Area of Research
Dr. Chung’s research integrates clinical data, modern statistical techniques, and pharmacokinetic (PK) models to advance therapeutic drug monitoring (TDM) and precision dosing approaches for neonates, children, and other high risk, understudied patient populations. She is dedicated to optimizing patient care by generating evidence that defines, predicts, and achieves optimal target exposure, individualizes dosing, and implements best practice in providing TDM pharmacy service.
Research Challenge
Neonatal and paediatric patients undergo rapid, nonlinear developmental changes that profoundly affect pharmacokinetics (PK) and pharmacodynamics (PD). Consequently, fixed, standard dosing regimens and generic TDM protocols are often suboptimal, leading to treatment failure or toxicity. Moreover, critically ill, chronic kidney disease/dialysis, oncology, and solid organ transplant patients possess unique PK/PD profiles that demand improved precision dosing to enhance efficacy while avoiding adverse effects. Current TDM practice for many high-risk drugs in these groups is hampered by the absence of unified, data driven target ranges or clear guidelines and tools for individualized dosing and TDM.
Proposed Solution
Dr. Chung collaborates closely with clinicians and researchers across specialties (biochemistry, neonatology, nephrology, oncology, paediatric intensive care, pharmacology) and mentors pharmacy students, graduate students and pharmacy residents. Together they conduct observational studies, quality improvement projects, and clinical PK investigations to develop, validate, and implement population PK models, precision dosing strategies, and TDM guidelines that translate big data insights to bedside practice.
Impact to Date
- Higher first dose success: Implementation of a population PK derived vancomycin dosing tool in the NICU increased the proportion of neonates attaining therapeutic concentrations with the initial regimen (see: https://app.firstline.org/en/clients/41-sickkids/steps/82579).
- Formulary and guideline enhancements: Revised dosing and TDM recommendations for vancomycin in paediatric patients receiving haemodialysis/haemodiafiltration, once daily gentamicin/tobramycin dosing, and procainamide monitoring in cardiac critically ill patients.
- Advanced PK guided TDM: Utilized sophisticated PK software to calculate area under the concentration-time curve (AUC) and other PK parameters, supporting dose adjustments for busulfan, ganciclovir, mycophenolate, and tacrolimus in complex paediatric patients.
- Reduced unnecessary testing: A Utilisation Management Committee funded quality improvement project streamlined aminoglycoside and vancomycin ordering/collection, markedly decreasing inappropriate blood draws for TDM.
- Pharmacist empowerment through education: Trained pharmacy students, residents, new graduates, and practicing pharmacists using practical TDM cases in an evidence based framework for interpreting TDM results and recommending dose modifications, expanding their role in precision pharmacotherapy.
Publications
Keywords: Population pharmacokinetics, therapeutic drug monitoring, target range definition, drug efficacy, drug safety, pharmacist driven practice improvement, big data analytics