The PREDICT Study (PRE-ICU Determinants of Post-ICU FunCTional Outcomes among Older Adults)

项目摘要/摘要 应聘者：我的职业目标是成为一名独立的内科科学家和老年医学领域的全国领导者 重症监护结果研究，其工作主体改善了危重病患者的长期功能结局 上了年纪的人。我作为肺部和重症监护医学(PCCM)医生和研究人员的临床培训 老年临床流行病学方面的培训使我为追求这条职业道路做好了准备。我过去的记录是 初步成功的证据是出版了影响很大的原始报告和收到了3000笔赠款， 包括GEMSSTAR奖。我也已经在我的专业领域脱颖而出，成为全国的领导者。 就像老年病学：我创立了美国胸科学会危重护理大会老龄化协会，并担任该协会的联合主席 和老年医学工作组，最近被选为美国老年医学联合会即将上任的联合主席 学会(AGS)医学专科组。我的研究努力在全国范围内得到了认可， AGS新研究员奖，并在耶鲁大学获得享有盛誉的Iva Dostanic医生科学家奖。 导师和环境：我有一个杰出的导师和顾问团队，包括我的主要导师 Thomas Gill博士(老年病学)，残疾流行病学和预防方面的领先专家，共同指导Dr。 玛格丽特·皮萨尼(PCCM)，重症监护结果研究专家，顾问特伦斯·墨菲博士， 在老龄化纵向研究和重症监护结果研究方面具有专业知识的生物统计学家。我的研究 职业发展计划利用了耶鲁大学丰富的资源，包括耶鲁项目 论老龄化/克劳德·D·佩珀老年美国人独立中心、耶鲁大学公共卫生学院和一所 耶鲁-纽黑文医院是美国最大的重症监护病房(ICU)之一。这些资源，以及 由耶鲁大学医学院肺、重症护理和睡眠医学部提供支持 医学，为我的职业发展和执行拟议的研究提供了一个理想的环境。 指导研究项目：每年有近140万老年人在ICU住院期间存活下来，其中许多人 将遭受更多的残疾。我们之前的工作已经证明，发病前的因素很强 与危重疾病后的残疾病程相关--但还没有机制来识别哪位老年人 ICU患者的残疾增加的风险。为了解决这一知识差距，我提出了一种创新的 该研究项目利用了耶鲁大学丰富的可用资源，此外还有两个高质量的 纵向数据集：国家健康和老龄化趋势研究(NHATS)和降水事件项目 (PEP)。总体目标是开发、外部验证和试点测试预测工具(包括 疾病前风险因素)，以识别ICU老年患者有ICU后残疾恶化的风险，并提供 个人对残疾增加的估计。其结果将为设计和实施一个更大的 前瞻性队列研究，以测试该工具在预测ICU后残疾以及 随后的临床试验测试干预措施，以改善老年人ICU后的功能结果。

PROJECT SUMMARY/ABSTRACT Candidate: My career goal is to become an independent physician-scientist and national leader in geriatric critical care outcomes research whose body of work improves the long-term functional outcomes of critically ill older adults. My clinical training as a Pulmonary & Critical Care Medicine (PCCM) physician and research training in Geriatric Clinical Epidemiology have prepared me to pursue this career path. My track record of early success is evidenced by the publication of high-impact original reports and the receipt of 3 grants, including a GEMSSTAR award. I have already distinguished myself as a national leader in my specialty as well as in geriatrics: I founded and am co-chair of the American Thoracic Society Critical Care Assembly's Aging and Geriatrics Working Group, and was recently selected as an incoming co-chair of the American Geriatrics Society (AGS) Medical Subspecialties Section. My research efforts have been recognized nationally, with the AGS New Investigator Award, and at Yale, with the prestigious Iva Dostanic Physician-Scientist Award. Mentors and Environment: I have an exceptional team of mentors and advisors, including my primary mentor Dr. Thomas Gill (Geriatrics), a leading expert on the epidemiology and prevention of disability, co-mentor Dr. Margaret Pisani (PCCM), an expert in critical care outcomes research, and advisor Dr. Terrence Murphy, a biostatistician with expertise in longitudinal studies of aging and critical care outcomes research. My research and career development plans draw on the wealth of resources available at Yale, including the Yale Program on Aging/Claude D. Pepper Older Americans Independence Center, the Yale School of Public Health, and one of the largest intensive care units (ICUs) in the country at Yale-New Haven Hospital. These resources, and the support provided by the Section of Pulmonary, Critical Care, and Sleep Medicine at the Yale School of Medicine, provide an ideal environment for my career development and execution of the proposed research. Mentored Research Project: Nearly 1.4 million older adults survive an ICU stay each year, and many of these will suffer from increased disability. Our prior work has demonstrated that premorbid factors are strongly associated with the course of disability after a critical illness – yet no mechanism exists to identify which older ICU patients are at risk of increased disability. To address this knowledge gap, I have proposed an innovative research project that leverages the wealth of resources available at Yale in addition to two high-quality longitudinal datasets: the National Health and Aging Trends Study (NHATS) and Precipitating Events Project (PEP). The overall objective is to develop, externally validate, and pilot test a predictive tool (that incorporates premorbid risk factors) to identify older ICU patients at risk of worsening post-ICU disability and provide a personal estimate of the increase in disability. The results will inform the design and conduct of a larger prospective cohort study to test the accuracy of the tool in predicting post-ICU disability as well as a subsequent clinical trial testing interventions to improve post-ICU functional outcomes among older adults.