|This month we hear from fellow Australian and colleague, Jason Roberts, whose work is recognized for advancing research in TDM to serve the critical patient, especially optimising the use of antimicrobial drugs. Building on previous work, Jason and his colleagues perform outstanding research from routine clinical work, as well as leading and participating in high quality international collaborations. Jason shares about these and various other initiatives.
Consultant Clinical Pharmacist, Royal Brisbane and Women’s Hospital
Professor & NHMRC Practitioner Fellow, Centre for Clinical Research University of Queensland, Australia
Can you tell us a little bit about your respective roles? What is a typical day like for you?
I work 30% clinically and carry a full academic/research load as well. My clinical work is in an intensive care unit where I work as a clinical pharmacist and I really enjoy this work as it helps identify gaps in current approaches to treatment from which I can then identify important research opportunities. My research life is very rewarding – I run 2 groups – a clinical pharmacokinetics group at the School of Medicine and an in vitro infection model laboratory in School of Pharmacy (both at The University of Queensland). I have about 25 people that I am responsible for in some way including PhD Students, post-doctoral fellows, visitors, research assistants and they all have excellent and engaged minds that keep me learning more and more about the work we do. So, there are many meetings and discussions to problem solve our research and translation challenges.
Is there anything that your laboratory does, or that is done at your hospital/centre, that you would consider innovative?
Clinically we are quite innovative in my view compared to many other centres. From an antimicrobial perspective, although it is increasing in availability around the world, we were one of the first centres to set up a formal beta-lactam TDM service, certainly the first in the Southern hemisphere that I am aware of. We also inform our dose recommendations with Bayesian forecasting which is done in some places but, is certainly not widespread. From a research perspective, we have a state of the art dynamic infection model called the Hollow Fibre Infection Model System which isn’t widely used because of its complexity and cost, but which is very useful because it allows one to replicate the PK observed clinically. Our clinical PK research system is outstanding with very committed clinical researchers ensuring that we are able to run many studies concurrently but to also have the laboratory expertise and data analysis expertise to make the most of our clinical research data.
What technological innovations have entered into use during your career that have permitted a change, or evolution, in practice?
I am not sure that I’m old enough for this, but a big opportunity which some hospitals have had for a long time is an electronic medical record. We have had this in our ICU for ~20 years now, but it is not common to all ICUs and not all hospitals. However, the data available from these systems will truly revolutionise our understanding of medicine and health services and can provide brilliant support to clinical care. The opportunities for these to have drug dosing software included that individualise and optimize drug therapy is significant and is something I watch with great interest.
How did you become interested in your area of expertise?
As a pharmacist, I’m ‘naturally’ interested in PK, and TDM presents a compelling opportunity to clinically apply knowledge of PK and use an iterative process to ensure optimal drug exposures are achieved.
Is there anything that you’ve seen or heard about recently and thought “I’d like to incorporate that idea at my center”?
Rapid diagnostics for identifying causative pathogens of problematic infections – if sufficient health services costing data could support this, it would be highly valuable for better identification of drug exposures needed to optimize treatment in individual patients.
What sort of research do you have on the horizon that you think might influence clinical practice in the future?
Can’t give that away! Suffice to say, any work that decreases the time to a critically ill patient receiving the right drug at the right exposure is very important for maximizing health outcomes.
What do you consider is the future for TDM and CT? What are you excited about? What are the challenges we face?
Some challenges relate to technology, but most really relate to expanding systems widely into clinical use and making them easy for non-experts to use. Demonstrating cost-effectiveness is also an important challenge that the TDM field needs to address.
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