Clinical Question Search Assignment
Clinical Question Search Assignment
PICOT idea : URINARY TRACT INFECTION .
The purpose of this Assignment is to give you a practical application to implement your PICOT idea, supported by the evidence-based research you have obtained in during your systematic review. You will apply evidence-based research findings discovered from your clinical question, and then integrate those to support your suggested change in nursing practice.
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- Identify your refined PICOT question.
- Using PubMed and the Cochrane collaboration database, do a systematic review of your clinical question.
- Describe your systematic review and include an errors analysis.
- Determine an evidence-based quantitative article from the search that contains an evidence-based randomized control trial.
- Summarize the case study selected.
- Describe the study approach, sample size, and population studied.
- Apply the evidence from this review to your practice specifically in your overview.
- Evaluate the outcomes, identifying the validity and reliability.
- Discuss if the study contained any bias.
- Determine the level of evidence identified in the review.
- The length should be no less than 10 Pages in APA format.
URINARY TRACT INFECTION 1
URINARY TRACT INFECTION 7
Urinary Tract Infection
Urinary tract infections are more prevalent in women than in men since the anatomy of the female reproductive system is exposed and can contact the infection quickly than men. The urethra is very short; therefore, as it links the bladder, it makes it easy to allow bacteria to enter and cause a lot of damage. On the other hand, the urethral opening is near the anus. The anus contains a large number of E. coli bacteria which cause the urinary tract infection, therefore, making women more susceptible to the infections (Occhipinti, Germano & Maffei,2016). The anus and the vagina are close, and they can transmit the infection since many of the bacteria originate from the anus. Several factors increase the chances of getting UTI in women, such as frequent change of sex partners, menopause and birth control method that is used. UTIs are not a women disease but also affects men. Some situations lead to both men and women contracting the UTIs. They include urinary surgery, blockage of the urinary tract that is brought about by kidney stones and weak immunity of an individual. Clinical Question Search Assignment
Nurses stand a better chance to explain some of the hygienic practices that persons are required to carry out in controlling UTIs. Such practices include wiping the front to back to avoid contact of the urethral opening from being exposed to the bacteria that are in large numbers from the anus. Sexual activities can increase the chance of one getting UTIs, especially in women because the sexual reproductive organs of women are attached to the urinary tract; makes women vulnerable to the infection. Women are advised immediately after sex they should urinate so that the bacteria can be flashed off from the body. Washing of the genitalia before and after sex will also cut the risk of getting UTIs. The genitalia will be clean and reduce the chance of getting the infection spreading into the urethra. Frequent changing of partners results in the spread of the infection from one to another. Practising sexual discipline will work a great deal in controlling the UTIs.
Naturally, the vagina contains a large number of natural bacteria which are of great importance in keeping the vagina health and balance the acidity and alkalinity of the vagina. Such bacteria are lactobacilli. The strong soaps and scented products that are used by women disrupt the PH balance and allow the growth of harmful bacteria. Such instances will increase the impact of the infection since they dwell in an acidic environment which will support them in multiplication. The infection is more in women since they have an extensive urinary tract and the infecting bacteria readily gets into the body of the women. The infection is more prolific to women who don’t observe body hygiene properly, and this has been an effect that is placing women in a position that they are not able to handle situations. Men have a shorter urinary tract, and this helps men to have little complications in the tract. Additionally, the track is not open; thus, it will not be able to contact the infection. Having the tract closed helps men to have little exposure that has provided an excellent impact to survive without UTI infections.
Cranberries consumption is among the ways of preventing the urinary tract infection since the traditional medication has the proanthocyanidins. The preventive substance helps to prevent the E. coli from spreading the body tissues of the urinary tract; this will help have the best ways of having the PH of the urinary tract to be at a balance not supporting the body to have the best way of fighting back the bacteria. The cranberries have vitamins C, which mainly increases the acidity of the urine so that they can reduce the growth of the bacteria. The vitamins c will help have a balanced PH in the vagina which will be a boost of having the body to have the balance of having the bacteria backed off the body. The consumption of the cranberries will help have the best ways of having the PH of the body to a balance of neutral, thus having the basis of having all activities at balance. Despite the healing of the UTI, the medicine is a low essential product that will have the body recovering slowly and having the production of other illness that will fuel the growth of bacteria in the urinary tract. The cranberry that is required should be purely juice with a lot of sugar, and this will help to have a conducive environment that will help have the bacteria of the body (Singh, Gautam & Kaur, 2016). Eating fresh and frozen cranberries will help have the bacteria reduced in the body, and this will help have a healthy body that will ensure they have all aspects of the contents of the treatment covered in the body.
Populations such as infants, pregnant women and older women as prone to infection of the UTI. Young children who have the UTI in some cases they have structural abnormalities of the urinary system that will have the chances of having a urinary infection that will have the most attacking point of the system (Jepson, Williams & Craig, 2012). Some infants may not show signs and symptoms of the infection. Pregnant women are more prone to the UTI because of changes in hormones and production of fluids in the urinary tract that makes it to be neutral. A neutral environment favours the growth of the UTI bacteria, and this has made pregnant women be in danger of the infection. The growth of the uterus makes the bladder to have pressure, and this has resulted in having more complications in the urinary tract, which has made women have a worrying condition that will have the burning feeling. Older women have reached the stage of menopause, and they are producing little hormones and the fluids in the tract; this results in a neutral environment that favours the survival of the bacteria. Clinical Question Search Assignment
Women who use products that contain the content of the cranberry have low chances of getting urinary tract infection than those who don’t use (Fu et al.,2017). When they have the content in the body, they can fight the infection, and their tract has an acidic PH that would not allow bacteria to survive. Women who take cranberry components have high acidity in the vagina, and this helps to have a conducive environment of bacteria-free. The diagnosis of women who use cranberry derived products is less than those who don’t since they have more acidic vagina than those who don’t use the product. The dose will have little to do with the products since they already have the products in the body. The product of the cranberry products has the advantage of having an acidic vagina that will help make the bacteria to die and have little multiplication.
Cranberry derived products should be taken mostly in the morning and the evening so that they can raise the ant-adhesion in the body (Fu et al.,2017). This will help the body to have all activities that would be needed in the body so that they can have the best way of having their covering of the PH in the body. Taking the products in the evening will help the body to respond to the reactions when the body is relaxed, and this will help make advances in the level of acidity in the body. The body responds to changes quickly when it’s at a relaxed mode, and this will help boost the derived products take to work well in the body. The excellent products grams of derived cranberry are 72mg, and this will work effectively in the production of the protection and advancements of products that will help recover the PH of the body when it has lost its optimal levels (Jepson, Williams & Craig, 2012). The content below 72mg will not work effectively in the body, and this will make the PH not to be optimal in body parts that it’s needed to be high in acidity and low in basic. Through this imbalance, the situation will lead to having infections that will result in having UTI.
In America, many complications are associated with the infection that affects the urinary body tract. Persistent illness of the urinary may result to infects and other complications that may result to having the body to have abnormalities that will result to having the body to have other illness such as gonorrhoea since the body is vulnerable to infections that are associated with the body part that is affected (Matuszkiewicz-Rowińska, Małyszko & Wieliczko,2015). The body will have little fighting effort that will make it have week body protection capability of infections that are associated with the diseases that affect the body part. The high numbers of infection in America are caused by inadequate intake of cranberry derived products that would have built the body to have stable fighting off infections. Clinical Question Search Assignment
Conclusively, urinary tract infection is caused by bacteria doesn’t survive in acidic conditions; therefore, health practitioners should encourage patients to take vitamin C products that will help in raising the acidity in the urinary tract. Education of people about UTI would have a boost in the health sectors by enlightening people to have a better control measure this will help them to have a right way of containing the spread and effects that may come up with the infection. Cranberry is among the treatment that patients should take since it works effectively with many of the patients who have been treated with it. Eating cranberry derived products will be plus to protecting UTI infection, and this will help make a good boost of the body on fighting the infection. Taking anti-biotic will help make the body to adapt to the healing mechanisms that will be prescribed by a practitioner, and this will help in cleaning up the urinary tract.
Fu, Z., Liska, D., Talan, D., & Chung, M. (2017). Cranberry reduces the risk of urinary tract infection recurrence in otherwise healthy women: a systematic review and meta-analysis. The Journal of Nutrition, 147(12), 2282-2288.
Jepson, R. G., Williams, G., & Craig, J. C. (2012). Cranberries for preventing urinary tract infections. Cochrane database of systematic reviews, (10).
Matuszkiewicz-Rowińska, J., Małyszko, J., & Wieliczko, M. (2015). Urinary tract infections in pregnancy: old and new unresolved diagnostic and therapeutic problems. Archives of medical science: AMS, 11(1), 67.
Occhipinti, A., Germano, A., & Maffei, M. E. (2016). Prevention of urinary tract infection with Oximacro®, a cranberry extract with a high content of a-type proanthocyanidins: a pre-clinical double-blind controlled study. Urology Journal, 13(2), 2640-2649.
Singh, I., Gautam, L. K., & Kaur, I. R. (2016). Effect of oral cranberry extract (standardized proanthocyanidin-A) in patients with recurrent UTI by pathogenic E. coli: a randomized placebo-controlled clinical research study. International urology and nephrology, 48(9), 1379-1386.
Urinary Tract Infection
Purdue Global University
Scientific and Analysis Approaches to Advanced Evidence -Based PracticePICOT
PICOT is an acronym of the following;
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.
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
MY PICOT QUESTION
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 Question Search Assignment
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?
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
“Evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCT)” (Melnyk & Fineout-Overholt, 2019, p. 18)
“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
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. Clinical Question Search Assignment
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
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.
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. Clinical Question Search Assignment
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).
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
Cranberries for Preventing Urinary Tract Infections
The purpose of evidence-based practice is to provide the most effective, up-to-date patient care, resulting in the best patient outcomes. Nursing research involves the development of new knowledge, on a particular topic, which may then be translated into evidence-based practice. The purpose of this paper is to assess the effectiveness of cranberry derived products in the prevention of UTIs in women with recurrent UTIs. The writer developed the following PICOT question to conduct the research: In women who experience recurrent urinary tract infections (UTIs), how does the use of cranberry derived products effect the number of diagnosed urinary tract infections compared to those women who do not use cranberry derived products in a twelve month period? Clinical Question Search Assignment
Preventing Urinary Tract Infections
Urinary tract infections (UTIs) refer to the presence of a certain threshold number of bacteria in the urine (usually > 105/mL)” (Occhipinti, Germano, & Maffei, 2016). UTIs are one of the most prevalent infections requiring outpatient treatment (Jepson, Williams, & Craig, 2012). “Complications resulting from persistent and repeated infections necessitate well over one million hospital admissions annually in the U.S.” (Jepson, Williams, & Craig, 2012). Certain sub-populations are at an increased risk of developing urinary tract infections including infants, pregnant women, elderly women, and individuals with urethral catheters (Jepson, Williams, & Craig, 2012). UTIs are 50% more common in women than men (Jepson, Williams, & Craig, 2012).
Cranberry derived products (juices, syrups, tablets, capsules, etc.) have been commonly used for several years to prevent urinary tract infections. Historically, it was thought that the acid in the fruit created a bacteriostatic environment in the urine, not allowing bacteria to adhere to the bladder wall. However, recently, “a group of proanthocyanidins (PACs) with A-type linkages (PAC-A) was isolated from cranberries and shown to exhibit bacterial antiadhesion activity against both antibiotic-susceptible and -resistant strains of uropathogenic bacteria” (Occhipinti, Germano, & Maffei, 2016). “A randomized controlled trial (RCT) evaluating the dosage effect of cranberry found that to achieve a bacterial anti-adhesion effect in urine, 36 mg of cranberry PAC equivalents/d is effective, but 72 mg may offer better protection” (Jepson, Williams, & Craig, 2012). In order to keep the anti-adhesion activity high in the urinary tract, cranberry derived products should be taken both in the morning and in the evening.
When conducting research for the PICOT question, the Cochrane Library was used. The following key words were used in the search: urinary tract infection, UTI, cranberry, cranberries. The search was also limited by studies published between January 2014 to current. The search revealed 6 Cochrane reviews, of which 1 was applicable to the PICOT question of interest and 112 Cochrane trials, of which several were applicable to the PICOT question of interest. Clinical Question Search Assignment
The Cochrane review “Cranberries for preventing urinary tract infections” identified 24 studies, totaling 4473 participants, “to assess the effectiveness of cranberries in the prevention of UTIs” (Jepson, Williams, & Craig, 2012). According to the results of the review, consumption of cranberry juice does not decrease the number of symptomatic UTIs over a 12-month period (Schneeberger, Geerlings, Middleton, & Crowther, 2015). Unfortunately, these results may be due to lack of compliance with the cranberry juice regimen. “To maintain levels of cranberry PAC that are necessary to prevent anti-adhesion, people would have to continuously drink the juice twice a day in serving of 150 mL for an indefinite period of time” (Jepson, Williams, & Craig, 2012). However, cranberry derived products in the form of tablets and capsules may reduce the number of diagnosed UTIs in women who experience recurrent infections. Unfortunately, there are only 3 current studies that evaluate this regimen, none of which have enough data reported.
The double blind randomized controlled trial, “Standardized high dose versus low dose cranberry Proanthocyanidin extracts for the prevention of recurrent urinary tract infection in healthy women,” is currently being performed to “describe the side effects of daily intake of cranberry extract containing 37 mg PACs compared to 2 mg PACs (placebo)” (Asma, et al., 2018). A Systematic Review and Meta-Analysis titled, “Cranberry Reduces the Risk of Urinary Tract Infection Recurrence in Otherwise Healthy Women,” was conducted to “assess the effect of cranberry on the risk of UTI recurrence in otherwise healthy women” (Fu, Liska, Talan, & Chung, 2017). This study included 7 randomized control trials, totaling 1498 participants. The results of this study “showed that cranberry reduced the risk of UTI by 26%” (Fu, Liska, Talan, & Chung, 2017).
The purpose of the randomized placebocontrolled clinical research study, “Effect of oral cranberry extract (standardized proanthocyanidinA) in patients with recurrent UTI by pathogenic E. coli” was to “evaluate the effect of cranberry extract (PAC-A, proanthocyanidin-A) on the in vitro bacterial properties of uropathogenic (E. coli) and its efficacy/tolerability in patients with subclinical or uncomplicated recurrent UTI (r-UTI)” (Singh, Gautam, & Kaur, 2016). The results of this study concluded that cranberry derived products containing PAC-A reduced bacterial adhesion in the urinary tract.
A significant number of RCTs have been conducted to assess the effectiveness of cranberry products for preventing UTIs, particularly in its juice form” (Jepson, Williams, & Craig, 2012). The majority of these studies suggest that the benefit of cranberry juice to prevent recurrent urinary tract infections is small. However, more studies focused on cranberry products such as tablets and capsules need to be performed (Jepson, Williams, & Craig, 2012). “There is some evidence that cranberry products may reduce the incidence of UTIs compared to placebo, though the most effective amount and concentration of PACs that must be consumed and the duration for the intervention are unknown” (Asma, et al., 2018). Clinical Question Search Assignment
Asma, B., Vicky, L., Stephanie, D., Yves, D., Amy, H., & Sylvie, D. (2018). Standardised high dose versus low dose cranberry Proanthocyanidin extracts for the prevention of recurrent urinary tract infection in healthy women [PACCANN]: A double blind randomised controlled trial protocol. BMC Urology, 18(1).
Fu, Z., Liska, D., Talan, D., & Chung, M. (2017). Cranberry Reduces the Risk of Urinary Tract Infection Recurrence in Otherwise Healthy Women: A Systematic Review and Meta- Analysis. The Journal of Nutrition, 147(12), 2282-2288.
Jepson, R. G., Williams, G., & Craig, J. C. (2012). Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews, (10), 1-80.
Occhipinti, A., Germano, A., & Maffei, M. E. (2016). Prevention of urinary tract infection with oximacro, a cranberry extract with a high content of a-type proanthocyanidins: A pre- clinical double-blind controlled study. Miscellaneous, 13(2), 2640-2649.
Schneeberger, C., Geerlings, S. E., Middleton, P., & Crowther, C. A. (2015). Interventions for preventing recurrent urinary tract infection during pregnancy. Cochrane Database of Systematic Reviews, (7), 1-31.
Singh, I., Gautam, L. K., & Kaur, I. R. (2016). Effect of oral cranberry extract (standardized proanthocyanidin-A) in patients with recurrent UTI by pathogenic E. coli: A randomized placebo-controlled clinical research study. International Urology and Nephrology, 48(9), 1379-1386.