• Carleton, Bruce

    Titles

    Investigator, BC Children's Hospital
    Director, Pharmaceutical Outcomes Programme, BC Children's Hospital
    Professor, Department of Pediatrics, University of British Columbia

    Degrees / Designations
    B.Pharm, Pharm.D.
    Primary Area of Research
    Evidence to Innovation
    Secondary Area(s) of Research
    Phone
    604-875-2179
    Fax
    604-875-2494
    Lab Phone
    Assistant Phone
    604-875-3609
    Mailing Address

    BC Children's Hospital Research Institute
    950 West 28th Avenue, Room A3-212
    Vancouver, BC V5Z 4H4

    Affiliate Websites
    Research Areas

    • Clinical pharmacology
    • Outcomes research
    • Drug policy evaluation
    • Health services research
    • Drug safety and adverse drug reactions

    Summary

    The central theme of my research program, Pharmaceutical Outcomes and Policy Innovations (POPi), is the study of drug therapy with the goal of improving human health and quality of life.

    I am particularly interested in developing models for evaluating drug effectiveness, medication use models designed to improve patient health, and effective surveillance systems to improve the safe use of medication.

    I have a particular clinical interest in pediatric medicine, with specific emphases on asthma and the epidemiology and clinical management of adverse drug reactions.

    Another area of interest is the translation of knowledge to aid evidence-based drug policy development. POPi contributes to solving the international drug policy crisis on two levels: the public policy level (federal and provincial), and the clinical policy level. In this way the needs of government are served to manage drug budgets, the needs of clinicians to improve patient care, and the public need to understand and improve the effectiveness, safety and cost effectiveness of drugs.

    Current Projects

    In 2011 we were awarded two CIHR team grants, by the Drug Safety and Effectiveness Network (DSEN) in Adverse Drug Reaction Active Surveillance - Principal Investigators Carleton BC/Hayden MR (2011-2014) and Pharmacogenomics of Adverse Drug Reactions - Principal Investigators Hayden MR /Carleton BC /Kim R (2011-2014). As DSEN teams we will carry out research to fill knowledge gaps identified by Canadian decision-makers (e.g., Health Canada, jurisdictional drug plans, health authorities) and to improve health outcomes for Canadians. Our initial projects investigate the safety of inhaled corticosteroids in children and pregnant women and apply new pharmacogenetic methods to understanding anthracycline-induced cardiotoxicity.

    In 2011 I founded the Provincial Health Services Authority’s Therapeutic Evaluation Unit (TEU). The TEU conducts population therapeutics translational research in order to improve the effective, safe and cost-effective use of drugs in patients within the PHSA.  This unit has 12 key projects underway utilizing epidemiologic methods applied to the large data repositories, available in BC and in other countries, as well as systematic review methods to respond to health evaluation topics of interest to healthcare decision makers. We are using our new database with medical service utilization information (1991-2010) for over 2 million British Columbians with respiratory disease to examine the safety of long-acting beta agonists and tiotropium.  We have also identified new ways to improve the safe use of drugs and create health system savings without harming care. Current projects include: hemoglobin A1C testing frequency and patient outcome, safety of tiotropium in chronic obstructive pulmonary disease, cardiovascular and ocular adverse events of bevacizumab and ranibizumab in patients with acute macular degeneration, and many other translational health projects

    Reducing the Acute Care Burden of Childhood Asthma on Health Services in British Columbia - Canadian Institutes of Health Research (CIHR) Partnership for Health Systems Improvement (PHSI)
    This research details the burden of asthma in British Columbia (BC) using health care utilization data and will establish that a simple and effective health system strategy for asthma management can be readily implemented in primary care and hospital settings, in order to reduce future severe exacerbations. The information obtained through this work will be used to develop a knowledge translation strategy to help us reach our overall goal, which is to arm clinicians, parents and decision makers with the necessary information and strategic guidance to implement a simple health system change, in order to improve the care of children with repeated asthma exacerbations.

    Canadian Pharmacogenomic Network for Drug Safety (CPNDS)  – Canadian Institutes for Health Research (CIHR), Canada Foundation for Innovation (CFI), Genome British Columbia
    The goal of CPNDS is to prevent adverse drug reactions (ADRs) in childhood by identifying predictive genomic markers for specific ADRs. Within five years, CPNDS intends to incorporate these markers into a diagnostic tool that will be used to predict and prevent ADRs in children through specific dosing recommendations for commonly used drugs based on an individual's genetic make-up. The long-term goal for this project is to develop a user-friendly, and effective ADR monitoring tool and national database, to proactively prevent adverse drug reactions in susceptible children.

    Modeling trends and regional variations in asthma and health services utilization to improve care - Canadian Institutes of Health Research (CIHR)
    The purpose of this research is to improve our understanding of how patients with asthma use their asthma-related medications and related health care services. The information obtained through this work will be beneficial in planning and targeting interventions with patients, physicians and health care policy makers to improve the quality of medication use, and ultimately to improve the quality of life of patients with asthma.
     
    Pharmaceutical Outcomes and Policy Innovations (POPi) research unit - Drug policy innovation with enhanced translation
    The mission of the Pharmaceutical Outcomes and Policy Innovations (POPi) Research Unit is to foster pharmaceutical policy innovation through proactive policy research, training and knowledge translation concerning the effectiveness, safety and cost management of prescription drugs.

    Selected Publications

    Shaw K, Amstutz U, Castro-Pastrana L, Loo TT, Ross CJ, Ito S, Rieder MJ, Maher M, MacLeod S, Koren G, Hayden MR, Carleton BC.  Pharmacogenomic investigation of adverse drug reactions: the ADR prioritization tool, APT.  J Popul Ther Clin Pharmacol. 2013 June;20(2):e110-127.

    Pussegoda K, Ross CJ, Visscher H, Yazdanpanah M, Brooks B, Rassekh SR, Feroz-Zada Y, Dube MP, Carleton BC, Hayden MR; CPNDS Consortium. Replication of TPMT and ABCC3 genetic variants highly associated with cisplatin-induced hearing loss in children. Clin Pharmacol Ther. 2013 Apr 10. [Epub ahead of print] 

    Amstutz U, Ross CJD, Castro-Pastrana LI, Rieder MJ, Shear NH, Hayden MR, Carleton BC. HLA-A*31:01 and HLA-B*15:02 as genetic markers for carbamazepine hypersensitivity in children. Clin Pharmacol Ther. 2013 March 18 [Epub ahead of print]  

    Visscher H, Ross CJ, Rassekh SR, Sandor GS, Caron HN, van Dalen EC, Kremer LC, van der Pal HJ, Rogers PC, Rieder MJ, Carleton BC, Hayden MR; the CPNDS Consortium.  Validation of variants in SLC28A3 and UGT1A6 as genetic markers predictive of anthracycline-induced cardiotoxicity in children.  Pediatr Blood Cancer.   2013 Feb 25.  [Epub ahead of print]

    Camp P, Zhang T, Smith A, Carleton B. The use of long-acting beta2-agonists as monotherapy in children and adults. J Popul Ther Clin Pharmacol. 2013 Jan;20(1):e1-12.

    Dionne F, Mitton C, Rassekh R, Brooks B, Ross CJ, Hayden MR, Carleton BC.  Economic impact of a genetic test for cisplatin-induced ototoxicity.  Pharmacogenomics J. 2012 Jun;12(3):205-13.

    Visscher H, Ross CJ, Rassekh SR, Barhdadi A, Dube MP, Al-Saloos H, Sandor GS, Caron HN, van Dalen EC, Kremer LC, van der Pal HJ, Brown AM, Rogers PC, Phillips MS, Rieder MJ, Carleton BC, Hayden MR.  Pharmacogenomic prediction of anthracycline-induced cardiotoxicity in children. J Clin Oncol. 2012 May;30(1):1422-8.

    Sistonen J, Madadi P, Ross CJ, Yazdanpanah M, Lee JW, Landsmeer MLA, Nauta M, Carleton BC, Koren G, Hayden MR. Prediction of codeine toxicity in infants and their mothers using a novel combination of maternal genetic markers.  Clin Pharmacol Ther. 2012 Apr;91(4):692-9.

    Amstutz U, Carleton BC.  Pharmacogenetic testing: time for clinical practice guidelines.  Clin Pharmacol Ther. 2011 Jun;89(6):924-7.

    Ross CJ, Katzov-Eckert H, Dubé MP, Brooks B, Rassekh SR, Barhdadi A, Feroz-Zada Y, Visscher H, Brown AM, Rieder MJ, Rogers PC, Phillips MS, Carleton BC, Hayden MR; the CPNDS Consortium.  Genetic variants in TPMT and COMT are associated with hearing loss in children receiving cisplatin chemotherapy.  Nat Genet. 2009 Dec;41(12):1345-9.

    Carleton BC, Poole RL, Smith MA, Leeder JS, Ghannadan R, Ross CJD, Philips MS, Hayden MR. Adverse drug reaction active surveillance: developing a national network in Canada’s children’s hospitals. Pharmacoepidemiol Drug Saf. 2009 Aug;18(8):713-21. 

    Grants
    • DSEN-SEARCH: active Surveillance and Evaluation of Adverse Reactions in Canadian Healthcare – CIHR (2011-2014)

    • DSEN-PREVENT: Pharmacogenomics of Adverse Reactions EVEnts Nation-wide Team – CIHR (2011-2014)

    • The Canadian Pharmacogenomics Network for Drug Safety - Canada Foundation for Innovation/ Canadian Institutes for Health Research (2008-2013)

    • Pharmacogenomics of Warfarin Safety and Effectiveness in Children – CIHR (2012-2013)

    • Implementation of A Pharmacogenetic ADR Prevention Program in BC – Genome British Columbia & BC Provincial Health Services Authority (2011-2013)

    • Reducing the Acute Care Burden of Childhood Asthma on Health Services in BC – CIHR & MSFHR (2009-2013)

    • The Canadian Pharmacogenomics Network for Drug Safety – CFI/CFRI (2008-2013)

    • Genotype Specific Approaches to Therapy in Childhood: The Canadian Pharmacogenomics Network for Drug Safety – Genome BC (2009-2011)

    • Genotype Specific Approaches to Therapy in Childhood (GATC) – Genome Canada (2005-2008)

    Honours & Awards

    2011 Canadian Society of Pharmacology and Therapeutics (CSPT) Senior Investigator Award

     

    2009 Award for Clinical Research, CIHR Institute of Human Development, Child and Youth Health (IHDCYH) for the Best Research Poster: Effectiveness of inhaled corticosteroids in preventing morbidity and mortality in individuals with chronic obstructive pulmonary disease and the impact of coexisting asthma.  Presented at the IHDCYH Scientific Forum, Winnipeg Manitoba, May 2009.

     

    2008 Awards for Clinical Research, Canadian Association of Paediatric Health Centres (CAPHC) and McMaster University Child Health Research Institute for the Best Research Poster: Genotypic Approaches to Therapy in Children: A National ADR Surveillance Network to Study and Prevent Severe Adverse Drug Reactions in Children. Presented at the CAPHC Annual meeting, Edmonton Alberta, October 2008.

     

    2008 Award for Clinical Research, CIHR Institute of Human Development, Child and Youth Health (IHDCYH): Genotypic Approaches to Therapy in Children. Presented at the CAPHC Annual meeting, Edmonton, Alberta, October 2008.

     

    2005 Award for Best Research Paper, Canadian Association for Continuing Health Education (CACHE). For the published work: Esmail L., Carleton B.C.  Collaborative Drug Therapy Decision-Making Between General Practitioners and Clinical Pharmacists Using Cellular Telephone Instant Group Conferencing: Learning at the Point of Patient Care. Presented at the CACHE Annual Meeting, Calgary, Alberta – September 2005.

     

    2005 Award for Research Excellence, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). For the published work: Schneeweiss S., Maclure M., Carleton B.C., Glynn R.J., Avorn J.  Clinical and economic consequences of a formulary restriction of nebulized respiratory drugs in adults: Direct comparison of randomized and observational evaluations. Br Med J.  2004;328:560-4.

     

    Shoppers Drug Mart Professorship, Faculty of Pharmaceutical Sciences, University of British Columbia – 1995-1996 and 1997-1998.

     

    Master Teacher Award, University of British Columbia Faculty of Pharmaceutical Sciences – 1996-97

    Research Group Members

    • Anne Smith – Research Manager
    • Claudette Hildebrand – CPNDS National Coordinator
    • Gabriella Groeneweg – Administration Coordinator
    • Jie Ie Baik - Finance Coordinator
    • Adrienne Borrie – CPNDS Adult Research Coordinator
    • Kaitlyn Shaw – CPNDS Research Coordinator
    • Shevaun Hughes – CPNDS Research Assistant
    • Mahyar Etminan – Therapeutic Evaluation Unit (TEU) Scientist
    • Ursula Amstutz – Post-doctoral Fellow
    • Benji Heran – Post-doctoral Fellow
    • Ricardo Jimenez-Mendez – Post-doctoral Fellow
    • Leah Mwai - Post-doctoral Fellow
    • Tingting Zhang – PhD Candidate
    • Kaarina Kowalec – PhD Student