In This Issue
- ACHORD Retreat
- Report from the Chair
- Project Update
- ACHORD Seen and Heard
- Recent Literature
- ACHORD Accolades
- Other ACHORD News
- Events
Previous Issues
ACHORD Seen and Heard
Recent Publications
Straus SE, Brouwers M, Johnson D, Lavis JN, Légaré F, Majumdar SR, McKibbon KA, Sales AE, Stacey D, Klein G, Grimshaw J; KT Canada Strategic Training Initiative in Health Research (STIHR). Core competencies in the science and practice of knowledge translation: description of a Canadian strategic training initiative. Implement Sci. 2011 Dec 9;6:127. PMID: 22152223
Koppel R, Majumdar SR, Soumerai SB. Electronic health records and quality of diabetes care. N Engl J Med. 2011 Dec 15;365(24):2338-9. PMID: 22168660
Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, Benchimol EI, Panaccione R, Ghosh S, Barkema HW, Kaplan GG. Increasing Incidence and Prevalence of the Inflammatory Bowel Diseases With Time, Based on Systematic Review. Gastroenterology. 2012 Jan;142(1):46-54.e42 PMID: 22001864
Au AG, Majumdar SR, McAlister FA. Preoperative Thienopyridine Use and Outcomes after Surgery: A Systematic Review. Am J Med. 2012 Jan;125(1):87-99.e1. PMID: 22079019
Yuksel N, Tsuyuki RT, Majumdar SR. Predictors of Bone Mineral Density Testing in Patients at High Risk of Osteoporosis: Secondary Analyses From the OSTEOPHARM Randomized Trial. J Clin Densitom. 2012 Jan-Mar;15(1):61-6. PMID: 22071024
Taffé P, Halfon P, Ghali WA, Burnand B. Test Result-Based Sampling: An Efficient Design for Estimating the Accuracy of Patient Safety Indicators. Med Decis Making. 2012 Jan-Feb;32(1):E1-12. PMID: 22065144
Abdelmoneim AS, Hasenbank SE, Seubert JM, Brocks DR, Light PE, Simpson SH. Variations in tissue selectivity amongst insulin secretagogues: a systematic review. Diabetes Obes Metab. 2012 Feb;14(2):130-8.PMID: 21923736
Rodondi N, Auer R, de Bosset Sulzer V, Ghali WA, Cornuz J. Atherosclerosis Screening by Noninvasive Imaging for Cardiovascular Prevention: A Systematic Review. J Gen Intern Med. 2012 Feb;27(2):220-31. PMID: 21882076
Evans CD, Eurich DT, Remillard AJ, Shevchuk YM, Blackburn D. First-fill medication discontinuations and nonadherence to antihypertensive therapy: an observational study. Am J Hypertens. 2012 Feb;25(2):195-203. PMID: 22089108
Vallance JK, Eurich DT, Lavallee CM, Johnson ST. Physical activity and health-related quality of life among older men: An examination of current physical activity recommendations. Prev Med. 2012 Mar;54(3-4):234-6. PMID: 22285441
Bresee LC, Majumdar SR, Patten SB, Johnson JA. Utilization of general and specialized cardiac care in people with and without schizophrenia. Psychiatric Services 2012;63:237-242. PMID: 22307876
Freiheit EA, Hogan DB, Eliasziw M, Patten SB, Demchuk AM, Faris P, Anderson T, Galbraith D, Parboosingh JS, Ghali WA, Knudtson M, Maxwell CJ. A dynamic view of depressive symptoms and neurocognitive change among patients with coronary artery disease. Arch Gen Psychiatry. 2012 Mar;69(3):244-55. PMID: 22393217
Asadi L, Eurich DT, Gamble JM, Minhas-Sandhu JK, Marrie TJ, Majumdar SR. Guideline adherence and macrolides reduced mortality in outpatients with pneumonia. Respir Med. 2012 Mar;106(3):451-8. PMID: 22182341
Eurich DT, Majumdar SR. Statins and sepsis – scientifically interesting but clinically inconsequential. J Gen Intern Med. 2012 Mar;27(3):268-9. PMID: 22135140
Gamble JM, McAlister FA, Johnson JA, Eurich DT. Quantifying the Impact of Drug Exposure Misclassification Due to Restrictive Drug Coverage in Administrative Databases: A Simulation Cohort Study. Value in Health 2012;15:191-197. PMID: n/a
Currie CJ, Poole CD, Jenkins-Jones S, Gale EAM, Johnson JA, Morgan CL. Mortality after incident cancer in people with and without type 2 diabetes: impact of metformin on survival. Diabetes Care 2012;35(2):299-304.PMID: 22266734
Manns BJ, Tonelli M, Zhang J, Campbell DJT, Sargious P, Ayyalasomayajula B, Clement F, Johnson JA, Laupacis A, Lewanczuk R, McBrien K, Hemmelgarn BR. Enrolment in primary care networks: impact on outcomes and processes of care in patients with diabetes. CMAJ 2012;184(2):E144-52. PMID: 22143232
Agborsangaya CB, Lahtinen M, Cooke T, Johnson JA. Multimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey. BMC Public Health 2012;12:201. PMID: 22429338
Keeling SO, Majumdar SR, Conner-Spady B, Battié MC, Carroll LJ, Maksymowych WP. Preliminary Validation of a Self-reported Screening Questionnaire for Inflammatory Back Pain. J Rheumatol. 2012 Apr;39(4):822-9. PMID: 22337237
Majumdar SR, Lix LM, Yogendran M, Morin SN, Metge CJ, Leslie WD. Population-based trends in osteoporosis management after new initiations of long-term systemic glucocorticoids (1998-2008). J Clin Endocrinol Metab. 2012 Apr;97(4):1236-42.PMID: 22298803
Majumdar SR, Ezekowitz JA, Lix LM, Leslie WD. Heart failure is a clinically and densitometrically independent risk factor for osteoporotic fractures: population-based cohort study of 45,509 subjects. J Clin Endocrinol Metab. 2012 Apr;97(4):1179-86.PMID: 22259058
Plotnikoff RC, Todosijczuk I, Johnson ST, Karunamuni N. Canada’s Physical Activity Guide: Examining Print-Based Material for Motivating Physical Activity in the Workplace. J Health Commun. 2012 Apr;17(4):432-42. PMID: 22206294
Recent Presentations
Eurich DT, Gamble JM. The confluence of drug coverage policies and study validity. SPH Research Seminar, University of Alberta, Edmonton Clinic Health Authority, Edmonton, AB January 27, 2012.
Colmers IN, Bowker SL, Richardson K, Majumdar SR, Johnson JA. Understanding the relationship between type 2 diabetes and bladder cancer. ADI Research in Progress, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB January 30, 2012.
Johnson JA. Alberta Diabetes Surveillance System: The 2011 Alberta Diabetes Atlas and Public Health Policy Options. Faculty of Medicine and Dentistry Grand Rounds, University of Alberta, Walter Mackenzie Centre, Edmonton, AB, February 24, 2012.
Johnson JA. Managing glucose control in diabetic patients with multi-morbidity: establishing priorities. 9th Peter and Anna Zbeetnoff Memorial Drug Therapy Decision Making Conference, Travelodge Hotel, Saskatoon, Saskatchewan, March 3, 2012.
Abdelmoneium AS, Eurich DT, Gamble JM, Johnson JA, Seubert J, Qiu W, Simpson SH. Is there a difference in the risk of cardiovascular events amongst sulfonylureas in patients with type 2 diabetes? ADI Research in Progress, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB March 5, 2012.
Weir DL, Johnson ST, Mundt C, Bray D, Taylor L, Eurich DT, Johnson JA. “Healthy Eating and Active Living for Weight Reduction and Diabetes Prevention in Primary Care”. Lost in Translation: The Perils of Nutrition Communication. Alberta Institute for Human Nutrition Symposium. Lister Conference Centre, Edmonton, AB. March 6, 2012.
Lau D, Majumdar SR, Katz A, Johnson JA. The association between diabetes and influenza-attributable health care utilization: A population-based cohort study. ADI Research in Progress, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB April 2, 2012.
Johnson JA. Diabetes, Its Treatments and Cancer Risk. Innovations in Pharmacy Visiting Professor, University of Illinois at Chicago, Chicago, Illinois, April 20, 2012.
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9th Annual ACHORD Retreat, March 8-9, 2012
The 9th Annual ACHORD Retreat was held on March 8-9, 2012 at The Banff Centre. As has been our tradition, this was an informal meeting that provided an opportunity for ACHORD investigators, collaborators and trainees to share research updates, and plan for continued growth of the ACHORD Research program. This year our guest speaker was Dr. Andreas Laupacis, Executive Director of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and a Professor in the Faculty of Medicine at the University of Toronto. Dr. Andreas Laupacis has recently developed and currently helps manage an interactive website called HealthyDebate.ca. We also once again hosted an international guest, Bendix Carstensen, Senior Statistician with Steno Center in Copenhagen, Denmark. Bendix is a collaborator in the Diabetes and Cancer Research Consortium, and this is the fourth ACHORD Retreat that Bendix has joined us.
Thank you to all who presented at the Retreat (also available on our website, www.achord.ca):
– Jeff Johnson on ACHORD activities (past, present & future) including accolades to celebrate ACHORD successes in the past year
– Student Project Presentations by Ahmed Abdelmoneim, Fatima Al Sayah, Marni Armstrong, Isabelle Colmers, Daniala Weir and Darren Lau
– Logan McLeod and Serena Humphries on Alberta’s Comprehensive Annual Care Plan (CACP) and HSC 03.04J
– Doreen Rabi – Sugar, sex and drugs (a provocative title for her research on sex differences in the treatment of men and women with diabetes)
– Peter Sargious on ACHORD and Healthcare Policy in Alberta, in particular the interactions with AHS and the recently established Strategic Clinical Networks
– Lisa Wozniak and Jeff Johnson provided an update on ABCD
– JM Gamble summarized his PhD thesis research on Confluence of Drug Coverage Policies and Study Validity
– Andreas Laupacis discussed his involvement in debate around Endovascular Treatment for MS and the intersection of science, policy and public opinion.
Due to popular demand, our organized physical activity event this year once again included the indoor bootcamp and was enjoyed by those who attended – it was a great workout! The ACHORD PI was notably absent – he claims to have been engaged in knowledge translation activities!
Dr. Laupacis and Steve Johnson also led a student breakout session where the trainees completed a “homework” assignment on writing a health policy brief. The trainees were able to discuss the use of a policy brief with other guests that include representatives from Alberta Health Services. As in past retreats, the trainees were able to participate and interact in a forum that is not always a part of their traditional course-based training.
Thank you to everyone who attended the Retreat. As is the case every year, this event is a success because of those of you that attend. Thank you to Steve Johnson and Sherry Lydynuik for planning the event and thank you to Allison Soprovich for creating ACHORD Bingo that was enjoyed prior to dinner on Thursday evening. Plans for the ACHORD Retreat 2013 at the Banff Centre are already underway; March 7-8, 2013 are the dates for next year’s retreat, so mark those dates in your calendar! This will be the 10th ACHORD Retreat so we are looking forward to celebrating 10 years of research success with all those in attendance!
 Report from the Chair
Hello everyone! Spring is arriving, NHL playoffs have begun, and ACHORD is as busy as ever! Here is a quick update on what we have been doing since our last newsletter.
As you can see from the article above, we held the 9th Annual ACHORD Retreat in Banff in March. This was a very productive meeting, it is always great to see everyone and hear about their research, and see how our work has potential influences in health care decision-making.
ACHORD members have been busy attending meetings/conference during the first quarter of 2012. Alberta Health Services recently established several key Strategic Clinical Networks (SCN), and I was invited to present, along with Peter Sargious, on research and CDM at the Inaugural SCN Leadership Meeting held in Banff in February; Samantha Bowker, Isabelle Colmers and I attended the 3rd International Diabetes and Cancer Research Consortium workshop in Brussels, Belgium; I have been asked to present on this topic at a number of meetings in recent months, including the University of Illinois College of Pharmacy in April. Lisa Wozniak and Allison Soprovich, from our ABCD team, attended a KT Canada End of Grant KT workshop at St. Michael’s in Toronto and the 5th Annual NIH Conference on the Science of Dissemination and Implementation Research in Bethesda, Maryland, put on by the National Institutes of Health. Darren Lau returned from Winnipeg after spending 4 months at the Manitoba Center for Health Policy, working on his PhD thesis research on diabetes and influenza. ACHORD trainees will be represented at upcoming conferences as well, Canadian Association for Health Services and Policy Research (CAHSPR) in Montreal May and American Diabetes Association (ADA) in Philadelphia in June.
The Alberta’s Caring for Diabetes (ABCD) project is still going strong. Patients with type 2 diabetes who are being supported by the pilot interventions in our partner PCNs are being followed up over the next year. Evaluation of the ABCD pilot interventions is ongoing. The ABCD Advisory Committee and Implementation & Evaluation Steering Committee meetings are planned for May, looking forward to those as they give us ideas and direction to move forward. The AHS SCN will be key stakeholders for our knowledge translation and dissemination strategies for ABCD. The ABCD Cohort study is now underway! Year 1 survey packages are being mailed out to people with type 2 diabetes around the province and we are beginning to receive quite a few back.
Will update you in the summer with our ongoing activities in ACHORD!
Project Update
Diabetes and influenza-attributable illness: A population-based cohort study
Lau D, Eurich DT, Majumdar SR, Katz A, Johnson JA
Clinical practice guidelines recommend annual vaccinations against seasonal vaccinations in diabetic adults. Because universal vaccination is already recommended in elderly adults, these guidelines have the effect of singling out non-elderly adults with diabetes for vaccination. However, the evidence that these individuals are actually at greater risk of influenza is limited.
Since direct measurement of influenza infection is infeasible, we measured the fraction of nonspecific outcomes attributable to influenza, using a community-level indicator of influenza activity. We performed a population-based cohort study using Manitoba claims data, examining the extent to which diabetes was associated with increased rates of influenza-like illness (ILI), pneumonia and influenza (PI) hospitalizations, and all-cause hospitalizations due to influenza.
In patients with diabetes, circulating influenza contributed 10-13% of physician visits and hospitalizations for ILI, 12-26% of PI hospitalizations, and 5-6% of all-cause hospitalizations each influenza season. In non-elderly adults, influenza was associated with a 6% (95% CI [2%, 10%], p < 0.001) increase in all-cause hospitalizations, but did not appear to affect all-cause hospitalizations rates in those without diabetes (RR = 1.00, [0.95, 1.06], p = 0.89). This difference in the relative rates of all-cause hospitalizations was statistically significant (p = 0.04). In absolute terms, influenza contributed 55 additional all-cause hospitalizations in non-elderly Manitoba adults with diabetes, of which 54 occurred because of their diabetes. Influenza-related rates of other outcomes were not statistically different for those with and without diabetes.
We focused on non-elderly adults with diabetes because guidelines single them out for vaccination. In Canada, national guidelines recommend vaccination in the non-elderly only in the presence of a high-risk condition. In this context, the rationale for prioritizing diabetes depends on the cost-benefit balance of preventing 54 hospitalizations.
Recent Literature from the ACHORD Journal Club
(Paper discussed Monday March 19, 2012; Commentary by Darren Lau)
Wong K, Campitelli MA, Stukel TA, Kwong JC. (2012) Estimating influenza vaccine effectiveness in community-dwelling elderly patients using the instrumental variable analysis method. Arch Intern Med 172(6):484-91. PMID: 22371873
What was the study about?
In previous observational studies, influenza vaccination for the elderly has been associated with 50% reductions in mortality. More recent studies suggest that these results are unrealistically high, because of unmeasured confounding. Instrumental variable (IV) analyses may provide unbiased estimates in the presence of unmeasured confounding. This study estimated influenza vaccination effectiveness among elderly adults, using an IV approach.
Instrumental variable (IV) analyses
IV analyses take advantage of natural variation in non-experimental data to simulate the benefits of a randomization. However, the assumptions required for a valid analysis are stringent, and impossible to verify.
What did this study find?
The authors used the overall vaccination rates in each subject’s census subdivision as an IV. The standard analytic approach produced results similar to those of previous observational studies. In contrast, the IV analysis found no significant decrease in mortality. A decreased risk for a composite outcome of pneumonia and influenza hospitalizations and all-cause mortality was observed. These benefits were not observed after influenza season, when influenza virus was no longer circulating.
Comments
Several limitations of this study must be considered. First, a post-season analysis is no longer considered a valid negative control, since depletion of sicker individuals from the study population may also lead to negative results. Second, the composite outcome of PI hospitalizations and all-cause mortality is difficult to interpret, since the latter is much less specific than the former. Third, in census sub-divisions with higher vaccination rates, herd immunity may reduce influenza-related outcomes. Whether herd immunity should be considered a violation of IV assumptions is unclear.
Bottom Line
The authors have demonstrated the use of a geographic IV to produce less biased estimates of vaccine effectiveness. Their results support recent studies suggesting much lower benefits of vaccination than previously thought.
ACHORD Accolades
Congratulations to the following students/trainees on completing significant milestones in their training or recipients of various awards:
Fatima Al Sayah who successfully completed her PhD Candidacy Exam on Thursday, January 5, 2012.
Sonia Butalia on the successfully defending her Masters on January 9, 2012.
JM Gamble on successfully defending his PhD on January 25, 2012.
Marni Armstrong received the Alexa W. Church Graduate Scholarship in Medical Sciences.
Ahmed Abdelmoneim received a CIHR-Drug Safety and Effectiveness Cross-Disciplinary Training (DSECT) Program Award.
Jongnam Hwang who successfully completed his PhD Candidacy Exam on Tuesday, April 10, 2012.
Daniala Weir received an AI-HS Summer Studentship. Daniala is working under the supervision of Dean Eurich this summer.
Congratulations to ACHORD Investigator Sumit Majumdar, awarded endowed research chair in patient health management at the University of Alberta.
Congratulations to Dean Eurich who was promoted to Associate Professor in the School of Public Health effective July 1, 2012.
Other ACHORD News
Congratulations to:
Calypse Agbosangaya on his marriage to Precious Enowbawa in January. The wedding was held in the south region of Cameroon.
Logan, Jen and Marielle McLeod on the addition of Katherine Ainsley to their family in January.
Stephanie, Justin and Helena Balko on the addition of Mila Pearl to their family in February.
JM, Emily, Scott and Sofia Gamble on the addition of Xavier Andrew to their family in April.
ACHORD Events
10th Annual ACHORD Retreat
March 7-8, 2013
The Banff Centre
Banff, Alberta, Canada |
