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Volume 19, Issue 1, Summer 2019


16th Annual ACHORD Retreat

The 16th Annual ACHORD Retreat was held in conjunction with the DON SCN Diabetes in Pregnancy (DIP) Summit on March 4 & 5, 2019 at the beautiful City Room in Peter Lougheed Hall on the University of Alberta campus. We shared the meeting with the DON SCN once in the past; this informal meeting provided an opportunity for ACHORD members, investigators, collaborators and trainees to share research activities, and plan for continued growth of the ACHORD group and potentially increase collaboration with the Diabetes in Pregnancy group. Unfortunately, the flu kept many presenters and participants away so the final agenda changed from the initial agenda. Thank you to everyone that attended.

The DON SCN DIP Summit took place on Monday, March 4 with the ACHORD Retreat taking place on Tuesday, March 5, 2019.

In particular, thank you to the following individuals who presented at the ACHORD Retreat:

▪ Jeff Johnson – ACHORD Past and Accolades
Jeff Johnson – ACHORD Past and Accolades

Project Updates:

▪ Allan Ryan – DISER Update.
▪ Allison Soprovich – ABCD Cohort Update.
▪ Jeff Johnson – Comprehensive Annual Care Plan Physician and Pharmacists Findings.
▪ Scott Campbell – Early addition of sitagliptin associated with a delay in diabetes progression.
▪ Jill Hall – Incident dysglycemia in randomized clinical trials of thiazide diuretics: a meta analysis.
▪ Dean Eurich and Denise Van Wheelden – RADAR Project Update
Allan Ryan – DISER Update.
Allison Soprovich – ABCD Cohort Update.
Jeff Johnson – Comprehensive Annual Care Plan Physician and Pharmacists Findings.
Scott Campbell – Early addition of sitagliptin associated with a delay in diabetes progression.
Jill Hall – Incident dysglycemia in randomized clinical trials of thiazide diuretics: a meta analysis.
Dean Eurich and Denise Van Wheelden – RADAR Project Update

Thank you to everyone who attended the 16th Annual Retreat. We hope to see you all again next year!


Report from the Chair

Hello All! Here is a quick update on what has been happening in the ACHORD Group since our last newsletter.

The ACHORD Retreat was held in conjunction with the DON SCN Diabetes in Pregnancy Summit on March 4 and 5 in the City Room at Peter Lougheed Hall, University of Alberta Campus. More information on this is later on in the newsletter.

April and May are typically busy months for attending conferences and presenting posters, and this year is no exception. ACHORD members attended the following: The 2019 CADTH Symposium in Edmonton, ICHOM Conference in Rotterdam, the Netherlands, Can-SOLVE CKD Annual Meeting in Montreal, the 2019 SPOR Summer Institute in Edmonton, the CPHA meeting in Ottawa, KT Canada Scientific Meeting in Winnipeg and CAHSPR meeting in Halifax.

We have some new faces this summer as four summer students are working with us! I would like to welcome the following students:

▪ Jessica Round is working as an intern with Dean Eurich as her supervisor.
▪ Elizabeth Ellehoj is recipient of the Alberta Innovates/Athabasca University Summer Studentship with Steve Johnson as her supervisor.
▪ Simrat Sandha, recipient of U of A Graduate Student Internship Program (GSIP) and Kai-Erh Kao are both working on projects within APERSU. Fatima Al Sayah is their supervisor.
Jessica Round is working as an intern with Dean Eurich as her supervisor.
Elizabeth Ellehoj is recipient of the Alberta Innovates/Athabasca University Summer Studentship with Steve Johnson as her supervisor.
Simrat Sandha, recipient of U of A Graduate Student Internship Program (GSIP) and Kai-Erh Kao are both working on projects within APERSU. Fatima Al Sayah is their supervisor.

We also welcomed back Nonsi Mathe from her maternity leave in April. Nonsi picks up her responsibility for the ABCD Cohort Study, which is part of the Diabetes Infrastructure for Surveillance, Evaluation and Research (DISER) project, helping to inform diabetes care in Alberta. The DISER project is in partnership with the Diabetes, Obesity and Nutrition Strategic Clinical Network (DON SCN) in Alberta Health Services (AHS). We are happy to report the data for Wave 4 of the ABCD cohort survey are cleaned and available for collaboration. These surveys were collected from November 2017-May 2018. Wave 5 of the survey recruitment began in January and continues through to May 2019. To date, 600 returning participants have responded (82% response rate). As we did for Wave 4, we are offering both online and paper surveys, each with 1 additional reminder, 1 month prior to the closing date. In the coming months, we are planning more analyses, including longitudinal analyses. Additionally we have recently received approval to link the ABCD self-administered survey data with the larger administrative data of DISER.

The Alberta’s PROMs and EQ-5D Research and Support Unit (APERSU), based in the ACHORD offices, continues to grow as more people are aware of the EQ-5D instruments and more people are asking for assistance. Many APERSU members attended the EuroQol Academy Meeting in Noordjwik, The Netherlands at the beginning of March. Plans are underway for the 5th Annual APERSU End-User Meeting, which will be held October 17 and 18, 2019, at the Coast Hotel and Conference Centre in Canmore.

I hope the information in our newsletter is informative, and if you have any questions about our activities, please do not hesitate to contact us. I look forward to updating you in late fall/early winter on ACHORD’s activities.


Project Update

Evaluation of routinely Measured PATtient reported outcomes in HemodialYsis care (EMPATHY)

The Northern Alberta Renal Program, now known as Alberta Kidney Care – North (AKC-N), began implementing the EMPATHY trial in 17 dialysis units in September 2018. The Southern Alberta Renal Program, now known as Alberta Kidney Care – South (AKC-S), began phasing units into the trial in January 2019. All 10 AKC-S dialysis units will be phased in by June 2019. The Ontario Renal Network (ORN) is also phasing units into the trial. They started in April 2019 and all 16 ORN units will be phased in by June 2019.

Jeff Johnson and Kara Schick-Makaraoff are leading a qualitative sub-study to evaluate the EMPATHY intervention in AKC-N. This study protocol has been developed and data collection began in March 2019. Lisa Wozniak and Hilary Short have been visiting various dialysis units enrolled in the study to observe the implementation of the intervention in practice. They are also interviewing clinicians and patients to elicit their perspectives and experiences of the EMPATHY intervention (PROMs and treatment aids).

Hilary Short and Natalie Ilkiw, the AKC-N and AKC-S coordinators, gave an oral presentation on EMPATHY at Alberta Kidney Days in Calgary on March 15, 2019. Hilary also gave an oral and poster presentation at the Can-SOLVE CKD Annual Meeting in Montreal on May 3, 2019 and she gave a poster presentation at the CAHSPR Conference in Halifax on May 30, 2019.
As for next steps for the EMPATHY team, we are preparing ongoing education material for the nursing staff delivering the EMPATHY intervention, we are preparing a manuscript of the EMPATHY study protocol for publication in a scientific journal, we will develop a plan for data analysis, and disseminate our research findings.

For more information on this project, please email Hilary Short,


Recent Literature from the ACHORD Journal Club

(Paper discussed Wednesday, January 23, 2019; Commentary by Lilla Roy)

Simone Kreimeier, Mark Oppe, Juan M. Ramos-Goñi, AmandaCole, Nancy Devlin, Michael Herdman, Brendan Mulhern, Koonal K Shah, Elly Stolk, Oliver Rivero-Arias, Wolfgang Greiner. Valuation of EuroQol Five-Dimensional Questionnaire, Youth Version (EQ-5D-Y) and EuroQol Five-Dimensional Questionnaire, Three-Level Version (EQ-5D-3L) Health States: The Impact of Wording and Perspective. Value Health 2018;21(11):1291-1298. PMID: 30442276

Article Summary:
The EuroQol Five Dimensional Questionnaire (EQ-5D) is a health status measurement instrument that is widely adopted around the world. There is a five-level (EQ-5D-5L) and a three-level (EQ-5D-3L) version of the tool, as well as a version designed for youth (EQ-5D-Y). However, the EQ-5D-Y is yet to have a value set established, prohibiting its use in economic evaluations. In an effort to compare the EQ-5D-3L and the EQ-5D-Y, which are very similar, this study looked at the impact of wording and perspective (child versus adult) on the values elicited for different health states.

The study used four arms: EQ-5D-Y (child perspective), EQ-5D-Y (adult perspective), EQ-5D-3L (child perspective) and EQ-5D-3L (adult perspective). Respondents were from the adult general population, and answered a composite time trade-off (C-TTO) and discrete choice experiment (DCE) task. Respondents were from four countries (Germany, Netherlands, Spain, and England).

Results showed that values for health states were higher from the child perspective (versus the adult perspective), and higher in the EQ-5D-Y (versus the EQ-5D-3L). Aversion to death was observed in the child perspective when compared to the adult perspective. The authors conclude that the difference in scale (from 11111 to 33333) is not different between instruments for wording or perspective.

Discussion Within Journal Club:
Jeff Johnson helped facilitate the journal club. We discussed the history and the evolution of the EQ-5D from the EQ-5D-3L, to the EQ-5D-5L, and the EQ-5D-Y. The effects of word choice and perspective on valuation tasks are important areas of investigation, which has been studied by some journal club members. The group felt the differences found in the study were not surprising considering the variety in our own interpretation of the wording differences. We also discussed the significance of using a value set derived from a different instrument and/or country (i.e., a “proxy” or “cross-walk”), the differences in conventional and composite TTO and DCE elicitation tasks and their advantages/disadvantages, the various methods of selecting health states for valuation, the rationale for/against including/excluding respondents with “illogical” health state valuations using a priori defined criteria, and the potential for (mis)representation of the “public’s” preferences in outcomes research and economic evaluations.


ACHORD Seen and Heard

Recent Publications

Armstrong MJ, Rabi DM, Southern DA, Nanji A, Ghali WA, Sigal RJ. Clinical Utility of Pre-Exercises Stress Testing in People with Diabetes. Can J Cardiol 2019;35(2):185-192. PMID: 30760425.

Avedzi HM, Storey K, Johnson JA, Johnson ST. Healthy Eating and Active Living for Diabetes-Glycemic Index (HEALD-GI): study rationale, design and evaluation of a pragmatic randomized controlled trial. JMIR Res Protoc. 2019;8(3):e11707. PMID: 30839283.

Bansback N, Trenaman L, MacDonald KV, Hawker G, Johnson JA, Stacey D, Marshall DA. An individualized patient-reported outcome measure (PROM) based patient decision aid and surgeon report for patients considering total knee arthroplasty: protocol for a pragmatic randomized controlled trial. BMC Musculoskelet Disord. 2019;23;20(1):89. PMID:30797238.

Boothby CA, Dada BR, Rabi DM, Campbell TS, Tang KL. The Effect of Cardiac Rehabilitation Attendance on Sexual Activity Outcomes in Cardiovascular Disease Patients: A Systematic Review. Can J Cardiol 2018;34(12):1590-1599. PMID: 30527146.

Chowdhury MZI, Yeasmin F, Rabi DM, Ronksley PE, Turin TC. Prognostic tools for cardiovascular disease in patients with type 2 diabetes: A systematic review and meta-analysis of C-statistics. J Diabetes Complications 2019;33(1):98-111. PMID: 30446478.

Daskalopoulou SS, Feldman RD, McAlister FE, Rabi DM; Hypertension Canada. The History of Hypertension Guidelines in Canada. Can J Cardiol 2019;35(5):582-589. PMID: 31030861.

Donovan L, Edwards A, Savu A, Butalia S, Ryan E, Johnson J, Kaul P. Population-Level Outcomes With a 2-Step Approach for Gestational Diabetes Screening and Diagnosis: Response to the Letter to the Editor from Dr. Kong. Can J Diabetes 2018;42(6):581. PMID: 30026046.

Ishaque S, Johnson JA, Vohra S. Individualized Health-Related Quality of Life Instrument Measure Yourself Medical Outcome Profile (MYMOP) and Its Adaptations: A Critical Appraisal. Qual Life Res 2019;28(4):879-893. PMID: 30426277.

Lethebe BC, Williamson T, Garies S, McBrien K, Leduc C, Butalia S, Soos B, Shaw M, Drummond N. Developing a case definition for type 1 diabetes mellitus in a primary care electronic medical record database: an exploratory study. CMAJ Open 2019;7(2):E246-E251. PMID: 31061005.

McAlister FA, Ye C, Beaupre LA, Rowe BH, Johnson JA, Bellerose D, Hassan I, Majumdar SR. Adherence to biphosphonates after an upper extremity fracture: A pre-specified substudy of the C-Stop randomized controlled trial. Osteoporosis International 2019;30(1)127-134. PMID: 30232538.

Samii L, Kallas-Koeman M, Donovan LE, Lodha A, Crawford S, Butalia S. The association between vascular complications during pregnancy in women with Type 1 diabetes and congenital malformations. Diabet Med 2019;36(2):237-242. PMID: 30499197.

Siad FM, Fang XY, Santana MJ, Butalia S, Hebert MA, Rabi DM. Understanding the Experiences of East African Immigrant Women with Gestational Diabetes Mellitus. Can J Diabetes 2018;42(6):632-638. PMID: 29914780.

Soprovich A, Ingstrup M, Eurich, D. The frequency and availability of population-specific patient reported outcome measures and minimal clinically important differences among approved drugs in Canada. Health and Qual Life Outcomes. 2019;17(1):4. PMID: 30616654.

Soprovich AL, Sharma V, Tjosvold E, Eurich DT, Johnson JA. Systematic review of community pharmacy-based and pharmacist-led foot care interventions for adults with type 2 diabetes. Can Pharm J 2019;152(2):109-116. PMID: 30886663.

Tawiah AK, Al Sayah F, Ohinmaa A, Johnson JA. Discriminative Validity of the EQ-5D-5L and SF-12 in Older Adults with Arthritis. Health Qual Life Outcomes. 2019;17(1)68. PMID: 30995930.

Meeting Presentations and Invited Talks

McClure NS. Health-related quality of life and a minimally important difference. Oral Presentation at the Network of Alberta Health Economists Thesis Throwdown, December 3, 2018. Edmonton, AB, Canada.

Jin X. Responsiveness and Minimally Important Difference (MID): What, Why, and How? Seminar at China Pharmaceutical University in Nanjing, China. December 12, 2018.

Jin X. Responsiveness and Minimally Important Difference (MID) of PROMs: What, Why, and How? Seminar at Tianjin University in Tianjin, China. December 27, 2018.

McClure NS, Bernfort L et al. People in states worse than dead according to the EQ-5D UK value set: would they rather be dead? Paper Discussion at the Network of Alberta Health Economists-Health Economics and Outcomes Research Student-led Seminar Series, January 29, 2019, Edmonton, AB, Canada.

Voakland B, Eurich DT. 'The Prevalence of Diabetes In Pregnancy Among Indigenous Women: a Systematic Review. Canadian National Perinatal Research Meeting, February 13-15, 2019, Mont Tremblant, QC, Canada.

Jin X, McClure NS, Le CY, Baghbaninaghadehi F, Al Sayah F, Ohinmaa A, Johnson JA. Minimally Important Differences for EQ-5D instruments: A Systematic Review of Estimates in Published Literature. CADTH Symposium 2019, April 14-16, 2019, Edmonton AB, Canada.

McClure NS, Xie F, Johnson JA. Individual and public preferences for health states: what can be learned from ties in EQ-5D-5L time-trade-off valuation studies? Poster Presentation at the 2019 Canadian Agency for Drugs and Technologies in Health Symposium, April 14, 2019, Edmonton, AB, Canada.

Eurich DT. Moderator for Session: Tackling the Thorny Issue of Patient Partner Compensation in Research and Health Care. 2019 CADTH Symposium, April 16, 2019, Edmonton, AB, Canada.

McClure, N.S. The relevance of the minimally important difference in HRQL measurement. Oral Presentation at the Institute of Health Economics, April 18, 2019, Edmonton, AB, Canada.

Marozoff S, Veugelers PJ, Eurich DT, Ye M, Maximova K. Diet quality and depression in adults: a prospective cohort investigation of Alberta's Tomorrow Project. Poster presentation. Canadian Nutrition Society (CNS) Annual Conference 2019, May 2-4, 2019, Niagara Falls, ON, Canada.

Sanja K. Beaulieu C, Benatar M, Briemberg H, Dionne A, Dupre N, Eurich DT. The Canadian ALS Neuroimaging Consortium (CALSNIC). AAN 2019 Annual Meeting, May 5, 2019. Philadelphia, PA, USA.

Marozoff S, Veugelers PJ, Eurich DT, Ye M, Maximova K. Eating well to prevent depression: Findings from a large prospective cohort of adults from Alberta's Tomorrow Project. Poster Presentation. Canadian Society for Epidemiology and Biostatistics (CSEB) Conference, May 13-15, 2019, Ottawa, ON, Canada.

Ploeg J, Markle-Reid M, Valaitis R, Dicerni P, Fisher K, Ganann R, Eurich DT et all. Engaging Stakeholders in the Development and Evaluation of the ACHRU – Community Partnership Program. Annual Diabetes Action Canada Workshop, May 26-27, 2019. Toronto, ON, Canada.

Johnson JA, Buzinski R, Corradetti B, Davison S, Duperron P, Klarenbach S, Manns B, Short H, Thomas C, Walsh M. Evaluation of routinely Measured PATient reported outcomes in HemodialYsis care (EMPATHY): Implementing a cluster randomized controlled trial at the health system level. [Poster Presentation]. Canadian Association for Health Services and Policy Research Annual Conference (CAHSPR), May 29-31, 2019, Halifax, NS, Canada.


5th Annual APERSU End-User Meeting

October 17 & 18, 2019

Coast Hotel and Conference Centre

511 Bow Valley Trail

Canmore, Alberta


University of Alberta
2-040 Li Ka Shing CHRI
Edmonton, AB T6G 2E1
Phone: 780-248-1010

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