Screen Shot 2017-06-29 at 8.18.04 AM

Volume 17, Issue 2, Fall 2017


ACHORD Retreat 2018

The 15th Annual ACHORD Retreat will be held on March 1 and 2, 2018, at Alumni House, University of Alberta. Please mark this date in your calendars, we will be sending out more information in the months ahead. This is the second time we are holding the retreat at this beautiful facility here on campus. We are looking forward to the presentations and collaborations that occur at this annual event.

JAJ Office1 1

Report from the Chair

Hello All! I hope everyone had a wonderful summer. Even with summer vacations, we all managed to keep very busy; here is a quick update on what has been happening in the ACHORD Group since our last newsletter.

In June, we welcomed Melody Makenja-Cesar to the SPOR team as a Project Coordinator. Welcome Melody!

Our summer students completed their summer projects with us and are back to their regular classes and studies. Thank you Lauren Cormier, Abdul Alghamdi, Andrews Tawiah and Tahmid Kashem for your contribution to the projects you worked on. Lauren was supported by an ADI Studentship, Abdul held an Alberta Innovates Studentship, and Andrews and Tahmid were supported by funding from APERSU.

Congratulations to Maxim Eskin who recently defended his Master of Science thesis in the Health Policy Research stream under the supervision of Dean Eurich. Great work, Max!

Dean Eurich has many new Master’s students starting this term: Kristen Versluys, Afsoon Kabol, Roni Kraut, Vishal Sharma, Britney Voaklander, Curtis Mabilangan, Shehreen Hossain, Natalie Mclean, and Bianka Saravana-Bawan. Not all of these students will be housed in ACHORD but all are under Dean’s supervision or co-supervision with colleagues in the Faculty of Medicine and Dentistry.

We also have three Post-Doctoral Fellows that joined us at various times over the summer: Xuejing (Jennifer) Jin (see more below), Arsene Zongo under Dean Eurich’s supervision and Megan Highet, who is jointly supervised by Shannon Berg from Alberta Health and myself. We will be featuring the Post-Doctoral fellows in a future issue of our newsletter. Welcome to all!

Since our last newsletter, ACHORD members have attended a number of conferences, including the SPOR Summer Institute in Edmonton, ISPE Annual Conference in Montreal, American Society for Bone Mineral Research in Denver, Colorado, 53rd Annual EASD Annual Conference in Lisbon, Portugal and 34th EuroQol Annual Plenary in Barcelona, Spain.

The Alberta’s PROMs and EQ-5D Research and Support Unit (APERSU), based in the ACHORD offices, continues to grow as more groups register to use the EQ-5D. As mentioned above, we welcomed the first APERSU Post-Doctoral Fellow, Xuejing (Jennifer) Jin, in July. Xuejing recently completed her PhD at McMaster University in Hamilton. Welcome Xuejing! Members of the APERSU Team attended the 34th EuroQol Plenary in Barcelona in September and are holding the 3rd Annual APERSU End-User Meeting at the Coast Canmore Hotel and Conference Centre in Canmore, Alberta, November 15 and 16, 2017.

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 later in December on ACHORD’s activities. In the meantime, I would like to wish everyone a very safe and happy fall.


Recent Literature from the ACHORD Journal Club

(Paper discussed Tuesday, September 12, 2017; Commentary by Nathan McClure)

Gutacker N, Street A. Use of large-scale HRQoL datasets to generate individualised predictions and inform patients about the likely benefit of operation. Quality of Life Research 2017:26(9):2497-2505. PMID: 28567601

Starting April 2009 the English National Health Service (NHS) has required the completion of the EQ-5D-3L by all NHS-funded patients before and after operation for hip or knee replacement and varicose vein or groin hernia repair. This routine collection of health-related quality of life (HRQoL) data may be a useful source of information to inform patients on the likely benefit of these surgeries supporting shared decision-making based on outcomes that are important to the patient. It is generally accepted that randomised controlled trials, while useful for measuring an intervention’s efficacy across the study population (with strong internal validity), may not adequately represent its effectiveness in routine practice due to differences in patient characteristics. To this end, the abundance of information made available through routine data collection (i.e., large sample sizes and variation) creates an opportunity to calculate more personalised predictions of expected outcomes according to risk-stratified subgroups of patient pre-treatment characteristics.

The purpose of this study was to report on the development of an online patient information tool (available at: that can be used by pre-operative patients to generate individualised predications on the likely benefit of operation. The study used EQ-5D-3L data from NHS-funded patients in England aged 15 or older who received planned unilateral hip or knee replacement or groin hernia repair between April 2009 and March 2016. EQ-5D data was collected pre-operation (at the time of admission or at an earlier outpatient appointment), and post-operation (6 months after orthopaedic procedure, otherwise 3 months after). Data on revision operation was excluded, and complete-case analysis was performed. EQ-5D index scores were calculated from the 3L health profiles using the England value set. While there were numerous fields in the original dataset, after discussion with GP stakeholders and patients on using the tool during a 10-minute doctor visit, the authors decided to include only age, gender, symptom duration, and pre-operative EQ-5D-3L profiles as explanatory variables. For the outcome variable, the study used both the absolute change in EQ-5D index score, and the post-operative level for each dimension of the EQ-5D. Results of the study found 55 to 60 risk-stratified groups that explained between 14 and 27% of variation in post-operative EQ-5D index score depending on the type of operation.

The authors used iterative classification and regression tree analysis to create the best-fitting data splits with the terminal nodes representing the risk-stratified subgroups. To mitigate concerns of over-fitting results to the data, the authors used a leave-one-out approach splitting the data temporally into a single development (April 2009 – March 2015, n = 497,723) and test sample (April 2015 – March 2016). In addition, the authors used adjusted R-squared and Root-Mean-Squared-Error to evaluate model fit, showing that the development and test samples had similar results with improved fit over a reduced model that excluded pre-operative EQ-5D-3L information. The Journal Club discussed other methods of analysing big data and to mitigate over-fitting such as ensemble methods and k-fold cross-validation, and the use of other metrics to evaluate model performance.

The authors also considered the importance of “making the data meaningful to patients” (p. 2499) particularly in regards to the interpretation of the EQ-5D index score. Therefore, the authors estimate the minimally important difference (MID) of the EQ-5D index score by way of responses to a global-rating of change question: ‘Overall, how are your hip/knee/hernia problems now, compared to before the operation?’ (p. 2498). For each type of operation, the MID was calculated for improvement and deterioration as the difference in average change in index score (pre and post operation) between those that reported ‘a little better/wore’ and those that reported ‘about the same’. The MID was then used to convert changes in index score to a categorical response of no (noticeable) change, and noticeable improvement/deterioration. The MIDs generated much discussion in the Journal Club on the value of MIDs to evaluate change that is meaningful to patients, and the limitations of calculating the MID as the authors chose. Firstly, how would the results compare if the outcome of interest were changed to the global-rating of change question? Would this be more easily understood? Secondly, if the goal is to generate personalised predictions, is it sensible to apply one MID estimate based on the overall sample, or should MIDs be calculated and applied at the level of subgroups? Relatedly, in calculating an MID is it useful to subtract the average change in index score of the ‘about the same’ group when it is possible that these individuals may differ systematically from the ‘a little worse/better’ group? Finally, the authors suggest that the MID depends on the direction of change (i.e., improvement versus deterioration), but what about the patient’s current level of HRQoL (i.e., pre-operative EQ-5D index score)? However, based on the authors use of the MID, Figure 2 demonstrated the variability in the benefit of operation across different risk-strata, which was striking, but lacked explanation of what is responsible for driving these differences.

An example printout of the online patient tool was passed around for the Journal Club to examine, which generated discussion on the usefulness and challenges of having a similar tool for patients in Canada.


Meet the Staff - Hilary Short

Hilary was born and raised in Cole Harbour, Nova Scotia. Hilary graduated from the University of Alberta in 2012 with a Bachelor in Physical Education and again in 2014 with a Master of Science in Health Policy Research. Hilary’s thesis research focused on adult obesity management in primary care and surveyed family physicians across Alberta on their attitudes, knowledge, and practices in obesity management.

Upon completing her graduate degree, Hilary worked for the Clinical Trials Program in the Division of Nephrology and Transplant Immunology at the University of Alberta Hospital, coordinating various drug and observational trials in renal transplant, dialysis, and renal insufficiency patient populations.

Hilary joined ACHORD in January 2017 and works on APERSU projects, primarily coordinating the EMPATHY trial.

meghan ingstrup

Meet the Staff - Meghan Ingstrup

Meghan completed a Master of Arts degree with a Sport Psychology focus at the University of Alberta in 2016. Her thesis research focused on an emotion regulation strategy called self-compassion examining how female varsity athletes developed and used self-compassion to cope with adversity in sport. Meghan supports several research projects within ACHORD, using her expertise in qualitative research and project coordination. She enjoys working in research that focuses on encouraging participants to live a healthy, active lifestyle and brings a unique perspective to projects due to her psychology background.

Meghan leads an active lifestyle herself, as an avid soccer player, a yogi, and an adventure seeker. In her spare time, she works as a mental skills coach, teaching youth athletes about psychological skills related to performance and coping in sport.


Meet the Student - Nathan McClure

Training Program: PhD in Public Health, School of Public Health, University of Alberta.

Nathan is working on his 4th degree as a PhD student in Public Health supervised by Dr. Jeff Johnson. After completing his BSc at UBC in Vancouver, Nathan went on to pursue an MSc in Mathematical Biology at Queen’s University. It was during his internship with the Global Malaria Programme that Nathan realized his interests were in Public Health, deciding to enrol in an MPH in Biostatistics at the University of Alberta. Nathan completed his practicum in Tuberculosis surveillance with the Department of Health and Social Services in the Northwest Territories, and his capping project with APERSU. Nathan then worked as an analyst with Emergency Medical Services at Alberta Health Services, but decided to return in 2017 as a full-time student to further explore health-related quality of life! Nathan is currently investigating methods to support the interpretability of scores from patient-reported outcome measures.


ACHORD Seen and Heard

Recent Publications

Alsabbagh MW, Eurich DT, Lix LM, Wilson TW, Blackburn DF. Does the association between adherence to statin medications and mortality depend on measurement approach? A retrospective cohort study. BMC Med Res Methodol. 2017;20;17(1):66. PMID 28427340.

Bowker SL, Savu A, Yeung RO, Johnson JA, Ryan EA, Kaul P. Patterns of Glucose-Lowering Therapies and Neonatal Outcomes in the Treatment of Gestational Diabetes in Canada, 2009-2014. Diabet Med 2017;34(9):1296-1302. PMID: 28586507.

Crick K, Thomson D, Fernandes RM, Nuspl M, Eurich DT, Rowe BH, Hartling L. Descriptive Analysis of Cochrane Child-Relevant Systematic Reviews: An Update and Comparison Between 2009 and 2013. BMC Pediatr. 2017 11;17(1):155. PMID: 28693463.

Ekwaru JP, Ohinmaa O, Tran BX, Setayeshgar S, Johnson JA, Veugelers PJ. Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach. PLOS One 2017;12(5):e0177848. PMID: 28542399.

Johnson ST, Mladenovic AB, Mathe N, Davenport MH, Butalia S, Qiu W, Johnson JA. Healthy Eating and Active Living after Gestational Diabetes Mellitus (HEALD-GDM): Rationale, design and proposed evaluation of a randomized controlled trial. Contemp Clin Trials 2017;61:23-28. PMID: 28700892.

Marrie TJ, Tyrrell GJ, Majumdar SR, Eurich DT. Concurrent Infection with Hepatitis C Virus and Invasive Pneumococcal Disease. Emerg Infect Dis. 2017;23(7):1118-1123. PMID: 28628455.

Naicker K, Overland S, Johnson JA, Skogen JC, Manuel D, Sivertson B, Colman I. Symptoms of Anxiety and Depression in Type 2 Diabetes: Associations with Clinical Diabetes Measures and Self-Management Outcomes in the Norwegian HUNT Study. Psychoneuroendocrinology 2017;84:116-123. PMID: 28704763.

Schultz M, Keeling SO, Katz SJ, Maksymowych WP, Eurich DT, Hall JJ. Clinical effectiveness and safety of leflunomide in inflammatory arthritis: a report from the RAPPORT database with supporting patient survey. Clin Rheumatol. 2017;36(7):1471-1478. PMID: 28550389.

Simpson SH, Lin M, Eurich DT. Community Pharmacy-Based Inducement Programs are Associated with Better Medication Adherence: A Cohort Study. Annals of Pharmacotherapy. 2017;51(8):630-639. PMID: 28372491.

Soprovich A, El Kurdi S, Eurich DT. An analysis of redactions in Canada’s Common Drug Review Clinical Review Reports and how they relate to the patients’ voice BMJ Open 2017;7:e015497. PMID: 28893743..

Ye M, Robson PJ, Eurich DT, Vena JE, Xu JY, Johnson JA. Cohort Profile: Alberta’s Tomorrow Project. Int J Epidemiol 2017;46(4):1097-1098l. PMID: 28338725.

Book Chapter

Asche CV, Hippler S, Eurich DT. Application of CER to Promote Adherence to Clinical Practice Guidelines. Decision Making in a World of Comparative Effective Research. Springer Publishing 2017: 221-234.

Meeting Presentations and Invited Talks

Mah D, Treit S, Khan M, Beaulieau C, Briemberg H, Dionne A, Dupre N, Eurich DT, Frayne R, Genge A, Graham S, Korngut L, Shoesmith C, Wilman A,Yunusova Y, Zinman L, Kalra S. Progress towards automated data analysis in the Canadian ALS Neuroimaging Consortium (CALSNIC). 13th Annual ALS Canada Research Forum, Toronto, May 1-4, 2017.

Ye M, Eurich DT. Changes in Body Mass Index and Incidence of Diabetes: A Longitudinal Study of Alberta’s Tomorrow Project Cohort. 2017 CSEB Conference, in Banff, AB. May 30 - June 2, 2017.

Eurich DT. Panel: How Can AbSPORU Help You? SPOR Summer Institute. Lister Center, University of Alberta, June 25-27, 2017.

Wozniak LA, Beaupre LA, Rowe BH, McAlister FA, Bellrose D, Johnson JA, Majumdar SR. Patients’ Perceptions of Case-Managed Osteoporosis Care as Acceptable, Accessible and Appropriate: Qualitative Data from a Randomized Trial. ASBMR 2017 Annual Meeting, Denver Colorado, September 8-11, 2017.

Short HE, Al Sayah F, Ohinmaa A, Johnson JA. The Relationship of Material and Social Deprivation with Health Status. [Poster Presentation] 34th EuroQol Plenary Meeting, Barcelona, Spain September 20-23, 2017.


ACHORD Accolades

Congratulations to:

▪ Maxim Eskin who successfully defended his Master of Science degree in the Health Policy Stream under the supervision of Dean Eurich
▪ Candace Necyk on receiving a CIHR Doctoral Scholarship
▪ Nathan McClure on receiving an Alberta Innovates Graduate Studentship
Maxim Eskin who successfully defended his Master of Science degree in the Health Policy Stream under the supervision of Dean Eurich
Candace Necyk on receiving a CIHR Doctoral Scholarship
Nathan McClure on receiving an Alberta Innovates Graduate Studentship

Other ACHORD News

Congratulations to Michelle Lindberg and Sean on the birth of their daughter, Daria.


Upcoming Events

3rd Annual APERSU End-User Meeting

November 15-16, 2017

Coast Canmore Hotel and Conference Centre

Canmore, Alberta, Canada

15th Annual ACHORD Retreat

March 1-2, 2018

Alumni House

University of Alberta Campus

Edmonton, Alberta, Canada


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

ihe jpeg colour
Powered by Mad Mimi®A GoDaddy® company