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Barker CIS, Groeneweg G, Maitland-van der Zee AH, Rieder MJ, Hawcutt DB, Hubbard TJ, Swen JJ, Carleton BC. Pharmacogenomic testing in paediatrics: clinical implementation strategies. Br J Clin Pharmacol 2021; 88:4297-4310. [PMID: 34907575 PMCID: PMC9544158 DOI: 10.1111/bcp.15181] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 11/27/2022] Open
Abstract
Pharmacogenomics (PGx) relates to the study of genetic factors determining variability in drug response. Implementing PGx testing in paediatric patients can enhance drug safety, helping to improve drug efficacy or reduce the risk of toxicity. Despite its clinical relevance, the implementation of PGx testing in paediatric practice to date has been variable and limited. As with most paediatric pharmacological studies, there are well‐recognised barriers to obtaining high‐quality PGx evidence, particularly when patient numbers may be small, and off‐label or unlicensed prescribing remains widespread. Furthermore, trials enrolling small numbers of children can rarely, in isolation, provide sufficient PGx evidence to change clinical practice, so extrapolation from larger PGx studies in adult patients, where scientifically sound, is essential. This review paper discusses the relevance of PGx to paediatrics and considers implementation strategies from a child health perspective. Examples are provided from Canada, the Netherlands and the UK, with consideration of the different healthcare systems and their distinct approaches to implementation, followed by future recommendations based on these cumulative experiences. Improving the evidence base demonstrating the clinical utility and cost‐effectiveness of paediatric PGx testing will be critical to drive implementation forwards. International, interdisciplinary collaborations will enhance paediatric data collation, interpretation and evidence curation, while also supporting dedicated paediatric PGx educational initiatives. PGx consortia and paediatric clinical research networks will continue to play a central role in the streamlined development of effective PGx implementation strategies to help optimise paediatric pharmacotherapy.
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Affiliation(s)
- Charlotte I S Barker
- Department of Medical & Molecular Genetics, King's College London, London, UK.,Department of Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gabriella Groeneweg
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Anke H Maitland-van der Zee
- Respiratory Medicine/Pediatric Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Michael J Rieder
- Departments of Paediatrics, Physiology and Pharmacology and Medicine, Western University, London, Ontario, Canada.,Molecular Medicine Group, Robarts Research Institute, London, Ontario, Canada
| | - Daniel B Hawcutt
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.,NIHR Clinical Research Facility, Alder Hey Children's Hospital, Liverpool, UK
| | - Tim J Hubbard
- Department of Medical & Molecular Genetics, King's College London, London, UK.,Genomics England, London, UK
| | - Jesse J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Network for Personalized Therapeutics, Leiden, The Netherlands
| | - Bruce C Carleton
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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Loucks CM, Groeneweg G, Roy C, Lee DK, Rieder MJ, Lebel D, Ito S, Ross CJ, Carleton BC. Pharmacogenomic testing: Enhancing personalized medication use for patients. Can Fam Physician 2020; 66:241-243. [PMID: 32273406 PMCID: PMC7145138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Catrina M Loucks
- Postdoctoral fellow in the Department of Pediatrics at the University of British Columbia in Vancouver
| | - Gabriella Groeneweg
- Program Manager in the Department of Pediatrics at the University of British Columbia
| | - Carl Roy
- President and Chief Executive Officer of the Provincial Health Services Authority in Vancouver
| | - David K Lee
- Chief Regulatory Officer in the Health Products and Food Branch at Health Canada in Ottawa, Ont
| | - Michael J Rieder
- Professor in the Department of Paediatrics, the Department of Physiology and Pharmacology, and the Department of Medicine at Western University in London, Ont
| | - Denis Lebel
- Pharmacist at the Centre Hospitalier Universitaire Sainte-Justine in Montreal, Que
| | - Shinya Ito
- Professor in the Department of Paediatrics at the University of Toronto in Ontario
| | - Colin J Ross
- Assistant Professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia
| | - Bruce C Carleton
- Professor and Chair in the Division of Translational Therapeutics in the Department of Pediatrics at the University of British Columbia.
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Loucks CM, Groeneweg G, Roy C, Lee DK, Rieder MJ, Lebel D, Ito S, Ross CJ, Carleton BC. [Not Available]. Can Fam Physician 2020; 66:247-249. [PMID: 32273408 PMCID: PMC7145132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Catrina M Loucks
- Boursière postdoctorale au Département de pédiatrie de l'Université de la Colombie-Britannique à Vancouver
| | - Gabriella Groeneweg
- Gestionnaire de programmes au Département de pédiatrie de l'Université de la Colombie-Britannique
| | - Carl Roy
- Était président et chef de la direction des Autorités sanitaires provinciales à Vancouver
| | - David K Lee
- Chef de la réglementation à la Direction générale des produits de santé et des aliments de Santé Canada à Ottawa (Ontario)
| | - Michael J Rieder
- Professeur au Département de pédiatrie, au Département de physiologie et de pharmacologie, et au Département de médecine de l'Université Western à London (Ontario)
| | - Denis Lebel
- Pharmacien au Centre Hospitalier Universitaire Sainte-Justine à Montréal (Québec)
| | - Shinya Ito
- Professeure au Département de pédiatrie de l'Université de Toronto (Ontario)
| | - Colin J Ross
- Professeur adjoint à la Faculté des sciences pharmaceutiques de l'Université de la Colombie-Britannique
| | - Bruce C Carleton
- Professeur et directeur à la Division de la thérapeutique translationnelle du Département de pédiatrie de l'Université de la Colombie-Britannique.
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Smith N, Wang A, Shaw K, Groeneweg G, Goldman RD, Wilkinson B, Jimenez R, Mwai L, Carleton B. Response to The routine use of oral steroids in paediatric asthma is not routine. Paediatr Child Health 2018; 23:239. [PMID: 29769812 DOI: 10.1093/pch/pxy006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Neale Smith
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia
| | - Alice Wang
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia
| | - Kaitlyn Shaw
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
- Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia
- Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Gabriella Groeneweg
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
- Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia
- Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Ran D Goldman
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
- Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia
- Pediatric Research in Emergency Therapeutics (PRETx.org), Division of Pediatric Emergency Medicine, BC Children's Hospital, Vancouver, British Columbia
| | - Bryan Wilkinson
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
- Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia
- Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Ricardo Jimenez
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
- Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia
- Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Leah Mwai
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
- Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia
- Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Bruce Carleton
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
- Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia
- Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
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Dionne F, Aminkeng F, Bhavsar AP, Groeneweg G, Smith A, Visscher H, Rassekh SR, Ross C, Carleton B. An initial health economic evaluation of pharmacogenomic testing in patients treated for childhood cancer with anthracyclines. Pediatr Blood Cancer 2018; 65. [PMID: 29271558 DOI: 10.1002/pbc.26887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/12/2017] [Accepted: 10/14/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Anthracyclines are a class of highly effective chemotherapeutic drugs commonly used to treat cancer patients. Anthracyclines, however, are associated with the development of serious adverse reactions, including anthracycline-induced cardiotoxicity (ACT). It is not possible, within current practice, to accurately individualize treatment to minimize risk. PROCEDURE Recently, genetic variants have been associated with the risk of ACT in children. Building on these findings and the related genetic test, a predictive model was developed which classifies pediatric patients by their risk of developing ACT. We assessed the value of this ACT-predictive risk classification in addressing ACT. RESULTS With current care, the estimated average lifetime cost of ACT is $8,667 per anthracycline-treated patient and approximately 7% of patients are expected to die from ACT. The projected impact of the information from the new predictive model is a 17% reduction in the risk of mortality from ACT and savings of about 6%: lives saved and lower costs. CONCLUSION The newly identified genetic variants associated with the risk of ACT provide information that allows a more reliable prediction of the risk of ACT for a given patient and can be obtained at a very moderate cost, which is expected to lead to meaningful progress in reducing harm and costs associated with ACT.
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Affiliation(s)
- Francois Dionne
- Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Folefac Aminkeng
- BC Children's Hospital Research Institute (formerly known as the Child and Family Research Institute), Vancouver, British Columbia, Canada.,Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amit P Bhavsar
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Gabriella Groeneweg
- BC Children's Hospital Research Institute (formerly known as the Child and Family Research Institute), Vancouver, British Columbia, Canada.,Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Anne Smith
- BC Children's Hospital Research Institute (formerly known as the Child and Family Research Institute), Vancouver, British Columbia, Canada.,Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Henk Visscher
- BC Children's Hospital Research Institute (formerly known as the Child and Family Research Institute), Vancouver, British Columbia, Canada.,Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shahrad Rod Rassekh
- BC Children's Hospital Research Institute (formerly known as the Child and Family Research Institute), Vancouver, British Columbia, Canada.,Division of Pediatric Hematology/Oncology/Blood and Marrow Transplantation, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colin Ross
- BC Children's Hospital Research Institute (formerly known as the Child and Family Research Institute), Vancouver, British Columbia, Canada.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce Carleton
- BC Children's Hospital Research Institute (formerly known as the Child and Family Research Institute), Vancouver, British Columbia, Canada.,Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia, Canada
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Smith N, Smith A, Wang A, Shaw K, Groeneweg G, Goldman RD, Wilkinson B, Jimenez R, Mwai L, Carleton B. Physician and parent barriers to the use of oral corticosteroids for the prevention of paediatric URTI-induced acute asthma exacerbations at home. Paediatr Child Health 2017; 22:190-194. [PMID: 29479212 DOI: 10.1093/pch/pxx047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives Administration of oral corticosteroids at the onset of an upper respiratory tract infection (URTI) can be effective in the management of acute asthma exacerbations in children. This study was designed to identify barriers to parent-initiated implementation of clinical practice guideline-recommended use of oral corticosteroids for prophylaxis against severe asthma exacerbations in children. Methods Twenty-seven children who presented to BC Children's Hospital with URTI-induced asthma exacerbations were recruited. Parents received a filled prescription for a course of oral corticosteroids to be used at the earliest onset of their child's next URTI. Each family was contacted monthly over a 1-year period to inquire about URTI events, asthma symptoms, medication use and health care utilization. Focus groups were held with family physicians, paediatricians and parents; transcripts were analyzed qualitatively to identify key themes. Results Incidence of URTI events among participants was high (85%). Uptake of study medication was low; 44% used the medication as directed at their first URTI event. Eleven per cent of the patients who used the study medication also visited the emergency department for an exacerbation. Focus groups identified four main barriers to the effective use of parent-initiated oral corticosteroids: physician resistance and conflicting messages from providers; parent uncertainty about oral corticosteroids; multiple caregivers and relative ease of access to an emergency department. Conclusion We have identified key barriers to the effective use of parent-administered oral corticosteroids as an asthma management strategy and gained important insights regarding the research that is required to enhance the applicability of the strategy.
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Affiliation(s)
- Neale Smith
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia
| | - Anne Smith
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Alice Wang
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia
| | - Kaitlyn Shaw
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Gabriella Groeneweg
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Ran D Goldman
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pediatric Research in Emergency Therapeutics (PRETx.org), Division of Pediatric Emergency Medicine, BC Children's Hospital, Vancouver, British Columbia
| | - Bryan Wilkinson
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Ricardo Jimenez
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Leah Mwai
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
| | - Bruce Carleton
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia
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Bardal S, Smith A, Luo HA, Zhang T, Groeneweg G, Jimenez Mendez R, Goldman R, Carleton BC. Asthma in British Columbia: Are we finally breathing easier? A population-based study of the burden of disease over 14 years. J Asthma 2016; 54:308-317. [PMID: 27414432 DOI: 10.1080/02770903.2016.1208223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Asthma presents a significant global burden, but whether the incidence and prevalence of asthma is rising is still debated. The objective of this study was to determine the prevalence and incidence of asthma in British Columbia (BC), Canada, and characterize associated health services utilization. METHODS We extracted data from provincial administrative hospitalization, medical services, and prescription drug databases for patients aged 5 to 55 years, during 1996 to 2009 having ≥270 MSP registration days and meeting asthma definition of: ≥1 hospital admissions with asthma as the principal diagnosis, or ≥2 physician visits for asthma as the principal diagnosis, or ≥3 asthma drug dispensings. Regression models were used to test change in asthma incidence and prevalence, and use of various health care services, such as physician and emergency department (ED) visits, and hospitalizations. RESULTS 379,950 patients met the study criteria. The prevalence (2.6%) and incidence (0.7%) of asthma was relatively stable over the study period. There was a decline in proportion of patients visiting family practitioners (FP) (OR 0.92; 95% CI 0.90-0.94), specialists (OR 0.60; 95% CI 0.58-0.62), using ED services (OR 0.31; 95% CI 0.30-0.32) and hospitalizations (OR 0.34; 95% CI 0.31-0.37). Regional differences were noted, with lower rates of FP and specialist visits and higher rates of ED visits for asthma in rural versus urban areas. CONCLUSIONS In BC, the incidence and prevalence of asthma has remained stable over 14 years. Although health service utilization declined, there is variation between rural and urban regions.
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Affiliation(s)
- Stan Bardal
- a Island Medical Program, University of British Columbia , Vancouver , British Columbia , Canada
| | - Anne Smith
- b Pharmaceutical Outcomes Programme (POPi), Department of Pediatrics, University of British Columbia , Vancouver , British Columbia , Canada
| | - Hao Allan Luo
- c Department of Statistics , University of British Columbia , Vancouver , British Columbia , Canada
| | - Tingting Zhang
- d Department of Neurology , University of British Columbia , Vancouver , British Columbia , Canada
| | - Gabriella Groeneweg
- b Pharmaceutical Outcomes Programme (POPi), Department of Pediatrics, University of British Columbia , Vancouver , British Columbia , Canada
| | - Ricardo Jimenez Mendez
- b Pharmaceutical Outcomes Programme (POPi), Department of Pediatrics, University of British Columbia , Vancouver , British Columbia , Canada
| | - Ran Goldman
- e Division of Emergency Medicine, Department of Pediatrics, British Columbia Children's Hospital , Vancouver , British Columbia , Canada
| | - Bruce C Carleton
- f Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia , Vancouver , British Columbia , Canada
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Badry DE, Groeneweg G, Vrbancic M, Mcdonald L, Hornick J. Service needs of community and institution-based older persons with a developmental handicap in Alberta, Canada. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/07263868900033721] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- D. E. Badry
- The Vocational and Rehabilitation Research Institute, 3304-33 Street, N.W. Calgary, Alberta, T2L, 2A6, Canada
| | - G. Groeneweg
- The Vocational and Rehabilitation Research Institute, 3304-33 Street, N.W. Calgary, Alberta, T2L, 2A6, Canada
| | - M. Vrbancic
- The Vocational and Rehabilitation Research Institute, 3304-33 Street, N.W. Calgary, Alberta, T2L, 2A6, Canada
| | - L. Mcdonald
- The Faculty of Social Welfare, The University of Calgary
| | - J. Hornick
- The Faculty of Social Welfare, The University of Calgary
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Haller O, Dyke C, Groeneweg G. Effectiveness of rehabilitation programs on a remainder population: a retrospective analysis. Ment Retard 1990; 28:373-80. [PMID: 2290384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Retrospective analyses were conducted on a remainder population of 361 individuals with mental retardation at a rehabilitation institute. Program effectiveness was determined by means of aggregate and individual changes in performance on several instruments. Psychometric tests showed no significant increases in test scores whereas gains were found on all adaptive functioning instruments. Programs dealing with daily living and more conceptual material appeared to be more effective than vocational programs. One third of the remainder clients gained from the institute's programs.
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Affiliation(s)
- O Haller
- Vocational and Rehabilitation Research Institute, Department of Research, Calgary, Alberta, Canada
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van der Torren K, Groeneweg G, van Lith G. Measuring oscillatory potential during the course of an arterial occlusion: a method based on Fourier analysis. Doc Ophthalmol 1988; 70:199-203. [PMID: 3234185 DOI: 10.1007/bf00154454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Recently we developed a quantitative method of measuring the Oscillatory Potentials (OP's) for a clinical study in diabetic patients. Several problems were experienced in interpreting the results obtained with digital filtering. The main dilemma was the separation of the first OP from the a-wave, since their frequencies are within the same range. The fast Fourier transform (FFT) was applied for this purpose. From the FFT response the power of the OP's was calculated and expressed in microwatts. The advantage of this method is clearly demonstrated in the case of a patient with central retinal arterial occlusion.
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Abstract
Studying the oscillatory potentials in diabetic retinopathy, the authors experienced several problems interpreting results of digital filtering. The main problem was the separation of the first potential from the a-wave, since their frequencies are within the same range. To improve the procedure of measuring implicit times and of calculating amplitudes, the filtering was started with a finite impulse response filter and followed by a fast Fourier transform. The power of the oscillatory potential was calculated by determining the dominant frequency in the Fourier transformed response and expressed in microwatts. A group of normal subjects was compared with a group of early diabetic retinopathy patients. It appears that even in pathological circumstances a quantitative expression of the oscillatory potential is possible.
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Groeneweg G, Conway DG, Stan EA. Performance of adults with developmental handicaps on alternate forms of the Peabody Picture Vocabulary Test. J Speech Hear Disord 1986; 51:259-63. [PMID: 3736025 DOI: 10.1044/jshd.5103.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A total of 154 adults with developmental handicaps involved in a comprehensive community-based habilitation program were tested on alternate forms of the PPVT and PPVT--Revised to determine interest reliabilities. A comparison of response profiles indicated that there was a significant degree of correspondence in general performance using alternate forms (p less than .0001). This correspondence was maintained regardless of whether overall raw score or mental age equivalents were used. However, a comparison of performance on individual test items that were identical on alternate forms showed less consistent results. Particular aspects of the administration and structure of the PPVT/PPVT-R and response characteristics of individuals with developmental handicaps are suggested as being important factors in test administration and interpretation with this population.
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Berry P, Groeneweg G, Gibson D, Brown RI. Mental development of adults with Down syndrome. Am J Ment Defic 1984; 89:252-6. [PMID: 6240202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Measures of cognitive, verbal, and functional performance obtained at widely separated time periods were examined for adults with Down syndrome. Comparisons of first and last test profiles for Raven Coloured Progressive Matrices, Peabody Picture Vocabulary Test, and Adaptive Functioning Index (Social Education) Test all demonstrated significant increases over a mean time span of 5 years. These increases could not be attributed to year of entry into program, history of institutionalization, or age of the individuals. The findings indicate that mental development of adults with Down syndrome continues well into the third and fourth decade of life.
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