they described implementing or testing organizational-level factors, strategies or interventions to support healthcare workers’ mental health during pandemics or epidemics. There were no limitations by language, publication status, or publication date. Two reviewers independently conducted screening, data extraction, data analysis and quality appraisal, with conflicts resolved through discussion or third-party arbitration. Data analysis was guided by the Job Demands-Resources Model. A narrative synthesis is presented, given the high degree of heterogeneity across studies. Results A total of 10,805 articles from database searches and 190 records from other sources were screened. The final review included 86 articles. Studies were of low ( n  = 11), moderate ( n  = 39), and high quality ( n  = 36). Regarding job demands, 40 studies explored high work pressure or heavy workload factors, with the majority investigating working hours ( n  = 32). Increased working hours may be associated with an increased risk of diverse mental health outcomes. Regarding job resources, leadership factors, strategies (support, appreciation, responsiveness; n  = 19) and leadership interventions ( n  = 3) may be associated with decreased burnout, anxiety, stress, and increased well-being. The availability and adequacy of personal protective equipment ( n  = 20) may be associated with decreased burnout, anxiety, depression, and stress. Mixed findings were reported on associations between diverse mental health outcomes and training and education ( n  = 28) or peer support ( n  = 3). Results should be interpreted cautiously given the high heterogeneity among factors, strategies, and interventions assessed and outcomes measured. Conclusions Organizational-level mechanisms can critically influence the mental health of healthcare workers’ during pandemics and epidemics. More focused attention is needed to explore and act on the integral role of leadership and the availability of protective equipment to support healthcare workers’ mental health.

Background The purpose of this review is to update previously published reviews on exercise programming in exercise trials in prostate cancer survivors. We evaluated: 1) the application of the principles of exercise training in prescribed programs; 2) the reporting of the components of the exercise prescription; and 3) the reporting of adherence of participants to the prescribed programs. Methods Building upon a previous review, a systematic review was conducted searching OVID Medline, Embase, CINAHL, and SPORTDiscus databases from 2012-2017. Randomized controlled trials of at least four weeks of aerobic and/or resistance exercise in men diagnosed with prostate cancer that reported physical fitness outcomes, including body composition were eligible for inclusion. Results Specificity was appropriately applied by 93%, progression by 55%, overload by 48%, initial values by 55%, and diminishing returns by 28% of eligible studies. No study adequately applied the principle of reversibility. Most (79%) studies reported all components of the exercise prescription in the study methods, but no study reported all components of adherence to the prescribed intervention in the study results. Conclusions Application of standard exercise training principles is inadequate in exercise trials in men with prostate cancer and could possibly lead to an inadequate exercise stimulus. While many studies report the basic components of the exercise prescription in their study methods, full reporting of actual exercise completed is needed to advance our understanding of the optimal exercise dose for men with prostate cancer and promote translation of controlled trials to practice.

Background As evidence related to the COVID-19 pandemic surged, databases, platforms, and repositories evolved with features and functions to assist users in promptly finding the most relevant evidence. In response, research synthesis teams adopted novel searching strategies to sift through the vast amount of evidence to synthesize and disseminate the most up-to-date evidence. This paper explores the key database features that facilitated systematic searching for rapid evidence synthesis during the COVID-19 pandemic to inform knowledge management infrastructure during future global health emergencies. Methods This paper outlines the features and functions of previously existing and newly created evidence sources routinely searched as part of the NCCMT’s Rapid Evidence Service methods, including databases, platforms, and repositories. Specific functions of each evidence source were assessed as they pertain to searching in the context of a public health emergency, including the topics of indexed citations, the level of evidence of indexed citations, and specific usability features of each evidence source. Results Thirteen evidence sources were assessed, of which four were newly created and nine were either pre-existing or adapted from previously existing resources. Evidence sources varied in topics indexed, level of evidence indexed, and specific searching functions. Conclusion This paper offers insights into which features enabled systematic searching for the completion of rapid reviews to inform decision makers within 5–10 days. These findings provide guidance for knowledge management strategies and evidence infrastructures during future public health emergencies.

Background Sexual dysfunction is prevalent among cancer survivors, significantly impacting patient and partner quality of life. Despite this, sexual health clinics (SHCs) remain rare in cancer centres across Canada. An innovative clinic was developed at Princess Margaret Cancer Centre in Toronto, Canada to address this significant gap in survivorship care. This study examines factors affecting the provision of sexual healthcare and the implementation of a sexual health clinic within a large urban centre. Methods The Quality Implementation Framework was used to explicate patient and provider experience and identify barriers and facilitators to integrating sexual healthcare into routine cancer care workflows. Healthcare providers and patients representing selected cancer types (prostate, cervical, ovarian, testicular, bladder, kidney, and head and neck cancer) participated in semi-structured interviews. Interviews were transcribed and analyzed using the Framework qualitative analysis protocol. Results The analysis identified three organizing domains and ten themes that describe the unique aspects of the sexual healthcare experience and critical factors for sexual health implementation. Both patients and providers described a lack of sexual health support in the oncology setting and emphasized the need for comprehensive and personalized care. Limitations of current care provision included mutual silence between patients and providers due to discomfort in discussing sexual issues, insufficient provider confidence in delivering optimal sexual healthcare, and constraints related to space and time. Key Factors for implementing a sexual health clinic in oncology emphasized the importance of having a dedicated clinic, flexibility in service delivery, proactive patient engagement, and ongoing staff education. Conclusions Findings highlight significant challenges in addressing sexual health in an oncology setting, underscoring the need for specialized sexual health clinics that are integrated with, but distinct from, routine oncology care. This study further emphasizes the need for incorporating sexual healthcare in survivorship programs as well as the necessity of conducting thorough implementation research, involving multiple stakeholders, prior to launching new programs.

Background There is limited evidence about the mental health and intention to leave of the public health workforce in Canada during the COVID-19 pandemic. The objectives of this study were to determine the prevalence of burnout, symptoms of anxiety and depression, and intention to leave among the Canadian public health workforce, and associations with individual and workplace factors. Methods A cross-sectional study was conducted using data collected by a Canada-wide survey from November 2022 to January 2023, where participants reported sociodemographic and workplace factors. Mental health outcomes were measured using validated tools including the Oldenburg Burnout Inventory, the 7-item Generalized Anxiety Disorder scale, and the 2-item Patient Health Questionnaire to measure symptoms of depression. Participants were asked to report if they intended to leave their position in public health. Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for the associations between explanatory variables such as sociodemographic, workplace factors, and outcomes of mental health, and intention to leave public health. Results Among the 671 participants, the prevalence of burnout, and symptoms of depression and anxiety in the two weeks prior were 64%, 26%, and 22% respectively. 33% of participants reported they were intending to leave their public health position in the coming year. Across all outcomes, sociodemographic factors were largely not associated with mental health and intention to leave. However, an exception to this was that those with 16–20 years of work experience had higher odds of burnout (aOR = 2.16; 95% CI = 1.12–4.18) compared to those with ≤ 5 years of work experience. Many workplace factors were associated with mental health outcomes and intention to leave public health. Those who felt bullied, threatened, or harassed because of work had increased odds of depressive symptoms (aOR = 1.85; 95% CI = 1.28–2.68), burnout (aOR = 1.61; 95% CI = 1.16–2.23), and intention to leave (aOR = 1.64; 95% CI = 1.13–2.37). Conclusions During the COVID-19 pandemic, some of the public health workforce experienced negative impacts on their mental health. 33% of the sample indicated an intention to leave their role, which has the potential to exacerbate pre-existing challenges in workforce retention. Study findings create an impetus for policy and practice changes to mitigate risks to mental health and attrition to create safe and healthy working environments for public health workers during public health crises.