Discussion
To our knowledge, STRIDES is the largest and most comprehensive cluster randomised trial to date in the prevention of VVR among whole blood donors. The rationale for its conduct was suggested by our prior systematic review and meta-analysis of previous randomised trials assessing the effects of water loading, AMT and other interventions, which highlighted serious limitations in the quality and quantity of available randomised evidence [We anticipate that the STRIDES trial will yield novel information about the four pragmatic and scalable interventions we are assessing, both singly and in combination, for the prevention of VVRs. The trial results should, therefore, help generate policy-shaping evidence to inform blood services to improve donor health, donor experience, and service efficiency.More generally, this trial exemplifies another instance of NHSBT’s continuing aspiration, in collaboration with strategic academic partners, to be a “learning health organisation” in which internal data and experience are systematically integrated with external evidence, and that knowledge is put into practice to improve safety and efficiency in NHSBT and, potentially, in other blood services [