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（DTI）是一个调查研究不足的话题。本次申请的主要目标是培养候选人Juthani-Mehta博士成为老年感染性疾病的研究领导者，并推进养老院居民尿路感染的多学科研究。

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 (DTI) in nursing home residents is an investigatively understudied topic. The primary goal 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 short-term goals of the career development plan are: 1) to establish the candidate as a patientoriented 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; and 3) to obtain skills in clinical trial design, geriatric medicine, and infection control methodology in nursing homes that will be necessary for future studies. The long-term goal is to train the candidate to be an investigative leader in the field of infections in older adults prepared 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 UTI specific (e.g. flank pain or tenderness) and UTI non-specific (e.g., change in mental status) clinical features as assessed by nursing staff in nursing home residents with suspected UTI; 2) to identify those reliable clinical features in residents with suspected UTI that are associated with laboratory evidence of UTI (i.e., bacteriuria plus pyuria) to create an evidencebased definition of UTI; and 3) to validate the combination of clinical features that are both reliable and associated with laboratory evidence of UTI in a separate validation cohort of nursing home residents with suspected UTI. The candidate is an emerging patient-oriented investigator with unique training in infectious diseases and geriatric clinical epidemiology that make her an ideal candidate to be among the investigative leaders 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.