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博士在Baylor医学院（BCM）上完成了医学院， 华盛顿大学的康复医学，担任首席居民和临床研究金 BCM的脊髓损伤（SCI）药物。她是现任医疗服务研发（HSR＆D）博士后研究员 在Michael E. Debakey VA的质量，有效性和安全性创新中心（IQuest） 德克萨斯州休斯敦的医疗中心（MEDVAMC）。她有四个首次著名的出版物，其中一个提交了 手稿和两个未决的手稿。她致力于从事临床科学家的职业和黑人 女性，历史悠久的黑人学院或大学（HBCU）研究科学家培训的理想候选人 程序。职业发展和目标：在这个奖项期间，斯凯尔顿博士将获得必要的 流行病学，定性方法，数据库分析和实施科学技能 由独立资助的临床科学家探索与退伍军人的最佳医疗保健交付和成果 科学。这将通过完成课程完成，从而导致临床调查的硕士 BCM以及她多样化的导师和其他有针对性的教育机会 顾问。环境：IQuest和MedVAMC是完成这项研究的理想设置，因为 西南部的首屈一指的高铁中心，也是美国最大的SCI中心之一，服务于450多个 每年在门诊环境中的退伍军人。 Skelton博士得到了临床，研究， 该项目在本地和全国范围内的行政和患者倡导领导。研究： 细菌尿症，无症状（ASB）或有症状的尿路感染（UTI）在人体SCI中很常见。 现任退伍军人卫生管理局（VHA）指南建议每一种 在年度评估期间，有SCI的退伍军人，即使有症状，这与其他国家形成鲜明对比 指南。我们的初步数据表明尿液培养（即使没有迹象或症状 感染）驱动抗生素使用。由于尚未探讨年度考试测试的临床结果，我们 理论化一些退伍军人不必要接受抗生素。抗生素的负面后果 过度使用和抗生素耐药性已得到充分的文献记载，并且具有民族甚至全球的重点。这项研究 将制定旨在对利益相关者进行基于证据的ASB和UTI管理的干预措施， 并指导这种高风险人群中的抗生素管理。 AIM 1将确定患者，提供者和设施 SCI年度评估后，驱动细菌性测试和随后使用抗生素的因素使用 定性访谈和定量调查。 AIM 2将使用国家VHA数据库来识别预测指标 在年度检查期间尿液测试和随后的抗生素使用，并比较临床 那些接受抗生素的人的结果。 AIM 3将使用从中收集的信息 以前的目标是开发“智能测试，智能”干预措施，该干预措施是患者和提供者的组合 教育和资源将帮助所有利益相关者都了解有关尿液测试和的对话 抗生素使用；可行性将在一个站点进行测试。下一步将是完善干预措施并测试 在多个站点上的可行性和有效性，并具有VA功绩审查资金，并指导政策改革 围绕着这种常见但繁重的状况。

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

Current Approaches in Telehealth and Telerehabilitation for Spinal Cord Injury (TeleSCI).

• DOI: 10.1007/s40141-022-00348-5
• 发表时间: 2022
• 期刊: CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS
• 影响因子: 1.1
• 作者: Touchett, Hilary;Apodaca, Calvin;Siddiqui, Sameer;Huang, Donna;Helmer, Drew A;Lindsay, Jan A;Ramaswamy, Padmavathy;Marchant-Miros, Kathy;Skelton, Felicia
• 通讯作者: Skelton, Felicia