PICOT idea : URINARY TRACT INFECTION . I’M GOING TO PUT MY 2 PREVIOS ASSIGMENT WITH THE SAME PICOT QUESTION

Purpose:

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.

Directions:

1. Identify your refined PICOT question.
2. Using PubMed and the Cochrane collaboration database, do a systematic review of your clinical question.
3. Describe your systematic review and include an errors analysis.
4. Determine an evidence-based quantitative article from the search that contains an evidence-based randomized control trial.
5. Summarize the case study selected.
6. Describe the study approach, sample size, and population studied.
7. Apply the evidence from this review to your practice specifically in your overview.
8. Evaluate the outcomes, identifying the validity and reliability.
9. Discuss if the study contained any bias.
10. Determine the level of evidence identified in the review.
11. The length should be no less than 10 Pages in APA format. 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?

     

    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.

     

    Cochrane Library

     

    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.

    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.

    Conclusion

    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).

     

     

     

     

     

     

     

     

     

     

     

    References

    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.

Assessment 1 Instructions: Health Promotion Plan

• Develop a hypothetical health promotion plan, 2–3 pages in length, addressing a specific health concern for an individual or a group living in the community that you identified from the topic list provided. A hypothetical nonprofit group is highly recommended.
  • Bullying.
  • Home safety.
  • Fall prevention.
  • Immunizations.
  • Tobacco use (vaping, e-cigarettes, hookah, chewing tobacco, or smoking) cessation.
  • All assignments in the course are based upon hypothetical individuals or groups.
    For this assignment, you will plan for and enlist the participation of a hypothetical individual or group in a clinical learning activity based on a health promotion plan, addressing a particular health concern affecting these members of your community.
    Professional Context
    The first step in any effective project or clinical patient encounter is planning. This assessment provides an opportunity for you to plan a clinical learning experience focused on health promotion associated with a specific community health concern. Such a plan defines the critical elements of who, what, when, where, and why that establish the foundation for an effective clinical learning experience for the participants. Completing this assessment will strengthen your understanding of how to plan and negotiate individual or group participation.
    Demonstration of Proficiency
    By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
  • Competency 1: Analyze health risks and health care needs among distinct populations.
    • Analyze a community health concern that is the focus of a health promotion plan.
  • Competency 2: Propose health promotion strategies to improve the health of populations.
    • Explain why a health concern is important for health promotion within a specific population.
    • Establish agreed-upon health goals in collaboration with participants.
  • Competency 5: Apply professional, scholarly communication strategies to lead health promotion and improve population health.
    • Write clearly and concisely in a logically coherent and appropriate form and style.
  • Note: Assessment 1 must be completed first before you are able to submit Assessment 4.
    Preparation
    The first step in any effective project or clinical patient encounter is planning. This assessment provides an opportunity for you to plan a hypothetical clinical learning experience focused on health promotion associated with a specific community health concern. Such a plan defines the critical elements of who, what, when, where, and why that establish the foundation for an effective clinical learning experience for the participants. Completing this assessment will strengthen your understanding of how to plan and negotiate individual or group participation.
    You will need to satisfactorily pass Assessment 1 (Health Promotion Plan) before working on your last assignment (Assessment 4).
    To prepare for the assessment, consider various health concerns that you would like to be the focus of your plan from the topic list provided, the populations potentially affected by that concern, and hypothetical individuals or groups living in the community. Then, investigate your chosen concern and best practices for health improvement, based on supporting evidence.
    As you begin to prepare this assessment, you are encouraged to complete the Vila Health: Effective Interpersonal Communications activity. The information gained from completing this activity will help you succeed with the assessment. Completing activities is also a way to demonstrate engagement.
    Please choose one of the topics below:
  • Bullying.
  • Home safety.
  • Fall prevention.
  • Immunizations.
  • Tobacco use (vaping, e-cigarettes, hookah, chewing tobacco, or smoking) cessation.
  • In addition, you are encouraged to:
  • Complete the Vila Health: Effective Interpersonal Communications simulation.
  • Review the health promotion plan assessment and scoring guide to ensure that you understand the work you will be asked to complete.
  • Review the MacLeod article, “Making SMART Goals Smarter.”
  • Note: Remember that you can submit all, or a portion of, your draft assessment to Smarthinking Tutoring for feedback before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.
    Instructions
    Health Promotion Plan
  • Choose a one of these specific health concern as the focus of your health promotion plan.
    • Bullying.
    • Home safety.
    • Fall prevention.
    • Immunizations.
    • Tobacco use (vaping, e-cigarettes, hookah, chewing tobacco, or smoking) cessation.
  • Then, investigate your chosen concern and best practices for health improvement, based on supporting evidence.
  • Identify populations potentially affected by this health concern. Determine what their related concerns may be and explain why addressing this health concern is important for health promotion.
  • Identify a hypothetical individual or community group among the affected population who would benefit from an educational session about your chosen health concern and associated health improvement strategies.
  • Identify expectations for an educational session, determining goals, and suggestions on how the individual or group needs can be met. The hypothetical audience needs to be described and the educational plan should be outlined. Health goals need to be clear, measurable, and appropriate for this activity.
  • Then, research and document their potential learning needs and health promotion goals.
  • Document Format and Length
    Your health promotion plan should be 2–3 pages in length.
    Supporting Evidence
    Support your health promotion plan with peer-reviewed articles, course study resources, and Healthy People 2020 resources. Cite at least three credible sources published within the past five years, using APA format.
    Graded Requirements
    The requirements outlined below correspond to the grading criteria in the scoring guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed.
  • Analyze the health concern that is the focus of your health promotion plan.
    • Consider underlying assumptions and points of uncertainty in your analysis.
  • Explain why a health concern is important for health promotion within a specific population.
    • Examine current population health data.
    • Consider the factors that contribute to health, health disparities, and access to services.
  • Explain the importance of establishing agreed-upon health goals in collaboration with hypothetical participants.
  • Write clearly and concisely in a logically coherent and appropriate form and style.
    • Write with a specific purpose and audience in mind.
    • Adhere to scholarly and disciplinary writing standards and APA formatting requirements.
  • Before submitting your assessment for grading, proofread it to minimize errors that could distract readers and make it difficult for them to focus on the substance of your plan.
    Portfolio Prompt: Remember to save the assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.