UTI in Nursing Home Residents: Research Training and Clinical Investigation

描述（由申请人提供）：改善老年人的医疗保健服务需要由训练有素的老年病专家和以老年病为重点的专科医生进行调查。老年人感染是一个常见的公共卫生问题，可导致功能下降、死亡和医疗支出。特别是养老院的居民，他们是一个弱势群体，有必要进一步调查以优化医疗护理。养老院居民的尿路感染（UTI）是一个调查研究不足的话题。本次申请的主要目的是培养候选人Juthani-Mehta博士成为老年感染性疾病的调查领导者，并推进养老院居民尿路感染的多学科研究。该职业发展计划的目标是：1)将候选人培养为传染病、老年医学和养老院实践的面向患者的研究者；2)获得慢性病流行病学、传染病流行病学和纵向研究设计方面的额外培训和指导；3)在养老院获得临床试验设计、老年医学和感染控制方法的技能；4)准备候选人在长期护理机构进行多中心观察性和介入性临床试验。研究计划的具体目的是：1)确定养老院工作人员对疑似尿路感染的养老院居民评估的尿路特异性（如侧腹疼痛或压痛）和尿路非特异性（如精神状态变化）临床特征的可靠性；2)识别和验证疑似尿路感染居民中与尿路感染实验室证据相关的可靠临床特征（即细菌尿加脓尿）。补充目的是确定疑似尿路感染的居民，这些居民与尿路感染、治疗或两者都有不良后果。可靠和有效的临床特征、细菌尿和脓尿的结合将是基于证据的尿路感染定义的基础。该候选人是一名新兴的以患者为导向的研究者，在传染病和老年临床流行病学方面受过独特的培训。由于她被美国传染病学会（Infectious Diseases Society of America）认定为威廉姆斯学者（Williams Scholar），因此她是该领域研究领导者的理想人选。她所召集的知名导师和耶鲁大学的环境将为她提供出色的培训和成功完成拟议的研究提供条件。

DESCRIPTION (provided by applicant): Improving health care delivery for older adults requires investigation by both trained geriatricians and subspecialists with a geriatric focus. Infections in older adults are a common public health problem that lead to functional decline, mortality, and healthcare expenditures. Nursing home residents, in particular, are a vulnerable population in whom further investigation is warranted to optimize medical care. Urinary tract infection (UTI) in nursing home residents is an investigatively understudied topic. The primary objective of this application is to train Dr. Juthani-Mehta, the candidate, to be an investigative leader in geriatric infectious diseases and to advance multidisciplanary research in UTI in nursing home residents. The goals of this career development plan are: 1) to establish the candidate as a patient-oriented investigator at the interface of infectious diseases, geriatric medicine, and nursing home practice; 2) to gain additional training and mentorship in chronic disease epidemiology, infectious diseases epidemiology, and longitudinal study design; 3) to obtain skills in clinical trial design, geriatric medicine, and infection control methodology in nursing homes; and 4) to prepare the candidate to conduct multi-center observational and interventional clinical trials in long-term care facilities. The specific aims of the research plan are: 1) to determine the reliability of urinary tract specific (e.g. flank pain or tenderness) and urinary tract non-specific (e.g., change in mental status) clinical features as assessed by nursing home staff in nursing home residents with suspected UTI; and 2) to identify and validate those reliable clinical features in residents with suspected UTI that are associated with laboratory evidence of UTI (i.e., bacteriuria plus pyuria). Supplementary aims are to identify residents with suspected UTI that have adverse outcomes related to UTI, to treatment, or to either. The combination of reliable and validated clinical features, bacteriuria, and pyuria will be the basis for an evidence-based definition of UTI. The candidate is an emerging patient-oriented investigator with unique training in infectious diseases and geriatric clinical epidemiology. Since she has been recognized nationally by the Infectious Diseases Society of America as a Williams Scholar, she is an ideal candidate to be an investigative leader in this field. The renowned mentors she has assembled and the environment at Yale University will allow for outstanding training and the successful completion of the proposed study.