Optimizing Bacteriuria Management in Veterans with Spinal Cord Injury

优化脊髓损伤退伍军人的菌尿管理

• 批准号: 10308486
• 负责人: Felicia Skelton
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-11-01 至 2022-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308486
• 关键词: Acute; Aftercare; Age; Americas; Antibiotic Resistance; Antibiotic Therapy; Antibiotics; Attitude; Automobile Driving; Award; Bacteria; Bacteriuria; Benefits and Risks; Bladder; Centers for Disease Control and Prevention (U.S.); Chronic; Client satisfaction; Clinic; Clinical; Clinical Research; Communicable Diseases; Data; Databases; Documentation; Education; Effectiveness; Environment; Epidemiology; Ethers; Evaluation; Fellowship; Funding; Genitourinary system; Goals; Guidelines; Health Services; Historically Black Colleges and Universities; Infection; Intervention; Intervention Trial; Interview; Knowledge; Leadership; Manuscripts; Measures; Medical; Medical center; Medicine; Mentors; Methods; Neurogenic Bladder; Outcome; Outpatients; Patient advocacy; Patients; Pattern; Persons; Physical Medicine; Policies; Population; Postdoctoral Fellow; Predictive Factor; Pregnancy; Premenopause; Prevalence; Primary Health Care; Procedures; Provider; Publications; Publishing; Qualitative Methods; Qualitative Research; Quality of life; Reporting; Research; Residencies; Resources; Safety; Scientist; Signs and Symptoms; Site; Societies; Spinal cord injury; Standardization; Structure; Surveys; Symptoms; Testing; Time; Training; Training Programs; United Nations; Universities; Urinalysis; Urinary tract infection; Urine; Veterans; Veterans Health Administration; Visit; Washington; Woman; administrative database; black women; care outcomes; career; career development; clinical investigation; college; education resources; evidence base; evidence based guidelines; feasibility trial; health care delivery; health care service utilization; high risk; high risk population; implementation science; innovation; instrumentation; medical schools; medication compliance; multi-drug resistant pathogen; patient population; programs; provider factors; research and development; satisfaction; screening; skills; therapy design; treatment guidelines; urinary; urologic

Candidate: Dr. Felicia Skelton completed medical school at Baylor College of Medicine (BCM), residency in rehabilitation medicine at the University of Washington, serving as chief resident, and clinical fellowship in spinal cord injury (SCI) medicine at BCM. She is a current health services R&D (HSR&D) post-doctoral fellow at the Center for Innovations in Quality, Effectiveness and Safety (IQuESt) at the Michael E. DeBakey VA Medical Center (MEDVAMC) in Houston, TX. She has four first-authored publications, one submitted manuscript and two pending manuscripts. She is dedicated to a career as a clinician scientist, and as a Black female, an ideal candidate for the Historically Black College or University (HBCU) Research Scientist Training Program. Career Development and Goals: During this award period Dr. Skelton will obtain the necessary epidemiologic, qualitative methods, database analysis and implementation science skills to become an independently-funded clinician scientist exploring optimal health care delivery and outcomes for Veterans with SCI. This will be achieved through completion of coursework leading to a masters in clinical investigation from BCM, as well as other targeted educational opportunities developed by her diverse group of mentors and advisors. Environment: IQuESt and MEDVAMC are the ideal settings to complete this research, as the premiere HSR center in the Southwest and the one of the largest SCI centers in the nation, serving over 450 Veterans in the outpatient setting annually, respectively. Dr. Skelton has the support of clinical, research, administrative and patient advocacy leadership both locally and nationally for this project. Research: Bacteriuria, ether asymptomatic (ASB) or symptomatic urinary tract infection (UTI) is common in persons SCI. Current Veterans Health Administration (VHA) guidelines recommend a screening urine culture for every Veteran with SCI during their annual evaluation, even when symptomatic, which is contrary to other national guidelines. Our preliminary data suggest that a positive urine culture (even without signs or symptoms of infection) drives antibiotic use. As the clinical outcomes of the annual exam testing have not been explored, we theorize some Veterans are receiving antibiotics unnecessarily. The negative consequences of antibiotic overuse and antibiotic resistance are well documented, and have a national and even global focus. This study will develop an intervention aimed to educate stakeholders on evidence-based management of ASB and UTI, and guide antibiotic stewardship in this high-risk population. Aim 1 will identify patient, provider, and facility factors driving bacteriuria testing and subsequent antibiotic use after the SCI annual evaluation using qualitative interviews and quantitative surveys. Aim 2 will use national VHA databases to identify the predictors of urine testing and subsequent antibiotic use during the annual examination, and compare the clinical outcomes of those who received antibiotics to those who did not. Aim 3 will use the information gathered from the previous aims to develop the “Test Smart, Treat Smart” intervention, a combination of patient and provider education and resources that will help all stakeholders have informed conversations about urine testing and antibiotic use; feasibility will be tested at a single site. The next step wil be to refine the intervention and test its feasibility and effectiveness at multiple sites, with VA merit review funding, as well as guiding policy reform surrounding this common, but burdensome condition.

候选人：Felicia Skelton博士毕业于贝勒医学院（BCM），在

项目成果

Developing a user-friendly report for electronically assisted surveillance of catheter-associated urinary tract infection.

开发用户友好的报告，用于导管相关尿路感染的电子辅助监测。

• DOI: 10.1016/j.ajic.2016.09.014
• 发表时间: 2017
• 期刊: American journal of infection control
• 影响因子: 4.9
• 作者: Skelton,Felicia;Campbell,Bryan;Horwitz,Deborah;Krein,Sarah;Sales,Anne;Gundlapalli,Adi;Trautner,BarbaraW
• 通讯作者: Trautner,BarbaraW

Climate Change and Physiatry: A Call to Proportional and Prospective Action.

• DOI: 10.1097/phm.0000000000002017
• 发表时间: 2022-10-01
• 期刊: American journal of physical medicine & rehabilitation
• 影响因子: 3

Clinical outcomes associated with guideline-discordant management of asymptomatic bacteriuria and urinary tract infection in hospitalized patients with neurogenic bladder.

• DOI: 10.1017/ash.2022.348
• 发表时间: 2022
• 期刊: Antimicrobial stewardship & healthcare epidemiology : ASHE
• 作者: Fitzpatrick, Margaret A;Wirth, Marissa;Nguyen, Jimmy;Suda, Katie J;Weaver, Frances M;Burns, Stephen;Collins, Eileen;Safdar, Nasia;Patel, Ursula;Evans, Charlesnika T
• 通讯作者: Evans, Charlesnika T

Health Care Disparities Add Insult to Spinal Cord Injury.

医疗保健差异加剧了脊髓损伤。

• DOI: 10.1212/cpj.0000000000001095
• 发表时间: 2021
• 期刊: Neurology. Clinical practice
• 作者: Escalon,MiguelX;Houtrow,Amy;Skelton,Felicia;Verduzco-Gutierrez,Monica
• 通讯作者: Verduzco-Gutierrez,Monica

Telemedicine Use Among Physiatrists During the Early Phase of the COVID-19 Pandemic and Potential for Future Use.

COVID-19 大流行早期阶段物理医生的远程医疗使用情况以及未来使用的潜力。

• DOI: 10.1089/tmj.2022.0030
• 发表时间: 2023
• 期刊: Telemedicine journal and e-health : the official journal of the American Telemedicine Association
• 作者: Siddiqui,Sameer;Farr,Ellen;Dusto,Nathaniel;Chen,Liqi;Kocherginsky,Masha;Skelton,Felicia;Verduzco-Gutierrez,Monica;Lee,Sujin
• 通讯作者: Lee,Sujin