Browsing by Author "Ross, Sue"
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Item Open Access Correction: Development and validation of a case definition for problematic menopause in primary care electronic medical records(2023-10-19) Pham, Anh N.; Cummings, Michael; Yuksel, Nese; Sydora, Beate; Williamson, Tyler; Garies, Stephanie; Pilling, Russell; Lindeman, Cliff; Ross, SueItem Open Access Development and validation of a case definition for problematic menopause in primary care electronic medical records(2023-10-05) Pham, Anh N.; Cummings, Michael; Yuksel, Nese; Sydora, Beate; Williamson, Tyler; Garies, Stephanie; Pilling, Russell; Lindeman, Cliff; Ross, SueAbstract Background Menopause is a normal transition in a woman’s life. For some women, it is a stage without significant difficulties; for others, menopause symptoms can severely affect their quality of life. This study developed and validated a case definition for problematic menopause using Canadian primary care electronic medical records, which is an essential step in examining the condition and improving quality of care. Methods We used data from the Canadian Primary Care Sentinel Surveillance Network including billing and diagnostic codes, diagnostic free-text, problem list entries, medications, and referrals. These data formed the basis of an expert-reviewed reference standard data set and contained the features that were used to train a machine learning model based on classification and regression trees. An ad hoc feature importance measure coupled with recursive feature elimination and clustering were applied to reduce our initial 86,000 element feature set to a few tens of the most relevant features in the data, while class balancing was accomplished with random under- and over-sampling. The final case definition was generated from the tree-based machine learning model output combined with a feature importance algorithm. Two independent samples were used: one for training / testing the machine learning algorithm and the other for case definition validation. Results We randomly selected 2,776 women aged 45–60 for this analysis and created a case definition, consisting of two occurrences within 24 months of International Classification of Diseases, Ninth Revision, Clinical Modification code 627 (or any sub-codes) OR one occurrence of Anatomical Therapeutic Chemical classification code G03CA (or any sub-codes) within the patient chart, that was highly effective at detecting problematic menopause cases. This definition produced a sensitivity of 81.5% (95% CI: 76.3-85.9%), specificity of 93.5% (91.9-94.8%), positive predictive value of 73.8% (68.3-78.6%), and negative predictive value of 95.7% (94.4-96.8%). Conclusion Our case definition for problematic menopause demonstrated high validity metrics and so is expected to be useful for epidemiological study and surveillance. This case definition will enable future studies exploring the management of menopause in primary care settings.Item Open Access How do we measure vulvar pain?: objective measurement of a subjective parameter(2012) Robert, Magali Berthe Marie Therese Colette; Ross, SueObjectives The objective of the research was to explore the possible relationships of commonly used pain measures in women suffering from vulvar pain. Methods Characterization of the pain profiles of a twenty women cohort presenting with vulvar pain was undertaken. Descriptive analysis was used to describe the cohort. Scatter plots were used to explore the relationships between the vulvalgesiometer pain thresholds, the McGill Pain Questionnaire responses and modified visual analogue scale scores. Spearman 's correlation coefficient of Rho greater than eight was considered important. Results The cohort was representative of the spectrum of women suffering from vulvar pain. There was no correlation between the different pain measures. This was seen on scatter plots and confirmed with Spearman correlation coefficients less than eight. Conclusion There is no correlation between the commonly used pain measures in women presenting with vulvar pain. Better characterization and understanding of women suffering from vulvar pain is required.Item Open Access How do we measure vulvar pain?Objective measurement of a subjective parameter(2012-08-16) Robert, Magali; Ross, SueObjectives The objective of the research was to explore the possible relationships of commonly used pain measures in women suffering from vulvar pain. Methods Characterization of the pain profiles of a twenty women cohort presenting with vulvar pain was undertaken. Descriptive analysis was used to describe the cohort. Scatter plots were used to explore the relationships between the vulvalgesiometer pain thresholds, the McGill Pain Questionnaire responses and modified visual analogue scale scores. Spearman’s correlation coefficient of Rho greater than eight was considered important. Results The cohort was representative of the spectrum of women suffering from vulvar pain. There was no correlation between the different pain measures. This was seen on scatter plots and confirmed with Spearman correlation coefficients less than eight. Conclusion There is no correlation between the commonly used pain measures in women presenting with vulvar pain. Better characterization and understanding of women suffering from vulvar pain is required.Item Open Access Incidence of stress urinary incontinence following surgical repair of pelvic organ prolapse in previously continent women(2009) Al-Mandeel, Hazem M.; Ross, SueItem Open Access Multiple constraints compromise decision-making about implantable medical devices for individual patients: qualitative interviews with physicians(2017-12-22) Gagliardi, Anna R; Ducey, Ariel; Lehoux, Pascale; Turgeon, Thomas; Kolbunik, Jeremy; Ross, Sue; Trbovich, Patricia; Easty, Anthony; Bell, Chaim; Urbach, David RAbstract Background Little research has examined how physicians choose medical devices for treating individual patients to reveal if interventions are needed to support decision-making and reduce device-associated morbidity and mortality. This study explored factors that influence choice of implantable device from among available options. Methods A descriptive qualitative approach was used. Physicians who implant orthopedic and cardiovascular devices were identified in publicly available directories and web sites. They were asked how they decided what device to use in a given patient, sources of information they consulted, and how patients were engaged in decision-making. Sampling was concurrent with data collection and analysis to achieve thematic saturation. Data were analyzed using constant comparative technique by all members of the research team. Results Twenty-two physicians from five Canadian provinces (10 cardiovascular, 12 orthopedic; 8, 10 and 4 early, mid and late career, respectively) were interviewed. Responses did not differ by specialty, geographic region or career stage. Five major categories of themes emerged that all influence decision-making about a range of devices, and often compromise choice of the most suitable device for a given patient, potentially leading to sub-optimal clinical outcomes: lack of evidence on device performance, patient factors, physician factors, organizational and health system factors, and device and device market factors. In the absence of evidence from research or device registries, tacit knowledge from trusted colleagues and less-trusted industry representatives informed device choice. Patients were rarely engaged in decision-making. Physician preference for particular devices was a barrier to acquiring competency in devices potentially more suitable for patients. Access to suitable devices was further limited to the number of comparable devices on the market, local inventory and purchasing contract specifications. Conclusions This study revealed that decision-making about devices is complex, cognitively challenging and constrained by several factors limiting access to and use of devices that could optimize patient outcomes. Further research is needed to assess the impact of these constraints on clinical outcomes, and develop interventions that optimize decision-making about device choice for treating given patients.Item Open Access Nehiyawak (Cree) women’s strategies for aging well: community-based participatory research in Maskwacîs, Alberta, Canada, by the Sohkitehew (Strong Heart) group(2023-06-27) Listener, Luwana; Ross, Sue; Oster, Richard; Graham, Bonny; Heckman, Seth; Voyageur, CoraAbstract Background The Sohkitehew (Strong Heart) Research Group, which included an Elders Advisory Committee of seven Nehiyawak (Cree) women, set out to bring Maskwacîs community members together to understand Nehiyawak women’s experiences of “aging well”. The goals of this research were to generate information honouring Indigenous ways of knowing, and gather strengths-based knowledge about aging well, to help Maskwacîs, women maintain wellness as they age. Methods We facilitated qualitative Sharing Circles in three different settings in Maskwacîs. Discussions were prompted using the four aspects of the self, guided by Medicine Wheel teachings: Physical, Mental, Emotional, Spiritual. Detailed notes were recorded on flip charts during the discussions of each Sharing Circle. Data were analysed using descriptive content analysis to identify practical strategies for aging well. Results Thirty-six community members attended one or more Sharing Circle. Strategies included: Physical—keeping active to remain well; Mental—learning new skills to nourish your mind; Emotional—laughing, crying, and being happy; Spiritual—practicing Nehiyawak traditional ways. Participants commented that balancing these four aspects of the self is necessary to achieve wellness. Following the analysis of the Sharing Circle comments, three community feedback sessions were held to discuss the results in the wider community. These strategies were formatted into a draft booklet which incorporated Cree language, and archive photographs of Maskwacîs women and families. Conclusions The Nehiyawak Sharing Circles identified practical strategies that help women to remain well as they age. This positive approach to aging could be adopted in other Indigenous and non-Indigenous communities.Item Open Access Walking together: women with the severe symptoms of menopause propose a platform for a walking program; outcome from focus groups(2020-08-05) Sydora, Beate C; Alvadj, Tatjana; Malley, Alexandra; Mayan, Maria; Shandro, Tami; Ross, SueAbstract Background Menopause and midlife are stages in a woman’s life that can be marked by debilitating symptoms and increasing risks for cancer, cardiovascular, metabolic, and bone health issues. Walking represents a simple, low cost, and widely accessible activity with proven health benefits, though its therapeutic effect on alleviating menopause symptoms is not well characterized. Women are generally not opposed to exercise programs; however, increasing or maintaining exercise levels remains a challenge. We undertook a qualitative descriptive study to explore features of a walking program that would be conductive to menopausal women’s participation, as well as to inform the development of such a program. Methods We conducted focus groups with women recruited from two menopause clinics and who suffered from moderate to severe menopause symptoms. The focus groups were audio recorded and transcribed. Women were prompted to talk about their menopause experience and exercise practice and how they would envision a walking exercise program that would keep them engaged. Qualitative content analysis was used to analyze the data and to identify characteristics of a walking exercise program. Results Twenty women participated in 5 focus groups. Women were very interested in trying walking as a means of staying healthy and possibly reducing menopause symptoms. Four major characteristics emerged as important for a walking program: (a) sensitivity to health realities of menopausal women, (b) inclusivity of various needs/levels of physical ability, (c) attentiveness to the need for mutual social support, (d) flexibility in planning of locations and scheduling. A restricted social network platform with features catering to women in menopause was suggested as suitable to initiate and sustain an adequate walking program. Conclusions The findings of this study will be essential in designing a program that would be attractive for women to start and maintain a walking habit. The program would assist in elucidating whether walking is a useful and valuable alternative therapy for menopausal symptoms and, ultimately, might help women staying fit in midlife and postmenopausal.