Clinical Question Search Assignment . " 10 Pages in APA format :
lachuly1987
urinary22.pptx1
Urinary Tract Infection
Yuliet Hernandez
Purdue Global University
MN-504
Scientific and Analysis Approaches to Advanced Evidence -Based Practice
PICOT
PICOT is an acronym of the following;
P-Population
I-Intervention
C-Comparison
O-Outcome
T-Time Frame
In catheter associated urinary tract infections, the population can be represented by catheter patients, the silver alloy coated urinary catheters for intervention, regular indwelling urinary catheter for comparison and decreasing UTIs for outcome.
INTRODUCTION
A urinary tract infection (UTI) is an infection involving any part of the urinary system, including urethra, bladder, ureters, and kidney.
UTIs are the most common type of healthcare-associated infection reported
Among UTIs acquired in the hospital, approximately 75% are associated with a urinary cathete.
Between 15-25% of hospitalized patients receive urinary catheters during their hospital stay.
The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter
Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed
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MY PICOT QUESTION
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In the adult long term acute care patient (P) does the execution of a nursing urinary catheter protocol (UCP) on admission (I) compared to no protocol (C) affect catheter associated urinary tract infections (CAUTI) rates (O) over a 3 month period.
CLINICAL QUESTIONS
The background questions provides general knowledge information (Arnold, et al. 2016).
What is considered to be a urinary tract infection?
What causes urinary tract infection?
Who are the most individuals to be affected by urinary tract infections? Male or female?
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The foreground questions can be answered using studied evidence as well as using journal articles (Beahm, et al. 2017).
Does the assessment and management of body water help in preventing Urinary tract infection?
Is drinking of cranberry juice help to reduce the urinary tract infection?
Key Clinical Questions
What are the long term effects of urinary tract infections to the victims?
What are the usual treatment techniques for urinary tract infections victims more especially children and adults?
How does estrogen hormone helps in lowering the urinary tract infections more especially for the women victim?
Can hormone imbalance cause urinary tract infections?
The Levels of Evidence
Level I
“Evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCT)” (Melnyk & Fineout-Overholt, 2019, p. 18)
Level II
“Evidence obtained from well-designed RCTs” (Melnyk & Fineout-Overholt, 2019, p. 18).
Cochrane offers a smaller, manageable amount of studies including randomized controlled trial (RCTs) and systematic Cochrane reviews (Melnyk & Fineout-Overholt, 2019).
Keywords searches: “Urinary Tract Infections” AND “Estrogen” AND “Progesterone Receptors” AND ”Trimethoprim, Fosfomycin”
Time adjustment to search publications within 5 years
Results: 6 Cochrane reviews, 30 trials
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COCHRANE DATABASE
Level 1 Evidence
Article 1: ” Consumption of a cranberry juice beverage lowered the number of clinical urinary tract infection episodes in women with a recent history of urinary tract infection. “
Objective: To determine the effectiveness and safety of using cranberry juice in lowering the rate of infection of urinary tract infections.
Method: A randomized, placebo-controlled trial conducted over 24 weeks in 17 different research clinics (Maki, et al 2016).
Participants: 340 clinically healthy women agreed to participate in the study with one half assigned to the control group and the other half assigned to the experimental group.
Main Results: The meta-analysis shows that 39 women in the experimental group and 67 women in the control group developed a UTI based on the above criteria.
PUBMED DATABASE
PubMed is a free database with access to citations from life science journals maintained by the National Center for Biotechnology Information (NCBI) at the NLM at the National Library of Medicine (Melnyk & Fineout-Overholt, 2019).
Keyword searches: “Urinary Tract Infections” AND “Escherichia coli & cranberry juice ”
Time adjustment to search publications within 5 years
Results: 40 results, 15 RCTs
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Level 2 Evidence
Article 2: "Recurrent urinary tract infection and urinary Escherichia coli in women ingesting cranberry juice daily: a randomized controlled trial. ”
Objective: Assessing the efficacy of daily ingesting of cranberry juice as a treatment for women who have experienced Recurrent urinary tract infection and urinary Escherichia coli
Method: A randomized controlled trial performed at multiple research centers over the span of three years.
Inclusion Criteria: Women between the ages of 18 and 45 with a history of UTI within the past 12 months.
Exclusion Criteria: Women with a history of diabetes mellitus, kidney stones, malignant neoplasm, vaginitis, cystitis, asymptomatic bacteriuria, anatomical abnormalities of the urinary tract, allergy to cranberry products, antibiotic use within the last 7 days; women currently taking oral anticoagulants or prophylactic antibiotics; and women who were pregnant or lactating at the time.
Participants: 176 total participants took part, 120 were assigned to the experimental group and 56 were assigned to the control group (Stapleton, et al. 2012).
Main Results: The experimental group experienced a non-statistically significant decrease in UTI’s when compared with the control group, indicating that cranberry juice may be helpful in the prevention of UTI’s in otherwise healthy women.
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Analysis of Both Levels of Evidence
Cranberry juice supplementation may be a safe, non-pharmacological intervention to prevent urinary tract infections in otherwise healthy women.
Factors such as dosing, formulation, and frequency of ingestion may influence efficacy (Stapleton, et al. 2012).
It is typically tolerated very well and does not appear to have a side effect profile apart from the patient’s taste preferences.
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Conclusion
Although not first line treatment, cranberry juice is a safe measure that can be initiated for the prevention of urinary tract infection.
It would be beneficial to study these effects in other populations, such as males and those with indwelling catheters, as well as the effects of cranberry supplementation in other doses and forms (Stapleton, et al. 2012).
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References:
Arnold, J. J., Hehn, L. E., & Klein, D. A. (2016). Common questions about recurrent urinary tract infections in women. American family physician, 93(7), 560-569. Retrieved from https://www.aafp.org/afp/2016/0401/p560.html
Beahm, N. P., Nicolle, L. E., Bursey, A., Smyth, D. J., & Tsuyuki, R. T. (2017). The assessment and management of urinary tract infections in adults: guidelines for pharmacists. Canadian Pharmacists Journal/Revue des Pharmaciens du Canada, 150(5), 298-305. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/1715163517723036
Maki, K. C., Kaspar, K. L., Koo, C., Derrig, L. H., Schild, A. L., & Gupta, K. (2016). Consumption of a cranberry juice beverage lowered the number of clinical urinary tract infection episodes in women with a recent history of urinary tract infection. American Journal of Clinical Nutrition, 103(6), 1434-1442. http://dx.doi.org/10.3945/ajcn.116.130542
Stapleton, A. E., Dziura, D., Hooton, T. M., Cox, M. E., Yarova-Yarovaya, Y., Chen, S., & Gupta, K. (2012). Recurrent urinary tract infection and urinary Escherichia coli in women ingesting cranberry juice daily: a randomized controlled trial. Mayo Clinical Proceedings, 87(2), 143-150. http://dx.doi.org/10.1016/j.mayocp.2011.10.006
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