UTI in Nursing Home Residents: Research Training and Clinical Investigation

疗养院居民的尿路感染：研究培训和临床调查

• 批准号: 7618727
• 负责人: MANISHA JUTHANI-MEHTA
• 金额: $ 15.97万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-05-15 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7618727
• 关键词: Acute; Adverse drug effect; Americas; Antibiotic Therapy; Antibiotic-resistant organism; Area; Bacteremia; Bacteria; Bacteriuria; Burn injury; Caring; Cessation of life; Chronic Disease; Clinical; Clinical Trials; Clinical Trials Design; Colony-forming units; Communicable Diseases; Consensus; Data; Development; Development Plans; Diagnosis; Dysuria; Elderly; Environment; Epidemiology; Expenditure; Fatigue; Fever; Flank Pain; Frequencies; Future; Geriatrics; Goals; Gold; Growth; Healthcare; Hematuria; Increased frequency of micturition; Indwelling Catheter; Infection; Infection Control; Infectious Disease Epidemiology; Inflammatory Response; Interview; Investigation; Laboratories; Lead; Left; Leukocytes; Licensed Practical Nurse; Long-Term Care; Longitudinal Studies; Malaise; Medical; Mentors; Mentorship; Methodology; Nurses; Nursing Homes; Odors; Outcome; Pain; Pattern; Personal Satisfaction; Physicians; Psyche structure; Public Health; Pyuria; Registered nurse; Research; Research Design; Research Personnel; Research Training; Risk; Sepsis; Societies; Specimen; Symptoms; Temperature; Time; Training; Universities; Urinalysis; Urinary Incontinence; Urinary tract; Urinary tract infection; Urination; Urine; Validation; Vulnerable Populations; base; career development; clinical epidemiology; cohort; evidence base; functional decline; functional status; health care delivery; improved; meetings; member; mental state; milliliter; mortality; pathogen; patient oriented; programs; skills

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.

描述(由申请人提供)：改善老年人的医疗保健服务需要训练有素的老年医生和专注于老年病的专科医生进行调查。老年人的感染是一个常见的公共卫生问题，会导致功能衰退、死亡率和医疗保健支出。疗养院居民尤其是弱势群体，有必要对他们进行进一步调查，以优化医疗保健。疗养院居民的尿路感染(UTI)是一个研究较少的课题。这项申请的主要目标是培养候选人Juthan-Mehta博士成为老年传染病研究的领导者，并在疗养院居民中推进尿路感染的多学科计划研究。这一职业发展计划的目标是：1)在传染病、老年医学和疗养院实践之间建立一个以患者为中心的调查员；2)在慢性病流行病学、传染病流行病学和纵向研究设计方面获得额外的培训和指导；3)在疗养院获得临床试验设计、老年医学和感染控制方法方面的技能；以及4)为候选人在长期护理机构进行多中心观察性和干预性临床试验做准备。研究计划的具体目的是：1)确定疗养院工作人员对疑似尿路感染患者的尿路特异性临床特征(例如腰痛或压痛)和非特异性尿路临床特征(例如精神状态的改变)的可靠性；以及2)确定和验证疑似尿路感染患者与尿路感染实验室证据(即菌尿加脓尿)相关的可靠临床特征。补充目标是确定怀疑有尿路感染的居民，这些居民有与尿路感染、治疗或两者都有关的不良后果。可靠和有效的临床特征、菌尿和脓尿的结合将成为尿路感染循证定义的基础。候选人是一名新兴的以患者为导向的调查员，在传染病和老年临床流行病学方面接受过独特的培训。由于她已经被美国传染病学会认定为威廉姆斯学者，她是这一领域研究带头人的理想人选。她召集的知名导师和耶鲁大学的环境将使她能够进行出色的培训，并成功完成拟议中的研究。