Papers by Catherine Flood
Journal of obstetrics and gynaecology Canada, May 1, 2023
Canadian Journal of Zoology, Aug 1, 1984
The effects of the thiols DTT (dithiothreitol) and GSH (reduced glutathione) on hepatic in vitro ... more The effects of the thiols DTT (dithiothreitol) and GSH (reduced glutathione) on hepatic in vitro and in vivo T4 (L-thyroxine) deiodination by rainbow trout held at 11 °C were studied. Hepatic deiodination increased progressively over the DTT range of 0.02–20 mM. GSH was less potent than DTT at low concentrations and strongly inhibited deiodination at high concentrations (> 1 mM). Hepatic deiodination was not increased by 1 mM NADPH or anaerobic conditions and was enhanced and not inhibited by the GSH inhibitor, diamide (2.5 mM), indicating that the low T4 deiodination in the absence of DTT is not due to endogenous GSH deficiency. Intraperitoneally injected GSH consistently increased plasma levels of 125I and [125I]-3,5,3′-triiodo-L-thyronine (T3) in fed or starved [125I]T4-injected trout, suggesting a GSH stimulation of extrahepatic T4 deiodination. However, injected GSH did not elevate plasma T3 concentrations. This was probably due to a demonstrated GSH stimulation of plasma T4 and T3 clearance. Force-fed GSH did not increase [125I]T4 deiodination. It is concluded that exogenous thiols can enhance T4 deiodination both in vitro and in vivo. However, availability of neither endogenous nor dietary GSH appears to regulate T4 deiodination under physiological conditions, including altered nutritional state.
Canadian Journal of Zoology, Sep 1, 1983
Plasma T4 (L-thyroxine) and T3 (3,5,3′-triiodo-L-thyronine) levels were decreased by starvation i... more Plasma T4 (L-thyroxine) and T3 (3,5,3′-triiodo-L-thyronine) levels were decreased by starvation in both terminally sampled and serially sampled rainbow trout held at 11 °C, significant changes in T3 occurring by day 6. Diel variation in plasma T4 was confirmed for fed trout and could explain the previous inability to detect differences in plasma thyroid hormone levels between starved and fed states. Significant elevations in plasma T4 and T3 could be obtained 4 h after feeding previously starved trout. Based on studies with [125I]T4 it is concluded that the food-induced elevation in plasma T3 is due, in part at least, to increased extrathyroidal T4 deiodination to T3.
OBJECTIVE: To investigate whether procedure-specific skills acquired in a surgical lab, versus us... more OBJECTIVE: To investigate whether procedure-specific skills acquired in a surgical lab, versus usual training, result in improved operative competence. DESIGN: randomised controlled trial. Didactic and procedural training occurred using three low fidelity vaginal surgery models: anterior repair (AR), posterior repair (PR), vaginal hysterectomy (VH). POPULATION/SETTING: Junior gynaecology residents at three academic centres. METHODS: The primary outcome was performance evaluated by attending staff blinded to group, via global rating scale (GRS) in the real operating room and for corresponding procedures. Prespecified secondary outcomes included procedural steps knowledge, overall performance impression, resident satisfaction, self-confidence and intraoperative parameters. A priori sample size estimated 50 residents (20% absolute difference in GRS score, 25% SD, 80% power, alpha 0.05). RESULTS: 83 residents were randomised to intervention or control and 55 completed the trial (2012-22...
Journal of Obstetrics and Gynaecology Canada
Journal of Obstetrics and Gynaecology Canada, 2005
Objective: To provide an introduction to the tension-free vaginal tape (TVT) procedure, placing i... more Objective: To provide an introduction to the tension-free vaginal tape (TVT) procedure, placing it in the context of minimally invasive surgeries for the treatment of urinary stress incontinence in women, and to provide guidance to surgeons counselling women on the merits of this surgical choice. Options: This discussion is limited to surgical treatment of urinary stress incontinence in women. Evidence: A search of both MEDLINE and the Cochrane Library identified the most relevant medical evidence. This document represents an abstraction of the evidence rather than a methodological review. Values: This update is the consensus of the Sub-Committee on Urogynaecology of the Society of Obstetricians and Gynaecologists of Canada (SOGC). Benefits, Harms, and Costs: Counselling for the surgical treatment of urinary incontinence should consider the harmsbenefits ratios of various options and include a measure of the “weight” of the evidence. Recommendations: 1. The Burch procedure should be...
Journal of Obstetrics and Gynaecology Canada, 2005
Objective: To evaluate the effects of an interdisciplinary session on medical ethics and legal is... more Objective: To evaluate the effects of an interdisciplinary session on medical ethics and legal issues related to obstetrics and gynaecology on medical students' knowledge, attitudes, and behaviours. Methods: Second-year medical students at the University of Alberta were asked to complete surveys before and after an interdisciplinary panel session on ethics and legal issues in reproductive health. Survey questions were related to knowledge of ethics and law, attitudes toward controversial topics in reproductive health, and predicted behaviours in specific clinical scenarios. In the postsession survey, students were asked to evaluate the session's usefulness and impact. Results: Fifty-seven students completed both the pre-and postsession surveys. Most students listed family, religion, culture, peer groups, scientific thought and theory, and school and education as influences on their own personal ethics and morality. Fifty-five students (97%) stated that the panel session was useful. Most students (79%) reported that the session increased their knowledge of ethical and legal issues in reproductive health. Many students felt that the panel session would change the way they practise in similar clinical situations (63%). The panel session appeared to affect knowledge and predicted behaviour. Conclusion: A large-group interdisciplinary panel session can influence medical students' knowledge and future behaviours related to ethics and law in obstetrics and gynaecology. Medical students gave this session a high rating. Resume Objectif : Evaluer les effets, sur les connaissances, attitudes et comportements des etudiants de medecine, d'une session interdisciplinaire portant sur les questions ethiques et juridiques associees au domaine de I'obstetrique-gynecologie. Methodes : Nous avons demande aux etudiants de medecine de deuxieme annee de l'Universite de I'Alberta de remplir des sondages, avant et apres la tenue d'une session interdisciplinaire sur les questions ethiques et juridiques associees au domaine de la sante genesique. Les questions du sondage pre-session portaient sur les connaissances quant a I'ethique et a la loi, sur les attitudes envers les sujets controverses du domaine de la sante genesique et sur les comportements anticipes dans Ie cadre de
Journal of Obstetrics and Gynaecology Canada, 2014
Objective: To compare clerkship medical students' confidence in performing a simulated normal vag... more Objective: To compare clerkship medical students' confidence in performing a simulated normal vaginal delivery (NVD) after participating in a simulation training session using two different models. Methods: Medical students were randomized to participate in a simulated NVD session using either an obstetrics mannequin or a birthing pelvis model. Questionnaires were used to assess confidence and evaluate the simulation before and immediately after the session and on the last day of the obstetrics clerkship rotation. Results: One hundred ten students were randomized. At the start of the clerkship, both groups had similar obstetrics exposure and confidence levels. Only 15 students (13.9%) agreed they were ready to attempt a NVD with minimal supervision or independently. This increased significantly to 43 students (39.4%) immediately after the session. At the end of the clerkship, 79 of 81 responding students (97.5%) were confident that they could attempt a NVD with minimal supervision or independently. There were no significant differences noted between simulator groups at any point. The sessions were rated as equally useful and realistic, and this remained unchanged at the end of the clerkship.
Journal of Pediatric and Adolescent Gynecology, 2008
Videoconferencing enables distance learning and subspecialty teaching. The objective of this stud... more Videoconferencing enables distance learning and subspecialty teaching. The objective of this study is to describe and evaluate a 3-hour teaching session on Pediatric and Adolescent Gynecology held by videoconferencing from the Hospital for Sick Children and broadcast to 8 other Canadian universities. Evaluation forms were completed by attendees on the clinical applicability, content quality, delivery quality, meeting of objectives and overall assessment of each session. Further evaluations asked whether presentations were received clearly, material could be followed, method of videoconferencing seemed too impersonal, and whether there were any technical problems. Presenters were asked for a qualitative assessment of their experience. The teaching session was broadcast from Toronto. Local residents attended and 8 other centers were connected by videoconferencing. Participants were residents at the 9 involved Canadian centers. PowerPoint presentations were shown at each location with rotating views of the 4 presenters. Monitors enabled each location to view fellow participants. After participating in a videoconferenced teaching session, participants were asked to fill out evaluations. Presenters were asked for a qualitative assessment of their experience providing the session. Successful use of videoconferencing as a means of subspecialty resident education. There were at most 61 responses to evaluation questions. Presentations were well received; 98.6% of responses were "excellent," "very good," or "good." Comments indicated significant variability in video quality received at different centers. Presenters felt the experience was positive but that there was a lack of connection with the distant audience. Videoconferencing offers opportunities for expanding medical subspecialty education to geographical areas without subspecialty representation. Overall, this experience was positive but recommendations to ensure equal levels of technology at all centers and to enhance the interactive nature of the presentation would be made for future experiences.
Journal of Obstetrics and Gynaecology Canada, 2009
To determine the prevalence of and risk factors for urinary and fecal incontinence four months af... more To determine the prevalence of and risk factors for urinary and fecal incontinence four months after vaginal delivery. All patients who had vaginal deliveries at a tertiary care hospital over a three-month period were approached during their postpartum hospital stay regarding participation in the study. Participants underwent a telephone interview at four months after their delivery to determine the presence and type of any incontinence. Of 632 patients, 145 (23%) had stress incontinence, 77 (12%) had urge incontinence, 181 (29%) had any urinary incontinence and 23 (4%) had fecal incontinence. In univariate analysis, stress incontinence was found to be increased in patients>or=30 years of age (26.2%) compared with patients<30 years of age (19.3%) (RR 1.4; 95% CI 1.0-1.8, P=0.05). Urge incontinence was increased in patients who had a forceps delivery (21%) compared with no forceps delivery (9%) (RR 2.2; 95% CI 1.4-3.6, P=0.005), an episiotomy (32.4%) compared with no episiotomy...
Journal of Obstetrics and Gynaecology Canada
A paucity of effective interventions exists for the prevention of preterm birth (PTB). Renewed in... more A paucity of effective interventions exists for the prevention of preterm birth (PTB). Renewed interest has focused on cervical pessaries, which have the benefits of being inexpensive, nonsurgical, and easily inserted and removed. In this study, we aim to describe our experience with this device in a Canadian tertiary care centre. Primary outcomes were rates of spontaneous or iatrogenic PTB before 37, 34, and 28 weeks gestation in pregnancies complicated by short cervix treated with cervical pessary. This was a retrospective cohort study of women with singleton, twin, and triplet pregnancies with pessary placement from August 2013 to March 2015 in the Urogynecology Clinic at the Lois Hole Hospital for Women in Edmonton, AB. Included women were deemed to be at high risk of PTB due to short cervix (≤25 mm) found on ultrasound. Among 115 women included, pessaries were placed at a mean gestation of 25.3 weeks. Forty-nine singleton women (52.7%) delivered at term. Of these deliveries, 75% were spontaneous. Rates of PTB before 34 and 28 weeks gestation for all deliveries, respectively, were 37.4% and 10.4%. Removal data were available for 87.8% of patients, and the pessary remained in situ for a mean of 48 days. In this study&#39;s high-risk obstetrical population, the rates of preterm birth remained high. The effectiveness of pessary use, particularly when compared to other preventative strategies, remains a topic in need of further investigation. To our knowledge, this is the first study to contribute pessary data from a Canadian population.
Journal of Obstetrics and Gynaecology Canada
Studies from disciplines outside gynaecology have found that most patients do not understand the ... more Studies from disciplines outside gynaecology have found that most patients do not understand the clinical responsibilities allocated to physicians-in-training. No research on this topic has been published in gynaecology, despite litigation against gynaecological surgeons regarding the role of residents in surgery. The goal of this research was to explore what gynaecological surgery patients understand about the role of resident doctors. A questionnaire was distributed to female patients in gynaecological surgery pre-admission clinics in Edmonton, Alberta. Surveys included knowledge and opinion statements about residents&#39; duties. Anonymous responses were entered into a secure database. Descriptive statistics were used to characterize the results. Of 108 participants, 83% understood that residents had a higher level of training than medical students, yet 40% were unsure whether residents were doctors. Almost one half (43%) of participants were uncertain whether residents required supervision, including while operating (20%). Most (92%) believed it was important to know their physician&#39;s level of training, yet only 63% reported knowing this information. Only 50% of participants would be comfortable with residents operating on them under supervision. A considerable number (56%) wanted to learn more about residents&#39; roles. Patients do not fully understand the role of residents, and many are uncomfortable with trainees operating on them under supervision. Considering the significant role of residents in patient care, educating patients is essential to improve their comfort and the overall consent process.
International Urogynecology Journal, 2009
Tension-free vaginal tape (TVT) is increasingly being used as the gold standard to treat stress u... more Tension-free vaginal tape (TVT) is increasingly being used as the gold standard to treat stress urinary incontinence. Previously reported complications include peritoneal perforation with acute bowel injury. A thin, petite 51-year-old woman with stress urinary incontinence underwent uneventful TVT placement. Three years later, she presented to hospital with de novo small-bowel obstruction. Laparotomy revealed TVT tape violating the peritoneum and causing the distal ileum to adhere to the pelvic sidewall. The compromised bowel was resected and primary anastomosis performed. Delayed, adhesion-related small-bowel obstruction can be a complication of TVT.
Journal of Obstetrics and Gynaecology Canada Jogc Journal D Obstetrique Et Gynecologie Du Canada Jogc, 2009
Objective: To determine the prevalence of and risk factors for urinary and fecal incontinence fou... more Objective: To determine the prevalence of and risk factors for urinary and fecal incontinence four months after vaginal delivery. Methods: All patients who had vaginal deliveries at a tertiary care hospital over a three-month period were approached during their postpartum hospital stay regarding participation in the study. Participants underwent a telephone interview at four months after their delivery to determine the presence and type of any incontinence. Results: Of 632 patients, 145 (23%) had stress incontinence, 77 (12%) had urge incontinence, 181 (29%) had any urinary incontinence and 23 (4%) had fecal incontinence. In univariate analysis, stress incontinence was found to be increased in patients ³ 30 years of age (26.2%) compared with patients < 30 years of age (19.3%) (RR 1.4; 95% CI 1.0-1.8, P = 0.05). Urge incontinence was increased in patients who had a forceps delivery (21%) compared with no forceps delivery (9%) (RR 2.2; 95% CI 1.4-3.6, P = 0.005), an episiotomy (32.4%) compared with no episiotomy (18.7%) (RR 1.9; 95% CI 1.2-2.9, P < 0.01) and a longer second stage of labour (108 min vs. 77 min, P = 0.01). The prevalence of any urinary incontinence was increased with forceps delivery (15.5%) compared with no forceps delivery (8.7%) (RR 1.5; 95% CI 1.1-2.1, P = 0.01) and maternal age of ³ 30 years (34.1%) compared to < 30 years (23.5%) (RR 1.5; 95% CI 1.1-1.9, P = 0.003). In multivariate analysis, the two variables that remained significant for any urinary incontinence were maternal age ³ 30 years (P < 0.01) and forceps delivery (P < 0.01). There were no identified risk factors for fecal incontinence. Conclusion: Urinary incontinence is common in women at four months post partum. Fecal incontinence is less common. Maternal age and forceps assisted delivery were risk factors for urinary incontinence. Résumé Objectif : Déterminer la prévalence et les facteurs de risque de l'incontinence urinaire et fécale, quatre mois à la suite d'un accouchement vaginal.
Journal of Obstetrics and Gynaecology Canada Jogc Journal D Obstetrique Et Gynecologie Du Canada Jogc, Jul 1, 2006
To assess the overall success of sling procedures and surgical sling release in achieving urinary... more To assess the overall success of sling procedures and surgical sling release in achieving urinary continence and voiding function in women with stress urinary incontinence. We reviewed the charts of 107 patients with stress urinary incontinence who had a two-team abdominal-vaginal fascial sling procedure performed between January 2000 and December 2003. Data reviewed included the patients&amp;amp;amp;amp;#39; medical history, demographic data, findings on physical examination, urodynamic studies, operative report, and findings at visits 6 weeks, 6 months, and 12 months after surgery. Patients with sling releases were followed up to assess pelvic organ prolapse, uroflowmetry, and post-void residual urine volume, and to complete the quality of life questionnaire IIQ-7. At one year after pubovaginal sling surgery, 82.1% of patients were cured of stress urinary incontinence. The majority (85.1%) of patients did not develop postoperative voiding dysfunction. Only 5.6% of those who did develop postoperative voiding dysfunction required surgical sling release. Sling release resolved the post-sling voiding dysfunction in three out of five patients. Pubovaginal sling surgery is a highly successful strategy for the management of stress urinary incontinence and has a low rate of postoperative voiding dysfunction. Surgical sling release may resolve post-sling voiding dysfunction.
Journal of Obstetrics and Gynaecology Canada Jogc Journal D Obstetrique Et Gynecologie Du Canada Jogc, Apr 1, 2013
Objective: Midurethral slings have become the standard of care for women with stress urinary inco... more Objective: Midurethral slings have become the standard of care for women with stress urinary incontinence; prolapse repair is often also required. The primary objective of our study was to compare voiding dysfunction rates and the need for reoperation between patients having midurethral sling procedures alone versus those having midurethral sling procedures with concomitant prolapse repair. Methods: We performed a retrospective chart review over a two-year period in a tertiary urogynaecology clinic. Of 108 charts, 93 had complete data for analysis. Results: Patients having concomitant prolapse repair had a longer operating time, a longer hospital stay, and a longer time to resume normal voiding in the immediate postoperative period. Conclusion: Although tension-free vaginal tape or transobturator tape procedures with concomitant prolapse repair have a higher incidence of voiding dysfunction in the immediate postoperative period, we found that this did not persist to the six-week follow-up visit. There appeared to be no greater risk of lasting voiding dysfunction or need for reoperation after concomitant procedures.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada
Interactive case study discussions were an integral part of the program at the 3(rd) Annual Canad... more Interactive case study discussions were an integral part of the program at the 3(rd) Annual Canadian Urology Forum (2013). The following is a summary of discussions pertaining to a case illustrating the difficulties in the management of pelvic floor disorders.
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2006
To assess the overall success of sling procedures and surgical sling release in achieving urinary... more To assess the overall success of sling procedures and surgical sling release in achieving urinary continence and voiding function in women with stress urinary incontinence. We reviewed the charts of 107 patients with stress urinary incontinence who had a two-team abdominal-vaginal fascial sling procedure performed between January 2000 and December 2003. Data reviewed included the patients' medical history, demographic data, findings on physical examination, urodynamic studies, operative report, and findings at visits 6 weeks, 6 months, and 12 months after surgery. Patients with sling releases were followed up to assess pelvic organ prolapse, uroflowmetry, and post-void residual urine volume, and to complete the quality of life questionnaire IIQ-7. At one year after pubovaginal sling surgery, 82.1% of patients were cured of stress urinary incontinence. The majority (85.1%) of patients did not develop postoperative voiding dysfunction. Only 5.6% of those who did develop postoperat...
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Papers by Catherine Flood