Médecine et sciences de la santé – Productions scientifiques
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Item Accès libre Z-scores for pediatric echocardiography dimensions adjusted for body size, BMI and age(2025) Lauzon-Schnittka, Jonathan; Plante, Virginie; Dallaire, Frédéric; Dahdah, Nagib; Greenway, Steven C.; Drolet, Christian; Wong, Kenny; Mackie, Andrew S.; Mertens, Luc; Cavallé-Garrido, Tiscar; Penslar, Joshua; Wong, Derek; Garrido-García, Luis MartínAbstract: BACKGROUND: Cardiovascular dimensions measured during pediatric echocardiograms must be normalized for body size. However, other variables may confound their interpretation, such as age and abnormal body habitus. This retrospective cross-sectional study of the Canadian Congenital and Pediatric Cardiology Research Network aimed to create Z score equations for commonly measured dimensions in pediatric 2-dimensional echocardiography that were free of residual confounding effects of body size, body mass index, and age. METHODS: The reference sample consisted of >20 000 children without heart disease from 9 institutions who underwent clinical echocardiography that was reported as normal. A generalized additive model for location, scale, and shape (GAMLSS) was used to model the expected distributions of measurements as a function of sex, height, weight, body mass index, and age. RESULTS: Compared with a model that only considered body surface area, the proposed Z scores demonstrated less bias in subgroups of overweight, young, and early school-aged children. CONCLUSIONS: The proposed Z score equations may improve diagnostic and therapeutic accuracy by ensuring that body size, body mass index, and age do not confound the interpretation of measurements.Item Accès libre Validity : one word with a plurality of meanings(2017) St-Onge, Christina; Young, Meredith; Eva, Kevin; Hodges, BrianValidity is one of the most debated constructs in our field; debates abound about what is legitimate and what is not, and the word continues to be used in ways that are explicitly disavowed by current practice guidelines. The resultant tensions have not been well characterized, yet their existence suggests that different uses may maintain some value for the user that needs to be better understood. We conducted an empirical form of Discourse Analysis to document the multiple ways in which validity is described, understood, and used in the health professions education field. We created and analyzed an archive of texts identified from multiple sources, including formal databases such as PubMED, ERIC and PsycINFO as well as the authors’ personal assessment libraries. An iterative analytic process was used to identify, discuss, and characterize emerging discourses about validity. Three discourses of validity were identified. Validity as a test characteristic is underpinned by the notion that validity is an intrinsic property of a tool and could, therefore, be seen as content and context independent. Validity as an argument-based evidentiary-chain emphasizes the importance of supporting the interpretation of assessment results with ongoing analysis such that validity does not belong to the tool/instrument itself. The emphasis is on process-based validation (emphasizing the journey instead of the goal). Validity as a social imperative foregrounds the consequences of assessment at the individual and societal levels, be they positive or negative. The existence of different discourses may explain – in part – results observed in recent systematic reviews that highlighted discrepancies and tensions between recommendations for practice and the validation practices that are actually adopted and reported. Some of these practices, despite contravening accepted validation ‘guidelines’, may nevertheless respond to different and somewhat unarticulated needs within health professional education.Item Accès libre Expectations, observations, and the cognitive processes that bind them : expert assessment of examinee performance(2016) St-Onge, Christina; Chamberland, Martine; Lévesque, Annie; Varpio, LaraPerformance-based assessment (PBA) is a valued assessment approach in medical education, be it in a clerkship, residency, or practice context. Raters are intrinsic to PBA and the increased use of PBA has lead to an increased interest in rater cognition. Although several researchers have tackled factors that may influence the variability in rater judgment, the critical examination of rater observation of performance and the translation of that data into judgements are being investigated. The purpose of this study was to qualitatively investigate the cognitive processes of raters, and to create a framework that conceptualizes those processes when raters assess a complex performance. We conducted semi-structured interviews with 11 faculty members (nominated as excellent assessors) from a Department of Medicine to investigate how raters observe, interpret, and translate performance into judgments. The transcribed verbal protocols were analyzed using Constructivist Grounded Theory in order to develop a theoretical model of raters’ assessment processes. Several themes emerged from the data and were grouped according to three macro-level themes describing how the raters balance two sources of data ([1] external sources of information and [2] internal/personal sources of information) by relying on specific cognitive processes to assess an examinee performance. The results from our study demonstrate that assessment is a difficult cognitive task that involves nuance using specific cognitive processes to weigh external and internal data against each other. Our data clearly draws attention to the constant struggle between objectivity and subjectivity that is observed in assessment as illustrated by the importance given to nuancing the examinee’s observed performance.Item Accès libre Evolving conceptualizations of validity : impact on the process and outcome of assessment?(2015) St-Onge, Christina; Young, Meredith« In health professions education, assessment functions as the formal gatekeeper to professional practice: it supports learning and encourages behavior change, it can enable professional regulation, and it is used by programs and licensing bodies to determine readiness to practice. Given these high stakes, using valid metrics for these purposes is absolutely vital. Thus validity is considered “the sine qua non of assessment, as without evidence of validity, assessments in medical education have little or no intrinsic meaning” (p. 830). ... »Item Accès libre Lessons from the implementation of developmental progress assessment : a scoping review(2020) St-Onge, Christina; Vachon Lachiver, Élise; Langevin, Serge; Boileau, Elisabeth; Bernier, Frédéric; Thomas, AlikiBackground/Purpose: Educators and researchers recently implemented developmental progress assessment (DPA) in the context of competency-based education. To reap its anticipated benefits, much still remains to be understood about its implementation. In this study, we aimed to determine the nature and extent of the current evidence on DPA, in an effort to broaden our understanding of the major goals and intended outcomes of DPA as well as the lessons learned from how it has been executed in, or applied across, educational contexts. Methods: We conducted a scoping study informed by Arksey and O’Malley’s methodology. Our search strategy yielded 2494 articles. Two team members screened them for inclusion/exclusion (90% agreement), and extracted numerical and qualitative data from 56 articles based on a pre-defined set of charting categories. The thematic analysis of the qualitative data was completed with iterative consultations and discussions until consensus was achieved for the interpretation of the results. Results: Tools used to document DPA include scales, milestones, and portfolios. Performances were observed in clinical or standardized contexts. We identified seven major themes in our qualitative thematic analysis: 1- Underlying aims of DPA, 2- Sources of information, 3- Barriers, 4- Contextual factors that can act as barriers or facilitators to the implementation of DPA, 5- Facilitators, 6- Observed outcomes, and 7- Documented validity evidences. Discussion: Developmental progress assessment seems to fill a need in the training of future competent health professionals. However, moving forward with a widespread implementation of DPA, factors such as lack of access to user-friendly technology and time to observe performance may render its operationalisation burdensome in the context of CBME.Item Accès libre The assessor role : exploring clinical supervisors' skill-set(2014) St-Onge, Christina; Chamberland, Martine; Lévesque, Annie; Varpio, LaraBackground. Clinical supervisors have several different responsibilities. While their responsibilities as assessor are important, little is known about what skill-sets should be acquired for this role and how to foster their development. Documenting assessor skills to study their acquisition and development is critical. Methods. A web survey based on the principles of Appreciative Inquiry was distributed to faculty members and residents from a Department of Medicine at a Canadian University. Participants were asked to 1) list five and then 2) identify five (from a list of 10) characteristics and/or skills demonstrated by clinical supervisors recognized for their excellent assessment skills. Results. 17% of faculty and 23% of residents completed the survey. Fairness is perceived as a key characteristic of an excellent assessor. Faculty members consider that appropriate medical knowledge and skills are important. Residents expressed the importance of appropriate feedback. Both groups indicated the importance of direct observation as a basis for assessment. Discussion. This study offers preliminary insights into the characteristics of excellent assessors. Given the importance of assessment in the daily activities of clinical supervisors, research efforts should strive to better characterize this role in hopes of increase the quality and accuracy of assessment.Item Accès libre Sound practices : an exploratory study of building and monitoring multiple-choice exams at Canadian undergraduate medical education programs(2021) St-Onge, Christina; Young, Meredith; Renaud, Jean-Sébastien; Cummings, Beth-Ann; Drescher, Olivia; Varpio, LaraPurpose Written examinations such as multiple-choice question (MCQ) exams are a key assessment strategy in health professions education (HPE), frequently used to provide feedback, determine competency, or for licensure decisions. However, traditional psychometric approaches for monitoring the quality of written exams, defined as items that are discriminant and contribute to increase the overall reliability and validity of the exam scores, usually warrant larger samples than are typically available in HPE contexts. The authors conducted a descriptive exploratory study to document how undergraduate medical education (UME) programs ensure the quality of their written exams, particularly MCQs. Method Using a qualitative descriptive methodology, the authors conducted semistructured interviews with 16 key informants from 10 Canadian UME programs in 2018. Interviews were transcribed, anonymized, coded by the primary investigator, and co-coded by a second team member. Data collection and analysis were conducted iteratively. Research team members engaged in analysis across phases, and consensus was reached on the interpretation of findings via group discussion. Results Participants focused their answers around MCQ related practices, reporting using several indicators of quality such as alignment between items and course objectives and psychometric properties (difficulty and discrimination). The authors clustered findings around 5 main themes: processes for creating MCQ exams; processes for building quality MCQ exams; processes for monitoring the quality of MCQ exams; motivation to build quality MCQ exams; and suggestions for improving processes. Conclusions Participants reported engaging multiple strategies to ensure the quality of MCQ exams. Assessment quality considerations were integrated throughout the development and validation phases, reflecting recent work regarding validity as a social imperative.Item Accès libre COVID-19 as the tipping point for integrating e-assessment in higher education practices(2022) St-Onge, Christina; Ouellet, Kathleen; Lakhal, Sawsen; Dubé, Timothy; Marceau, MélanieThe COVID-19 pandemic provoked an urgency for many educators to integrate digital information and communication technologies (ICT) in their educational practices. We explored how faculty members tackled the task of adapting their assessment practices to the pandemic to identify what is required to sustain and favor future quality development and implementation of e-assessment in higher education. Employing a qualitative descriptive approach, we conducted semi-structured interviews with thirty-one individuals six months into the COVID-19 pandemic. We identified four major themes in participants’ discourse about the integration of e-assessment during the COVID-19 pandemic: a) the considerations they had for the potential consequences on students and how they considered this while deciding how to move forward, b) the preoccupations for the potential for cheating, c) the importance of pedagogical alignment, and d) the affordances available to them. While the COVID-19 pandemic highlighted the fact that higher education institutions were not prepared for a pivot to- or greater integration of- eassessment, it also provided the tipping-point to do so. In other words, it offered an unprecedented opportunity to critically appraise and change assessment practices, this opportunity was also a very challenging balancing act of considering the social consequences of assessment, the alignment within set affordances.Item Accès libre Stakeholders’ perception on the implementation of Developmental Progress Assessment : using the Theoretical Domains Framework to document behavioral determinants(2022) St-Onge, Christina; Boileau, Elisabeth; Langevin, Serge; Bergeron, Linda; Nguyen, Lily H. P.; Drescher, Olivia; Thomas, AlikiBackground: The widespread implementation of longitudinal assessment (LA) to document trainees’progression to independent practice rests more on speculative rather than evidencebased benefits. We aimed to document stakeholders’ knowledge of- and attitudes towards LA, and identify how the supports and barriers can help or hinder the uptake and sustainable use of LA. Methods: We interviewed representatives from four stakeholder groups involved in LA. The interview protocols were based on the Theoretical Domains Framework (TDF), which contains a total of 14 behaviour change determinants. Two team members coded the interviews deductively to the TDF, with a third resolving differences in coding. The qualitative data analysis was completed with iterative consultations and discussions with team members until consensus was achieved. Saliency analysis was used to identify dominant domains. Results: Forty-one individuals participated in the study. Three dominant domains were identified. Participants perceive that LA has more positive than negative consequences and requires substantial ressources. All the elements and characteristics of LA are present in our data, with differences between stakeholders. Conclusion: Going forward, we could develop and implement tailored and theory driven interventions to promote a shared understanding of LA, and maintain potential positive outcomes while reducing negative ones. Furthermore, ressources to support LA implementation need to be addressed to facilitate its uptake.Item Accès libre From see one do one, to see a good one do a better one : learning physical examination skills through peer observation(2013) St-Onge, Christina; Martineau, Bernard; Harvey, Anne; Bergeron, Linda; Mamede, Sílvia; Rikers, RemyBackground: Learning and mastering the skills required to execute physical exams is of great importance and should be fostered early during medical training. It has been shown that observing peers positively influences the acquisition of psychomotor skills. Purpose: The current study investigated the influence of peer observation on the acquisition of physical examination skills. Methods: Second-year medical students (N = 194) learned the neurological physical examination (PE) for low back pain in groups of three. Each student learned and performed the PE while the other students observed. Analyses compared the impact of the quantity and the quality of observed performances on students’ learning of the PE skills. Results: Students benefited from observing peers while they executed their examination. Moreover, observing a high performing peer increased the acquisition of PE skills. Conclusions: Results suggest that group learning activities that allow students to observe their peers during physical examination should be favouredItem Restriction temporaire Prevention of cardiovascular and other systemic adverse outcomes in patients with asthma treated with biologics(2025) Couillard, Simon; Sadatsafavi, Mohsen; Tran, Trung N.; Scelo, Ghislaine; Tsai, Ming-Ju; Busby, John; Emmanuel, Benjamin; Heaney, Liam G.; Jenkins, Christine; Hoyte, Flavia; Canonica, Giorgio Walter; Katial, Rohit; Heffler, Enrico; Wang, Eileen; Puggioni, Francesca; Wechsler, Michael E.; Ardusso, Ledit R. F.; Máspero, Jorge; Sivori, Martin; Emmas, Cathy; Menzies-Gow, Andrew N.; Stjepanovic, Neda; Bosnic-Anticevich, Sinthia Z.; Cochrane, Belinda; Denton, Eve; Gibson, Peter G.; Hew, Mark; Middleton, Peter G.; Peters, Matthew J.; Brusselle, Guy G.; Louis, Renaud; Schleich, Florence; Christoff, George C.; Popov, Todor A.; Bergeron, Celine; Bhutani, Mohit; Chapman, Kenneth R.; Côté, Andréanne; Dorscheid, Delbert R.; Jiménez-Maldonado, Libardo; Solarte, Ivan; Torres-Duque, Carlos A.; Hansen, Susanne; Porsbjerg, Celeste M.; Suppli Ulrik, Charlotte; Altraja, Alan; Bourdin, Arnaud; Exarchos, Konstantinos P.; Gogali, Athena; Kostikas, Konstantinos; Makris, Michael P.; Papaioannou, Andriana I.; Mitchell, Patrick D.; Iwanaga, Takashi; Nagano, Tatsuya; Tohda, Yuji; Al-Ahmad, Mona S.; Larenas-Linnemann, Désirée; Bøgvald Aarli, Bernt; Kuna, Piotr; Chaves Loureiro, Claudia; Al-Lehebi, Riyad; Bulkhi, Adeeb A.; Chen, Wenjia; Juang, Yah Ru; Siyue Koh, Mariko; Liu, Anqi; Kook Rhee, Chin; Cosio, Borja G.; Perez-de-Llano, Luis; Perng, Diahn-Warng; Sheu, Chau-Chyun; Wang, Hao-Chien; Mahboub, Bassam; Salameh, Laila; Jackson, David J.; Patel, Pujan H.; Pfeffer, Paul E.; Lugogo, Njira; Pleasants, Roy Alton; Beastall, Aaron; Bulathsinhala, Lakmini; Carter, Victoria; Eleangovan, Nevaashni; Fletton, Kirsty; Townend, John; Murray, Ruth B.; Price, David B.Abstract: Rationale: Although clinical trials have documented the oral corticosteroid (OCS)-sparing effect of biologics in patients with severe asthma, little is known about whether this translates to areduction of new-onset OCS-related adverse outcomes. Objective: To compare the risk of developing new-onset OCS-related adverse outcomes between biologic initiators and noninitiators. Methods: This was a longitudinal cohort study using pooled data from the International Severe Asthma Registry (ISAR; 16 countries) and the Optimum Patient Care Research database (OPCRD; United Kingdom). For biologic initiators, the index date was the date of biologic initiation. For noninitiators, it was the date of enrollment (for ISAR) or a random medical appointment date (for OPCRD). Inverse probability of treatment weighting was used to improve comparability between groups, and weighted Cox proportional hazard models were used to estimate the hazard ratios (HRs) of developing OCS-related adverse outcomes for up to 5 years from the index date. Measurements and Main Results: A total of 42,908 patients were included. Overall, 27.3% and 4.7% of biologic initiators and noninitiators were long-term OCS users (daily intake >90 consecutive days in year before the index date), with a mean prednisolone-equivalent daily dose of 10.2 mg and 6.2 mg, respectively. Compared with noninitiators, biologic initiators had decreased rate of developing any OCS-related adverse outcome (HR [95% confidence interval (CI)]: 0.82 [0.72–0.93]; P = 0.002), primarily driven by reduced rate of developing diabetes (0.62 [0.45–0.87]; P = 0.006), major cardiovascular events (0.65 [0.44–0.97]; P = 0.034), and anxiety and/or depression (0.68 [0.55–0.85]; P = 0.001). There were no significant differences in the rates of new-onset cataract (HR, 0.77 [95% CI, 0.47–1.25]), sleep apnea (HR, 0.82 [95% CI, 0.78–1.41]), or other OCS-related adverse outcomes assessed (e.g., osteoporosis). The results were consistent across both datasets. Conclusions: Our findings highlight the role for biologics in preventing new-onset OCS-related adverse outcomes in patients with severe asthma.Item Restriction temporaire Smoking gun: when COPD therapies fail current smokers(2025) Ben Hamou, Elsa; Couillard, SimonAbstract: Chronic obstructive pulmonary disease (COPD) is mainly treated with bronchodilators (long-acting beta-agonists (LABA) and/or long-acting muscarinic antagonists (LAMA)) to reduce symptoms and exacerbations. Inhaled corticosteroids (ICS) are also frequently used, more recently in the form of single inhaler triple therapy (SITT).Item Accès libre Eosinophils in chronic obstructive pulmonary disease exacerbations are associated with increased readmissions(2017) Couillard, Simon; Larivée, Pierre; Courteau, Josiane; Vanasse, AlainAbstract : Rationale: A subset of patients with chronic obstructive pulmonary disease (COPD) demonstrates eosinophilic inflammation either in their sputum or blood. Previous studies regarding the association between increased blood eosinophils and poor readmission outcomes are conflicting. Objective: Investigate outcomes following severe COPD exacerbations in patients with higher blood eosinophils. Methods: With an observational study design, hospitalizations for severe COPD exacerbation were retrospectively gathered. Patient health data previous to and up to one year following the index hospitalization were included. Patients were stratified into the eosinophilic group if the blood eosinophil level on admission was ≥200 cells/μL and/or ≥2% of the total white blood cell count. Clinical outcomes were 12-month COPD-related readmission, 12-month all-cause readmission, length of stay, and time to COPD-related readmission. These outcomes were analysed using logistic, negative binomial, and Cox regression models. Results: A total of 167 patients were included: 55 with eosinophilia. Eosinophilia was associated with an increased risk of 12-month COPD-related readmission (OR 3.59 [1.65-7.82], p=0.0013), an increased risk of 12-month all-cause readmission (2.32 [1.10-4.92], p=0.0277), and a shorter time to first COPD-related readmission (HR 2.74 [1.56-4.83], p=0.0005). The length of stay was not statistically different between eosinophilic and non-eosinophilic patients. Sensitivity analyses using different eosinophilia definitions reveal a proportional increase in effect size with increasing eosinophil cell count definitions for predicting 12-month readmissions. Conclusion: Blood eosinophils can be used as a biomarker in severe COPD exacerbations for predicting higher readmission rates.Item Accès libre De-escalation of severe asthma therapy : do we wean the biologic or the inhaler first?(2025) Couillard, Simon; Lachapelle, PhilippeAbstract : "Asthma is a chronic respiratory disease affecting approximately 10% of Canadians. The disease is recognized by the presence of classical symptoms (dyspnea, wheezing, chest tightness, cough, and sputum), combined with objectively measured variable airflow obstruction. However, the simplicity of this definition overlooks one of the driving features of severe disease, type-2 inflammation, which is the single most treatable immune process. Over the past two decades, research has redefined asthma as a heterogeneous disease, recognizing type-2 inflammation as a prevalent, measurable, and treatable pathway. In clinical settings, the type-2 inflammatory phenotype is identified by the presence of increased blood/sputum eosinophils and/or elevated levels of exhaled nitric oxide (FeNO). With severe disease, this immune pathway remains active and is otherwise suppressed by corticosteroids in over 90% of patients. Indeed, the cornerstone of asthma therapy–inhaled corticosteroid and biologics–primarily functions by suppressing type-2 inflammation, with a failure to suppress this pathway being associated with adverse outcomes and, most frequently, necessitates the use of biologics. The approval and use of six monoclonal antibodies to treat people with severe asthma have led to extraordinary benefits for patients. The currently approved biologics include omalizumab, which targets immunoglobulin (Ig)E; mepolizumab, reslizumab, and benralizumab, which target interleukin (IL)-5/5receptor(R), and finally, dupilumab and tezepelumab, which target IL-4R and thymic stromal lymophoietin (TSLP), respectively. Although omalizumab was primarily trialled in moderate allergic asthma, the latter five biologics (anti-IL-5/5R, anti-IL-4R, and anti‑TSLP) have shown marked efficacy in severe asthma. These biologics have achieved a 50% reduction in annual severe asthma attack rates over placebo, a 50% reduction in the need for maintenance oral corticosteroids (OCS) in three of the biologics, and significant improvements in lung function and symptom scores. The benefits are most pronounced in patients with high type‑2 inflammation, with approximately 30% of these patients achieving near-normalization of asthma parameters, an endpoint referred to as ‘remission’. Interestingly, the move toward remission has introduced a novel goal of therapy: avoiding high-dose inhaled corticosteroids (ICS). Conversely, the astronomical cost of biologics has led clinicians to suspect that life-long therapy with these drugs may not be necessary for everyone, and may not be financially sustainable for societies. Thus, in this new era of asthma treatment, which allows for disease remission with biologics, the pressing question arises: should we wean off the biologic or the inhaler first? [...]"Item Accès libre Inflammatory and clinical prognostic factors for asthma attacks: a patient-level meta analysis of control arms of 22 randomised trials(2025) Couillard, Simon; Mailhot Larouche, Samuel; Celis Preciado, Carlos Andres; Meulmeester, Fleur L.; Lemaire-Paquette, Samuel; Ramakrishnan, Sanjay; Wechsler, Michael E.; Corren, Jonathan; Hardy, Jo; Brightling, Christopher E.; Castro, Mario; Hanania, Nicola A.; Jackosn, David J.; Martin, Neil; Laugerud, Annette; Brusselle, Guy; Diver, Sarah E.; Santoro, Emilio; Compton, Chris; Harding, Megan E.Abstract: Methods In this systematic review and meta-analysis of randomised controlled trials (RCTs), Oxford Asthma Attack Risk Scale 2 (ORACLE2), we searched MEDLINE from Jan 1, 1993, to April 1, 2021, for trials investigating fixed treatment regimen effects on asthma attack rates for at least 6 months with baseline blood eosinophil count and FeNO. Eligible participants were aged 12 years or older with asthma (any severity) who had been randomly assigned to the control group of an RCT. Relevant trials were manually retrieved and reviewed by two independent reviewers (SC and IDP). Disagreements were discussed with five reviewers. Individual patient data (IPD) for meta-analysis were requested from study authors. We investigated the rate of severe asthma attacks (≥3 days of systemic corticosteroids) for at least 6 months and prognostic effects of baseline blood eosinophil count and FeNO in control group participants. Rate ratios (RRs) with 95% CIs were derived for annualised asthma attack rates from negative binomial models adjusted for key variables, including blood eosinophil count and FeNO, and interactions between these type 2 inflammatory biomarkers were explored. Certainty of evidence was assessed using GRADE. The heterogeneity of the included studies and potential for ecological bias were quantified by the concordance statistic (C-statistic). This study was registered with PROSPERO, CRD42021245337. Findings We identified 976 potentially eligible studies. After automated screening, we manually reviewed 219 full-text articles. Of these, 19 publications comprising 23 RCTs were eligible. 6513 participants (4140 [64%] female; 2370 [36%] male; three missing) spanning 22 RCTs were included for data analysis. 5972 (92%) of 6513 patients had moderate-to- severe asthma. 4615 asthma attacks occurred during 5482 person-years of follow-up (annualised rate 0·84 per person- year). Higher blood eosinophil count or FeNO was linked to higher asthma attack risk (per 10-fold increase, RR 1·48 [95% CI 1·30–1·68] for blood eosinophil count and 1·44 [1·26–1·65] for FeNO; high-certainty evidence). Other prognostic factors were attack history (yes vs no, RR 1·94 [1·61–2·32]); disease severity (severe vs moderate, RR 1·57 [1·22–2·03]); FEV1 percentage predicted (FEV1%; per 10% decrease, RR 1·11 [1·08–1·15]); and 5-item Asthma Control Questionnaire score (ACQ-5; per 0·5 increase, RR 1·10 [1·07–1·13]). High blood eosinophil count and FeNO combined were associated with greater risk than either prognostic factor separately. Bronchodilator reversibility was associated with lower risk of severe asthma attacks (per 10% increase, RR 0·93 [0·90–0·96]), with the reduction observed primarily between 0% and 25%. Regarding heterogeneity of the included studies, the C-statistic ranged from 0·58 to 0·95, indicating major differences in patient and disease characteristics between studies. In the univariable meta-analysis per trial, we found substantial heterogeneity in associations between studies, with I² statistics ranging from 0·56 to 0·97. Interpretation Blood eosinophil count, FeNO, asthma attack history, disease severity, low lung function (low FEV1%), and symptoms (ACQ-5 score) are key predictors of asthma attacks. Conversely, we found that moderate bronchodilator reversibility was associated with reduced risk. These findings from high-quality multinational RCTs support incorporation of blood eosinophils and FeNO into clinical risk stratification for targeted risk reduction. More individualised clinical decision-making models should be explored. Funding National Institute of Health and Care Research Oxford Biomedical Research Centre; Association pulmonaire du Québec; Fonds de recherche du Québec—Santé; Québec Air-Intersectorialité-Respiratoire-Son network; Stichting Astma Bestrijding; Leiden University Fund; and Academy of Medical Sciences.Item Accès libre Impact of biologics initiation on oral corticosteroid use in the international severe asthma registry and the optimum patient care research database: a pooled analysis of real-world data(2025) Couillard, Simon; Chen, Wenjia; Townend, John; Christoff, George C.; Tsai, Ming-Ju; Altraia, Alan; Cochrane, Belinda; Cosio, Borja G.; Sivori, Martin; Murray, Ruth B.; Makris, Michael P.; Scelo, Ghislaine; Bulathsinhala, Lakmini; Ardusso, Ledit R.F.; Franchi, María Eugenia; Máspero, Jorge; Stok, Ana María; Tran, Trung N; Saldarini, Fernando; Price, David B.Abstract: Background: For severe asthma (SA) management, real-world evidence on the effects of biologic therapies in reducing the burden of oral corticosteroid (OCS) use is limited. Objective: To estimate the efficacy of biologic initiation on total OCS (TOCS) exposure in SA patients from real-world specialist and primary care settings. Methods: From the International Severe Asthma Registry (ISAR, specialist care) and the Optimum Patient Care Research Database (OPCRD, primary care, UK), adult biologic initiators were identified and propensity score-matched with non-initiators (ISAR, 1:1; OPCRD, 1:2). The impact of biologic initiation on TOCS (including bursts for exacerbations) daily dose in the first and second year follow-up period was estimated using multivariable generalized linear models. Results: Among 5663 patients (ISAR 48%, OPCRD 52%), the odds ratios (ORs) of biologic initiators achieving TOCS cessation in the first and second year of follow-up were 2.38 (95% CI, 1.87-3.04) and 2.11 (95% CI, 1.65-2.70), whereas the ORs of low (0-5mg) TOCS intake were 1.62 (95% CI, 1.40-1.86) and 1.40 (95% CI, 1.21-1.61) respectively. Compared to non-initiators, biologic initiators had a substantially higher chance of achieving >75% reduction from baseline (OR [95% CI]: 2.35 [2.06-2.68] and 1.53 [1.35-1.73] in first and second year, respectively). These findings remained persistent and robust, when analyses were repeated with one country setting removed at a time. Conclusion: Biologic initiation in SA patients led to substantial reduction in TOCS exposure, in particular in the first year. Future analyses will explore the impact on OCS-related adverse health events.Item Accès libre Real-life efficacy of type-2 targeting biologicals in the withdrawal from oral corticosteroid maintenance therapy in severe asthma: a retrospective cohort study(2025) St-Germain, Olivier; Phan, Frédéric; Celis Preciado, Carlos Andres; Grondin Beaudoin, Brian; Poulin, Yannick; Vézina, Félix-Antoine; Garand, Geneviève; Paquette, Samuel; Malick, Mandy; Larivée, Pierre; Lachapelle, Philippe; Couillard, SimonIntroduction: L'asthme corticodépendant sévère est associé à une morbidité importante, en partie due aux corticostéroïdes oraux (CSO). Les médicaments biologiques ciblant l'inflammation de type 2 ont montré leur efficacité pour réduire les corticostéroïdes d'entretien tout en préservant la maîtrise de la maladie. Il n'est pas clair si la réduction de 50 % de la dose de CSO observée dans les essais contrôlés randomisés de phase 3 est reproductible en situation réelle. Méthodologie: Nous avons cherché à déterminer l'effet d'épargne en corticostéroïdes du mépolizumab, du benralizumab et du dupilumab après 24 semaines dans un contexte réel. Nous avons mené une étude de cohorte rétrospective monocentrique comparant le sevrage libéral des corticostéroïdes oraux à Sherbrooke avec les résultats d'essais contrôlés randomisés à agent unique protocolisés dans la littérature. Nous avons sélectionné tous les patients adultes atteints d'asthme de type 2 sévère dépendants des CSO traités avec des médicaments biologiques entre le 1er janvier 2012 et le 1er mars 2022. Résultats: Soixante-treize patients répondant aux critères d'inclusion ont été sélectionnés, dont 33 (45 %) présentaient un chevauchement asthme-maladie pulmonaire obstructive chronique. Trente-neuf patients (53 %) ont reçu du mépolizumab, 30 (41 %) du benralizumab et 4 (5 %) du dupilumab. Dans l'analyse combinée, la réduction médiane de la dose de CSO à 24 semaines était de 50 % [0–100] (p < 0,0001) et de 75 % [23-100] (p < 0,0001) à 52 semaines; ces résultats n’étaient pas statistiquement différents de la réduction médiane de 50 % observée dans les essais de phase 3. Dans l'analyse par agent biologique, les pourcentages de réduction à 24 semaines étaient similaires : 33 % [0–88] pour le mépolizumab, 50 % [18–100] pour le benralizumab et 50 % [33–100] pour le dupilumab.Item Accès libre Antilipolytic insulin sensitivity indices measured during an oral glucose challenge: associations with insulin-glucose clamp and central adiposity in women without diabetes(2025-03-19) Naimi, Foued; Battista, Marie-Claude; Baillargeon, Jean-Patrice; Richer Dit Laflèche, Christophe; Carpentier, AndréAbstract: Background: Tissue overexposure to non-esterified fatty acids (NEFA) contributes to the development of metabolic conditions, with insulin-mediated suppression of lipolysis being an important mechanism in limiting this overexposure. We investigated which dynamic NEFA insulin-suppression indices derived from the oral glucose tolerance test (OGTT) were best associated with those de- rived from the insulin-glucose clamp, as well as with central adiposity and glucoregulatory parameters. Methods: This cross-sectional study recruited 29 women without diabetes, 15 healthy women, and 14 women with polycystic ovary syndrome. The OGTT indices of NEFA insulin-suppression were the decremental NEFA area under the curve, negative log-linear NEFA slope, percentage of NEFA suppression (%NEFAsupp ) and time to suppress NEFA levels by 50% (T50NEFA ). The indices de- rived from the two-step euglycemic-hyperinsulinemic clamp (low-dose insulin step) were delta NEFA and %NEFAsupp . Results: Among the OGTT and clamp indices, T50NEFA [OGTT] and %NEFAsupp [clamp] showed the closest associations in both sub- groups (r=–0.58). Additionally, T50NEFA correlated significantly in all women with waist circumference (r=0.64), body fat percent- age (r=0.60), fasting insulinemia (r=0.53), and M-value insulin sensitivity index (r=–0.45). Similarly, %NEFAsupp [clamp] correlat- ed significantly in all women with waist circumference (r=–0.57), body fat percentage (r=–0.54), fasting insulinemia (r=–0.55), and M-value insulin sensitivity index (r=0.51). T50NEFA and %NEFAsupp [clamp] also correlated with other anthropometric and meta- bolic parameters associated with lipotoxicity. Conclusion: For dynamic testing of NEFA insulin-suppression in women, T50NEFA was the OGTT-derived index best correlated with a clamp index (%NEFAsupp ). These indices were also the most closely associated with anthropometric and glucoregulatory parame- ters. Thus, the OGTT-derived T50NEFA appears valid for assessing dynamic antilipolytic insulin action.Item Accès libre Response and remission in asthma with tezepelumab: overlapping concepts informing on type-2 inflammatory-dependent treatment effects(2025-02-18) Mailhot Larouche, Samuel; Couillard, Simon; Busby, JohnAbstract: We believe the interpretation that baseline biomarkers such as blood eosinophil count (BEC) and fractional exhaled nitric oxide (FENO ) are more predictive of response than remission may be misleading. In practice, response and remission represent a continuum: from “no response” through “response” and then “remission” [4]. Using data from their tables 1 and S1, we calculated univariable odds ratios, which suggest that both BEC and FENO predict response and remission to similar extents (figure 1). We also re-analysed their table 3 using chi-square tests for trend. These showed no significant differences in trends for BEC (p=0.26) or FENO (p=0.58) between patients achieving response versus remission, indicating comparable associations. Without access to individual-level data, we could not analyse biomarkers continuously, but the reported medians suggest minimal differences. Could the authors clarify the statistical methods behind their conclusions?Item Accès libre Occupational pratice guideline - Promoting sexuality and intimate relationships in adults with a neuromuscular disease.(Université de Sherbrooke, 2025-02-10) Gagnon, Cynthia; Muslemani, Samar; Auger, Louis-Pierre; Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN); Gagnon-Roy, Mireille; Plourde, Annie; Berniquez, Éliane; Cloutier, Justine; Lamoureux, Geneviève; Mailhot Tanguay, Camélia; Lefebvre, Lydia; Moreau, EmmanuelleAbstract: This practice guide has been designed for occupational therapists working with adults with neuromuscular diseases (NMD) who wish to address sexuality with this population. Although sexuality is often perceived as a difficult subject to address, it is one of the fundamental needs of human beings and contributes to fulfilment. Sexuality includes biological sex, sexual identity and role, sexual orientation, eroticism, pleasure, intimacy and reproduction. In the practice setting of occupational therapists working with people with NMD, the area of sexuality remains problematic. While the impairments present in NMD (e.g. loss of strength, fatigue, respiratory problems, spasticity, loss of mobility) can interfere with the performance of the sexual act per se, not addressing sexuality with clients can also lead to the neglect of a fundamental need. Indeed, it is reported that over 72% of clients with chronic diseases have problems with their sexuality, and only 18% are able to overcome them independently. Despite this, only a small percentage of professionals will address this topic with their clients. The repercussions can affect the morale, behavior, well-being and quality of life, as well as the relationship with their partner, if applicable. Even so, clients rarely perceive an opportunity to discuss sexuality with their healthcare professional, especially if parents or relatives are present, and clients are often unaware that sexuality can be considered a focus for intervention. This partly explains why the subject is rarely raised in a consultation request. In addition, since professionals are aware of requests for consultation before they meet with clients, they tend to explore more the spheres or habits of life they deem to be priorities for developing the intervention plan. Sexuality, which is an area of life in its own right, is often relegated to the background, intentionally or unintentionally. In fact, one of the reasons given by professionals for their low level of involvement with sexuality is that they often feel ill-equipped or uncomfortable to question and intervene, because they perceive sexuality as belonging to the roles of other healthcare professionals. In other words, occupational therapists, feeling insufficiently competent to cover this area, prefer to set it aside. Indeed, despite the fact that 60% of healthcare professionals consider that sexual difficulties should be addressed, only 6% initiate the discussion on a frequent basis. Therefore, this practice guideline has been designed to support occupational therapists by identifying and documenting a set of interventions and approaches to address the subject of sexuality with people who have an NMD.