DNP-820 Implementation Into Practice

Grand Canyon University DNP-820 Implementation Into Practice – Step-By-Step Guide

This guide will demonstrate how to complete the Grand Canyon University DNP-820 Implementation Into Practice assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for DNP-820 Implementation Into Practice

Whether one passes or fails an academic assignment such as the Grand Canyon University NUR 550 Benchmark – Evidence-Based Practice Project: Literature Review depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for DNP-820 Implementation Into Practice

The introduction for the Grand Canyon University DNP-820 Implementation Into Practice is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

Need a high-quality paper urgently?

We can deliver within hours.

PLACE AN ORDER

How to Write the Body for DNP-820 Implementation Into Practice

After the introduction, move into the main part of the DNP-820 Implementation Into Practice assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for DNP-820 Implementation Into Practice

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for DNP-820 Implementation Into Practice

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

Stuck? Let Us Help You

Completing assignments can sometimes be overwhelming, especially with the multitude of academic and personal responsibilities you may have. If you find yourself stuck or unsure at any point in the process, don’t hesitate to reach out for professional assistance. Our assignment writing services are designed to help you achieve your academic goals with ease.

Our team of experienced writers is well-versed in academic writing and familiar with the specific requirements of the DNP-820 Implementation Into Practice assignment. We can provide you with personalized support, ensuring your assignment is well-researched, properly formatted, and thoroughly edited. Get a feel of the quality we guarantee – ORDER NOW.

Sample Answer for DNP-820 Implementation Into Practice

Regardless of their sizes, missions, and health care programs, health care facilities have a professional mandate to provide timely, safe, and quality care. The standard obligation requires health care facilities to apply multi-dimensional interventions to address patient needs. Research translation into clinical practice promotes evidence-based care and is instrumental in reducing adverse health outcomes through creative problem-solving (Wensing & Grol, 2019). Its significance obliges health care practitioners and organizational leaders to implement programs that reduce gaps between research findings and clinical practice. Accordingly, health care facilities should be open to change and support evidence-based practice (EBP) adequately. The purpose of this paper is to discuss a topic where a gap exists between research findings and their implementation into practice.

Topic, Supporting Research, and Desired Outcomes

The Agency for Healthcare Research and Quality (AHRQ) explores many health topics relevant to current nursing practice. A topic related to the direct practice improvement (DPI) project is hospital readmissions, represented as a priority for payers, providers, and policymakers striving to improve health outcomes and reduce costs (AHRQ, n.d.). Hospital readmissions connect with the DPI project since their occurrence hampers care quality in the practicum site. Besides, pressure ulcers are a leading cause of hospital readmissions, hospitalizations, and high costs (Wassel et al., 2020). Accordingly, any significant rise in pressure ulcers leads to a proportional increment in hospital readmissions, reducing care quality.

Hospital readmissions adversely affect health outcomes and require evidence-based, sustainable, and relevant solutions. Recent health data shows that over $52.4 billion is spent annually on readmitted patients (Beauvais et al., 2022). Unless health care organizations implement lasting programs, the cost will increase as time advances. Upadhyay et al. (2019) noted that readmission penalties exceed over half a billion dollars annually. Such penalties are detrimental to the growth of organizations and their ability to sustain safe and quality care. Furthermore, crucial aspects of quality sustainability, like organizational reputation and partnerships, become dysfunctional when readmission rates are high in hospitals. Patient-provider relationships are also broken due to reduced patients’ trust in health care professionals.

ALSO READ:

DNP-820 Literature Synthesis for Proposed Intervention

DNP-820 Reflective Journal

Pressure ulcers increase the risk of readmissions, and their prevention should be a priority for all hospitals. Research translation into practice implies implementing interventions supported by scientific evidence. Veith et al. (2019) emphasized high attention to wound care, patient education, and modifying risk factors to prevent pressure ulcers. Wound care strategies include preventive dressing, patient repositioning, and wound cleaning for the admitted patients. These strategies are among the core components of a preventive pressure bundle that is highly effective in reducing the incidence of pressure ulcers in critical care settings (Darvall et al., 2018; Hahnel et al., 2020). Implementing such a bundle would be pivotal in reducing readmission rates in the current setting.

Health care professionals implement research into clinical practice to improve health outcomes. The primary goal of implementing research on wound care is to reduce pressure ulcers which will lead to a proportional reduction in hospital readmissions. Reducing readmissions will reduce health care costs and improve the organization’s ability to invest in quality care programs. As Rasiah et al. (2020) mentioned, patients’ trust in health care professionals depends on the care quality and health care experiences. Consequently, implementing a care bundle and other wound care programs will improve patient-provider relationships and patients’ trust in health care professionals. High hospital readmissions hamper organizational reputation (Upadhyay et al., 2019). Implementing research will improve the organization’s reputation and accelerate its growth.

The Extent of Research Implementation

Organizations implement different wound care practices depending on the patients’ type and severity of health conditions. As an established health care institution, ProMedica Skilled Nursing and Rehabilitation (Wheaton) has invested in numerous programs to optimize patient outcomes. They include patient education, telehealth, follow-up care, and testing new treatments and care models (ProMedica, 2021). Despite these programs, the facility primarily relies on routine pressure ulcer prevention care. Overreliance on this care program depicts a huge gap between research findings and implementation into practice, and substantive improvement is essential. More evidence-based interventions should be implemented to reduce the incidence of pressure ulcers among high-risk groups such as the elderly and debilitated patients. Their implementation will reduce the incidence of pressure ulcers and associated adverse outcomes, including hospital readmissions, mortality, and hospitalization.

Possible Barriers to Implementation

Research translation faces multiple barriers depending on the intensity of work required, resources, and the project’s type. Potential barriers to implementing a preventive bundle to prevent pressure ulcers and hospital readmission in the facility include resource facilitation, availability of implementation team members, and patients’ reluctance to participate in the project. Resource inadequacy is a significant barrier since effective research implementation of a care bundle for pressure ulcers requires technologies like patient monitors and alert systems to optimize patient turns. Research also recommends silicone dressing as the most effective preventive dressing for wound care for pressure ulcers (Hahnel et al., 2020). Combining such resources makes the project expensive and inconvenient for timely implementation. The implementation requires teamwork, where the change leader works together with organizational leaders and support nursing staff. However, the intensity of nursing care in the facility would affect their availability and successful research implementation.

Possible Ways to Overcome the Barriers

Success in research translation depends on how change implementers overcome present and emerging barriers. A suitable strategy to overcome the identified barriers is stakeholder engagement. As Haynes et al. (2018) underlined, active stakeholder engagement is crucial to successful change since it influences them positively to support change. The engagement process involves providing stakeholders with adequate information about the research translation and its potential benefits while engaging them throughout the implementation. The other potential intervention is implementing the affordable components of a preventive bundle. For instance, patient repositioning and optimizing turns are affordable and would improve outcomes. Importantly, intensive patient education is crucial to improve health literacy, increase patients’ confidence in the project, and ensure participation and compliance.

Resources Available on the Site

As a modern facility and an affiliate of the extensive ProMedica Health System, ProMedica Skilled Nursing and Rehabilitation (Wheaton) has multiple resources vital in informing the transition from research into practice. They include an equipped health workforce, modality-based equipment, comfortable surroundings, and essentials like the internet (ProMedica Health System, 2022). An equipped and educated health workforce is open to change and readily supports research translation into practice to achieve positive change. Modern equipment and comfortable surroundings are also vital in successful research translation to ensure that research subjects are protected from harm and are comfortable with the process.

Conclusion

Health care facilities should be committed to continuous quality improvement. Such a commitment necessitates continuous research translation into practice and progressive outcomes assessment. Although ProMedica Skilled Nursing and Rehabilitation (Wheaton) has invested in massive programs to improve care quality, more interventions are needed to reduce hospital readmissions. Reducing pressure ulcers will be instrumental in achieving this goal hence implementing research on interventions for pressure ulcer prevention like wound care, patient education, and risk assessment.

References

AHRQ. (n.d.) Hospital readmissions. https://www.ahrq.gov/topics/hospital-readmissions.html

Beauvais, B., Whitaker, Z., Kim, F., & Anderson, B. (2022). Is the hospital value-based purchasing program associated with reduced hospital readmissions?. Journal of Multidisciplinary Healthcare, 15, 1089–1099. https://doi.org/10.2147/JMDH.S358733

Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries. Critical Care and Resuscitation, 20(3), 217-222. https://europepmc.org/article/med/30153784

Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621

Haynes, S. C., Rudov, L., Nauman, E., Hendryx, L., Angove, R. S., & Carton, T. (2018). Engaging stakeholders to develop a patient-centered research agenda: Lessons learned from the research action for health network (REACHnet). Medical Care, 56(10 Suppl 1), S27-S32. doi: 10.1097/MLR.0000000000000785

ProMedica. (2021). Your health. Our mission. https://www.promedica.org/redefining-healthcare/#

ProMedica Health System. (2022). ProMedica Skilled Nursing and Rehabilitation. https://www.promedicaskillednursing.org/locations/promedica-skilled-nursing-and-rehabilitation-wheaton/?contentIdString=14063

Rasiah, S., Jaafar, S., Yusof, S., Ponnudurai, G., Chung, K. P. Y., & Amirthalingam, S. D. (2020). A study of the nature and level of trust between patients and healthcare providers, its dimensions and determinants: A scoping review protocol. BMJ Open, 10(1), e028061. http://dx.doi.org/10.1136/bmjopen-2018-028061

Upadhyay, S., Stephenson, A. L., & Smith, D. G. (2019). Readmission rates and their impact on hospital financial performance: A study of Washington Hospitals. Inquiry: A Journal of Medical Care Organization, Provision and Financing, 56, 46958019860386. https://doi.org/10.1177/0046958019860386

Veith, J. P., Collier, W., Kim, J., Agarwal, J., & Kwok, A. (2019). A national analysis of readmissions for wound healing complications following the repair of lower back, hip, and buttock pressure ulcers using the Nationwide Readmissions Database. The American Journal of Surgery, 217(4), 658-663. https://doi.org/10.1016/j.amjsurg.2018.12.013

Wassel, C. L., Delhougne, G., Gayle, J. A., Dreyfus, J., & Larson, B. (2020). Risk of readmissions, mortality, and hospital‐acquired conditions across hospital‐acquired pressure injury (HAPI) stages in a US National Hospital Discharge database. International Wound Journal, 17(6), 1924-1934. https://doi.org/10.1111/iwj.13482

Wensing, M., & Grol, R. (2019). Knowledge translation in health: How implementation science could contribute more. BMC Medicine, 17(1), 1-6. https://doi.org/10.1186/s12916-019-1322-9

DNP 820 Week 4 Introduction to the Literature Review Assignment FINAL

DNP 820 Week 4: Introduction to the Literature Review Assignment

Part 1: Selection of 15 Articles

Empirical Research Checklist

Article 1: Ghouri, F., Hollywood, A., & Ryan, K. (2018). A systematic review of non-antibiotic measures for the prevention of urinary tract infections in pregnancy. BMC pregnancy and childbirth, 18(1), 99. DOI: 10.1186/s12884-018-1732-2.

Section	Defining Characteristic	Contained in Article	Not Contained in Article
Abstract	An abstract of the contents is provided.	Yes
Introduction	The purpose of the study is stated.	Yes
	The scope of the study is stated.	Yes
	A rationale for the study is provided.	Yes
	The hypothesis or research question is stated.		Yes
	Key concepts and terms are noted.	Yes
	A review of the literature is provided.	Yes
Methods	A description of the population sample is provided.	Yes
	The data collection procedure is presented.	Yes
	Other procedures to be used are described.	Yes
Results	A narrative statement of the findings is given.	Yes
	A description of the data collected is given.	Yes
	Findings are supported by graphs and charts.	Yes
	The analysis of the data is explained.	Yes
Conclusion	A summary of the study is provided.	Yes
	Conclusions related to the hypothesis are stated.	Yes
	Questions for future research are presented.	Yes
References	References used in the study are presented.	Yes

Article 2: García-Larrosa, A., & Alexe, O. (2016). Efficacy and Safety of a Medical Device versus Placebo in the Early Treatment of Patients with Symptoms of Urinary Tract Infection: A Randomized Controlled Trial. Clin Microbiol 5: 233. doi: 10.4172/2327-5073.1000233 Page 2 of 5 Clin Microbiol ISSN: 2327-5073 CMO, an open access journal Volume 5• Issue 1• 1000233. Figure, 1, 3. DOI: 10.4172/2327-5073.1000233.

Section	Defining Characteristic	Contained in Article	Not Contained in Article
Abstract	An abstract of the contents is provided.	Yes
Introduction	The purpose of the study is stated.	Yes
	The scope of the study is stated.	Yes
	A rationale for the study is provided.	Yes
	The hypothesis or research question is stated.	Yes
	Key concepts and terms are noted.	Yes
	A review of the literature is provided.		Yes
Methods	A description of the population sample is provided.	Yes
	The data collection procedure is presented.	Yes
	Other procedures to be used are described.		Yes
Results	A narrative statement of the findings is given.	Yes
	A description of the data collected is given.	Yes
	Findings are supported by graphs and charts.		Yes
	The analysis of the data is explained.	Yes
Conclusion	A summary of the study is provided.	Yes
	Conclusions related to the hypothesis are stated.	Yes
	Questions for future research are presented.	Yes
References	References used in the study are presented.	Yes

Article 3: Bosmans, J. E., Beerepoot, M. A., Prins, J. M., ter Riet, G., & Geerlings, S. E. (2014). Cost-effectiveness of cranberries vs antibiotics to prevent urinary tract infections in premenopausal women: a randomized clinical trial. PloS one, 9(4), e91939. DOI: 10.1371/journal.pone.0091939.

Section	Defining Characteristic	Contained in Article	Not Contained in Article
Abstract	An abstract of the contents is provided.	Yes
Introduction	The purpose of the study is stated.	Yes
	The scope of the study is stated.	Yes
	A rationale for the study is provided.	Yes
	The hypothesis or research question is stated.	Yes
	Key concepts and terms are noted.	Yes
	A review of the literature is provided.	Yes
Methods	A description of the population sample is provided.	Yes
	The data collection procedure is presented.	Yes
	Other procedures to be used are described.	Yes
Results	A narrative statement of the findings is given.	Yes
	A description of the data collected is given.	Yes
	Findings are supported by graphs and charts.		Yes
	The analysis of the data is explained.	Yes
Conclusion	A summary of the study is provided.	Yes
	Conclusions related to the hypothesis are stated.	Yes
	Questions for future research are presented.	Yes
References	References used in the study are presented.	Yes

Article 4: Kronenberg, A., Bütikofer, L., Odutayo, A., Mühlemann, K., da Costa, B. R., Battaglia, M., … & Jüni, P. (2017). Symptomatic treatment of uncomplicated lower urinary tract infections in the ambulatory setting: randomised, double blind trial. bmj, 359, j4784. DOI: 10.1136/bmj.j4784.

Section	Defining Characteristic	Contained in Article	Not Contained in Article
Abstract	An abstract of the contents is provided.	Yes
Introduction	The purpose of the study is stated.	Yes
	The scope of the study is stated.	Yes
	A rationale for the study is provided.	Yes
	The hypothesis or research question is stated.	Yes
	Key concepts and terms are noted.		Yes
	A review of the literature is provided.	Yes
Methods	A description of the population sample is provided.	Yes
	The data collection procedure is presented.	Yes
	Other procedures to be used are described.		Yes
Results	A narrative statement of the findings is given.	Yes
	A description of the data collected is given.	Yes
	Findings are supported by graphs and charts.	Yes
	The analysis of the data is explained.	Yes
Conclusion	A summary of the study is provided.	Yes
	Conclusions related to the hypothesis are stated.	Yes
	Questions for future research are presented.	Yes
References	References used in the study are presented.	Yes

Article 5: Beerepoot, M., & Geerlings, S. (2016). Non-antibiotic prophylaxis for urinary tract infections. Pathogens, 5(2), 36. DOI: 10.3390/pathogens5020036.

Section	Defining Characteristic	Contained in Article	Not Contained in Article
Abstract	An abstract of the contents is provided.	Yes
Introduction	The purpose of the study is stated.	Yes
	The scope of the study is stated.	Yes
	A rationale for the study is provided.	Yes
	The hypothesis or research question is stated.	Yes
	Key concepts and terms are noted.	Yes
	A review of the literature is provided.	Yes
Methods	A description of the population sample is provided.	Yes
	The data collection procedure is presented.	Yes
	Other procedures to be used are described.		Yes
Results	A narrative statement of the findings is given.	Yes
	A description of the data collected is given.	Yes
	Findings are supported by graphs and charts.	Yes
	The analysis of the data is explained.	Yes
Conclusion	A summary of the study is provided.	Yes
	Conclusions related to the hypothesis are stated.	Yes
	Questions for future research are presented.	Yes
References	References used in the study are presented.	Yes

Article 6: Geerlings, S. E., Beerepoot, M. A., & Prins, J. M. (2014). Prevention of recurrent urinary tract infections in women: antimicrobial and nonantimicrobial strategies. Infectious Disease Clinics, 28(1), 135-147. DOI: 10.1016/j.idc.2013.10.001.

Section	Defining Characteristic	Contained in Article	Not Contained in Article
Abstract	An abstract of the contents is provided.	Yes
Introduction	The purpose of the study is stated.	Yes
	The scope of the study is stated.	Yes
	A rationale for the study is provided.	Yes
	The hypothesis or research question is stated.		Yes
	Key concepts and terms are noted.	Yes
	A review of the literature is provided.		Yes
Methods	A description of the population sample is provided.	Yes
	The data collection procedure is presented.	Yes
	Other procedures to be used are described.	Yes
Results	A narrative statement of the findings is given.	Yes
	A description of the data collected is given.	Yes
	Findings are supported by graphs and charts.		Yes
	The analysis of the data is explained.	Yes
Conclusion	A summary of the study is provided.	Yes
	Conclusions related to the hypothesis are stated.	Yes
	Questions for future research are presented.	Yes
References	References used in the study are presented.	Yes

Article 7: Costantini, E., Giannitsas, K., & Illiano, E. (2017). The role of nonantibiotic treatment of community-acquired urinary tract infections. Current opinion in urology, 27(2), 120-126. DOI: 10.1097/MOU.0000000000000366.

Section	Defining Characteristic	Contained in Article	Not Contained in Article
Abstract	An abstract of the contents is provided.	Yes
Introduction	The purpose of the study is stated.	Yes
	The scope of the study is stated.	Yes
	A rationale for the study is provided.	Yes
	The hypothesis or research question is stated.		Yes
	Key concepts and terms are noted.	Yes
	A review of the literature is provided.	Yes
Methods	A description of the population sample is provided.	Yes
	The data collection procedure is presented.	Yes
	Other procedures to be used are described.	Yes
Results	A narrative statement of the findings is given.	Yes
	A description of the data collected is given.	Yes
	Findings are supported by graphs and charts.		Yes
	The analysis of the data is explained.	Yes
Conclusion	A summary of the study is provided.	Yes
	Conclusions related to the hypothesis are stated.	Yes
	Questions for future research are presented.	Yes
References	References used in the study are presented.	Yes

Article 8: Luís, Â., Domingues, F., & Pereira, L. (2017). Can cranberries contribute to reduce the incidence of urinary tract infections? A systematic review with meta-analysis and trial sequential analysis of clinical trials. The Journal of urology, 198(3), 614-621. DOI: 10.1016/j.juro.2017.03.078.

Section	Defining Characteristic	Contained in Article	Not Contained in Article
Abstract	An abstract of the contents is provided.	Yes
Introduction	The purpose of the study is stated.	Yes
	The scope of the study is stated.	Yes
	A rationale for the study is provided.	Yes
	The hypothesis or research question is stated.	Yes
	Key concepts and terms are noted.	Yes
	A review of the literature is provided.		Yes
Methods	A description of the population sample is provided.	Yes
	The data collection procedure is presented.	Yes
	Other procedures to be used are described.	Yes
Results	A narrative statement of the findings is given.	Yes
	A description of the data collected is given.	Yes
	Findings are supported by graphs and charts.	Yes
	The analysis of the data is explained.	Yes
Conclusion	A summary of the study is provided.	Yes
	Conclusions related to the hypothesis are stated.	Yes
	Questions for future research are presented.	Yes
References	References used in the study are presented.	Yes

Article 9: Kim, K. H. (2014). Non-Antibiotic Prophylaxis for Recurrent Urinary Tract Infections. The Korean Journal of Urogenital Tract Infection and Inflammation, 9(1), 9-13. DOI: 10.14777/kjutii.2014.9.1.9.

Section	Defining Characteristic	Contained in Article	Not Contained in Article
Abstract	An abstract of the contents is provided.	Yes
Introduction	The purpose of the study is stated.	Yes
	The scope of the study is stated.	Yes
	A rationale for the study is provided.	Yes
	The hypothesis or research question is stated.		Yes
	Key concepts and terms are noted.		Ye
	A review of the literature is provided.	Yes
Methods	A description of the population sample is provided.	Yes
	The data collection procedure is presented.	Yes
	Other procedures to be used are described.
Results	A narrative statement of the findings is given.	Yes
	A description of the data collected is given.	Yes
	Findings are supported by graphs and charts.		Yes
	The analysis of the data is explained.	Yes
Conclusion	A summary of the study is provided.	Yes
	Conclusions related to the hypothesis are stated.	Yes
	Questions for future research are presented.	Yes
References	References used in the study are presented.	Yes

Article 10: 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. DOI: 10.1029.uj/article/view/3190.

Section	Defining Characteristic	Contained in Article	Not Contained in Article
Abstract	An abstract of the contents is provided.	Yes
Introduction	The purpose of the study is stated.	Yes
	The scope of the study is stated.	Yes
	A rationale for the study is provided.	Yes
	The hypothesis or research question is stated.	Yes
	Key concepts and terms are noted.	Yes
	A review of the literature is provided.	Yes
Methods	A description of the population sample is provided.	Yes
	The data collection procedure is presented.	Yes
	Other procedures to be used are described.	Yes
Results	A narrative statement of the findings is given.	Yes
	A description of the data collected is given.	Yes
	Findings are supported by graphs and charts.	Yes
	The analysis of the data is explained.	Yes
Conclusion	A summary of the study is provided.	Yes
	Conclusions related to the hypothesis are stated.	Yes
	Questions for future research are presented.		Yes
References	References used in the study are presented.	Yes

Article 11: Gágyor, I., Bleidorn, J., Kochen, M. M., Schmiemann, G., Wegscheider, K., & Hummers-Pradier, E. (2015). Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomized controlled trial. bmj, 351, h6544. DOI: 10.1136/bmj.h6544.

Section	Defining Characteristic	Contained in Article	Not Contained in Article
Abstract	An abstract of the contents is provided.	Yes
Introduction	The purpose of the study is stated.	Yes
	The scope of the study is stated.	Yes
	A rationale for the study is provided.	Yes
	The hypothesis or research question is stated.	Yes
	Key concepts and terms are noted.	Yes
	A review of the literature is provided.	Yes
Methods	A description of the population sample is provided.	Yes
	The data collection procedure is presented.	Yes
	Other procedures to be used are described.		Yes
Results	A narrative statement of the findings is given.	Yes
	A description of the data collected is given.	Yes
	Findings are supported by graphs and charts.	Yes
	The analysis of the data is explained.	Yes
Conclusion	A summary of the study is provided.	Yes
	Conclusions related to the hypothesis are stated.	Yes
	Questions for future research are presented.	Yes
References	References used in the study are presented.	Yes

Article 12: Behzadi, P. (2018). Introductory Chapter: An Overview on Urinary Tract Infections, Pathogens, and Risk Factors. In Microbiology of Urinary Tract Infections: Microbial Agents and Predisposing Factors. IntechOpen. DOI: 10.5772/intechopen.82230.

Section	Defining Characteristic	Contained in Article	Not Contained in Article
Abstract	An abstract of the contents is provided.		Yes
Introduction	The purpose of the study is stated.	Yes
	The scope of the study is stated.	Yes
	A rationale for the study is provided.		Yes
	The hypothesis or research question is stated.		Yes
	Key concepts and terms are noted.	Yes
	A review of the literature is provided.		Yes
Methods	A description of the population sample is provided.		Yes
	The data collection procedure is presented.		Yes
	Other procedures to be used are described.		Yes
Results	A narrative statement of the findings is given.		Yes
	A description of the data collected is given.		Yes
	Findings are supported by graphs and charts.		Yes
	The analysis of the data is explained.		Yes
Conclusion	A summary of the study is provided.	Yes
	Conclusions related to the hypothesis are stated.	Yes
	Questions for future research are presented.	Yes
References	References used in the study are presented.	Yes

Article 13: Liska, D., Derrig, L., & Mah, E. (2018). Urinary Tract Infection: Should Cranberry and Probiotics Be Considered?. Nutrition Today, 53(5), 207-212. DOI: 10.1097/NT.0000000000000297.

Section	Defining Characteristic	Contained in Article	Not Contained in Article
Abstract	An abstract of the contents is provided.	Yes
Introduction	The purpose of the study is stated.	Yes
	The scope of the study is stated.	Yes
	A rationale for the study is provided.	Yes
	The hypothesis or research question is stated.		Yes
	Key concepts and terms are noted.		Yes
	A review of the literature is provided.	Yes
Methods	A description of the population sample is provided.	Yes
	The data collection procedure is presented.	Yes
	Other procedures to be used are described.		Yes
Results	A narrative statement of the findings is given.	Yes
	A description of the data collected is given.	Yes
	Findings are supported by graphs and charts.	Yes
	The analysis of the data is explained.	Yes
Conclusion	A summary of the study is provided.	Yes
	Conclusions related to the hypothesis are stated.	Yes
	Questions for future research are presented.		Yes
References	References used in the study are presented.	Yes

Article 14: Ng, Q. X., Peters, C., Venkatanarayanan, N., Goh, Y. Y., Ho, C. Y. X., & Yeo, W. S. (2018). Use of Lactobacillus spp. to prevent recurrent urinary tract infections in females. Medical hypotheses, 114, 49-54. DOI: 10.1016/j.mehy.2018.03.001.

Section	Defining Characteristic	Contained in Article	Not Contained in Article
Abstract	An abstract of the contents is provided.	Yes
Introduction	The purpose of the study is stated.	Yes
	The scope of the study is stated.	Yes
	A rationale for the study is provided.	Yes
	The hypothesis or research question is stated.	Yes
	Key concepts and terms are noted.	Yes
	A review of the literature is provided.	Yes
Methods	A description of the population sample is provided.	Yes
	The data collection procedure is presented.	Yes
	Other procedures to be used are described.	Yes
Results	A narrative statement of the findings is given.	Yes
	A description of the data collected is given.	Yes
	Findings are supported by graphs and charts.		Yes
	The analysis of the data is explained.	Yes
Conclusion	A summary of the study is provided.	Yes
	Conclusions related to the hypothesis are stated.	Yes
	Questions for future research are presented.	Yes
References	References used in the study are presented.	Yes

Article 15: Toh, S. L., Boswell‐Ruys, C. L., Lee, B. S. B., Simpson, J. M., & Clezy, K. R. (2017). Probiotics for preventing urinary tract infection in people with neuropathic bladder. Cochrane Database of Systematic Reviews, (9). DOI: 10.1002/14651858.CD.010723.pub2.

Section	Defining Characteristic	Contained in Article	Not Contained in Article
Abstract	An abstract of the contents is provided.	Yes
Introduction	The purpose of the study is stated.	Yes
	The scope of the study is stated.	Yes
	A rationale for the study is provided.	Yes
	The hypothesis or research question is stated.	Yes
	Key concepts and terms are noted.		Yes
	A review of the literature is provided.	Yes
Methods	A description of the population sample is provided.	Yes
	The data collection procedure is presented.	Yes
	Other procedures to be used are described.		Yes
Results	A narrative statement of the findings is given.	Yes
	A description of the data collected is given.	Yes
	Findings are supported by graphs and charts.		Yes
	The analysis of the data is explained.	Yes
Conclusion	A summary of the study is provided.	Yes
	Conclusions related to the hypothesis are stated.	Yes
	Questions for future research are presented.	Yes
References	References used in the study are presented.	Yes

Part 2: Research Article Chart

Criteria and Defining Characteristics

Article 1: Ghouri, Hollywood & Ryan, K. (2018).

Article 2: García-Larrosa & Alexe, (2016).

Article 3: Bosmans et al., (2014).

Article 4: Kronenberg et al., (2017).

Article 5: Beerepoot & Geerlings, (2016).

Article 6: Geerlings, Beerepoot & Prins, (2014).

Article 7: Costantini, Giannitsas & Illiano, (2017).

Article 8: Luís, Domingues & Pereira, (2017).

Article 9: Kim, (2014).

Article 10: Occhipinti, German & Maffei, (2016).

Article 11: Gágyor et al., (2015).

Article 12: Behzadi, (2018).

Article 13: Liska, Derrig& Mah, (2018).

Article 14: Ng et al., (2018).

Article 15: Toh et al., (2017).

Abstract

After reading the abstract what do you expect to learn from the article?

Potential measures to prevent UTI in pregnant women.

The use of hibiscus and propolis in treating urinary tract infection.

Application of non-antibiotic agents in the management of UTIs.

To understand how to reduce antibiotic use in ambulatory care for patients with UTI.

Gain knowledge on how the use of cranberry juice is effective in treating UTIs.

Non-antimicrobial strategies using cranberries and lactobacilli to treat UTI.

To develop insights into the non-antibiotic treatments of UTIs.

To identify the mechanism for the use of cranberry juice for the management of UTI.

How to analyze the overall use of non-antibiotic methods for prevention of recurrent UTI.

To be able to understand how cranberry extracts have been used for long term management of UTI.

Provide understanding on how the treatment of complicated symptoms of UTI with ibuprofen can reduce the rate of antibiotic prescription.

No abstract

To acquire knowledge on multidrug resistance uropathogens in the prevention of UTI.

Develop insights on how probiotic lactobacilli strains are able to prevent recurrent urinary tract infections.

Utilize effective methods using probiotics to prevent UTI in people with spinal cord injury (SCI).

Introduction: Summarize the following in paragraph form.

What is the purpose of the study?

What is the scope of the study?

What is the rational for the study?

What is the hypothesis or research question?

What key concepts and terms are noted?

Is a review of the literature provided?

The safety and efficacy of non-antibiotic measures in managing UTI.

Antibiotic use is associated with increased microbial resistance of UTI. Rationale of the study is to minimize antibiotic use for prevention of UTI.

No hypothesis or research question. Terms noted, UTIs, non-antimicrobial measures, pregnancy. Yes, literature review provided.

To analyze the efficacy and safety of hibiscus and propolis (RGHP) in the early treatment of UTI

To evaluate the cost-effectiveness of cranberry prophylaxis compared to antibiotic prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) over a 12 month period in premenopausal women with recurrent UTIs.

To investigate how the treatment of symptoms of UTI using NSAIDs is non-inferior to antibiotics in the treatment of uncomplicated lower UTI in women in order to reduce antibiotic use in ambulatory care.

Increasing antimicrobial resistance has stimulated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (UTIs). Well-known steps in the pathogenesis of UTIs are urogenital colonization and adherence of uropathogens to uroepithelial cell receptors. To prevent colonization in postmenopausal women, vaginal, but not oral, estrogens have been shown to restore the vagina lactobacilli flora, reduce vaginal colonization with Enterobacteriaceae, and reduce the number of UTIs compared to placebo.

To identify ways in which non-antimicrobial strategies can be used to treat UTI.

To summarize evidence on the efficacy of nonantibiotic treatments in the prevention of recurrent urinary tract infections (UTIs). The need for antibiotic-free regimens seems to be imperative given the worldwide rates of resistance of uropathogens to available antibiotics.

We sought to clarify the association between cranberry intake and the prevention of urinary tract infections.

To discuss the effectiveness of non-antibiotic methods for the prevention of recurrent UTIs.

Urinary tract infections (UTIs) are widespread and affect a large portion of the human population. Cranberry juices and extracts have been used for UTI prevention due to their content of bioactive proanthocyanidins (PACs), particularly of the A type (PAC-A). Controversial clinical results obtained with cranberry are often due to a lack of precise determination and authentication of the PAC-A content. This study used Oximacro® (Biosfered S.r.l., Turin, Italy), a cranberry extract with a high content of PAC-A, to prevent UTIs in female and male volunteers.

To discuss the benefits of the use of ibuprofen in the management of UTI condition. This is supported by the research question which states that: can treatment of the symptoms of uncomplicated urinary tract infection with ibuprofen reduce the rate of antibiotic prescriptions without a significant increase in symptoms, recurrences, or complications?

To address the urinary tract infection and related concerns

To establish the role of nonantibiotic approaches such as the use of cranberry in the treatment of urinary tract infections (UTIs).

This paper hypothesizes that Lactobacillus spp. containing products are able to prevent recurrent urinary tract infections in females.

This review looked at the benefits and harms of probiotics in preventing symptomatic UTI in people with neuropathic bladder compared with placebo, no therapy, or non‐antibiotic prophylaxis (cranberry juice, methenamine hippurate, topical oestrogen).

Methods: Summarize the following in paragraph form.

What is the population being sampled?

What data collection procedure is presented?

What other procedures are described?

3276 publications reviewed and 56 full text article were retrieved for final analysis. Methodology including use of cohort study, randomized controlled trial, and case control study. Narrative synthesis was also used as a methodology.

: A double-blind, placebo-controlled trial was carried out in 60 patients who were randomized (1:1) to RGHP or placebo twice daily for 5 days. Follow-up was 11 days.

An economic evaluation was performed alongside a randomized trial. Primary outcome was the number of UTIs during 12 months. Secondary outcomes included satisfaction and quality of life. Healthcare utilization was measured using questionnaires. Missing data were imputed using multiple imputation. Bootstrapping was used to evaluate the cost-effectiveness of the treatments.

253 women with uncomplicated lower UTI were randomly assigned 1:1 to asymptomatic treatment with the NSAID diclofenac (n=133) or antibiotic treatment with norfloxacin (n=120). The randomization sequence was computer generated, blocked, stratified by practiced and concealed using sealed, sequentially numbered drug containers.

Randomized, double-blind and non-inferiority trial was conducted on 89 premenopausal women with recurrent UTI using different dosages of cranberry juice.

Experimental design were used to investigate the outcome of the study from 120 participants.

300 participants diagnosed with UTI were randomly selected to address the use of cranberry juice.

This systematic review, which complies with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement, was done as a meta-analysis and trial sequential analysis of clinical trials.

120 women with UTI were enrollee into the program. Cross sectional study design was used to analyze the quality of outcomes.

The Oximacro® PACs content was assayed using the Brunswick Laboratories 4-dimethylaminocinnamaldehyde (BL-DMAC) method, and the dimer and trimer PACs-A and PACs-B percentages were determined via high-performance liquid chromatography/electrospray ionization tandem mass spectrometry (HPLC/ESI-MS/MS). A balanced group of female (ranging from 19 to over 51 years) and male volunteers (over 51 years) was divided into two groups. The experimental group received 1 capsule containing Oximacro® (36 mg PACs-A) twice per day (morning and evening) for 7 days, and the placebo group was given the same number of capsules with no PACs.

Women aged 18-65 with typical symptoms of UTI and without risk factors or complications were recruited in 42 German general practices and randomly assigned to treatment with a single dose of fostomycin 3 g (n=246; 243 analysed) or ibuprofen 3×400 mg (n=248; 241 analysed for three days (and respective placebo dumdum in both groups). In both groups, additional antibiotic treatment was subsequently prescribed as necessary for persistent, worsening, or recurrent symptoms. The primary endpoints were the number of all courses of antibiotic treatment on days 0-28 (for UTI or other conditions) and burdens of symptoms on days 0-7. The symptom score including dysurai, frquency/urgency, and low abdominal pain.

None utilized

The study utilized randomized control trails (RCTs) involving 120 participants diagnosed with UTI. The intervention group (n=61) received cranberry and probiotics for the treatment of UTI. The control group (n=59) received no therapies and both the groups were monitored for one week.

Using the keywords [lactobacillus OR lactobacilli OR probiotic] and [urinary tract infection OR UTI OR cystitis], a preliminary search on the PubMed, Ovid, Google Scholar and   database yielded 1,647 papers published in English between 1-Jan-1960 and 1-May-2017. 9 clinical trials with a total of 726 patients were reviewed

We searched the Cochrane Kidney and Transplant Specialised Register up to 10 March 2017 through contact with the Information Specialist using search terms relevant to this review. Studies in the Specialised Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov.

All randomised controlled trials (RCTs), quasi‐RCTs and cross‐over RCTs looking at the use of probiotics for the prophylaxis of UTI in people with neuropathic bladders was considered for inclusion. Men, women and children of all ages with neuropathic bladders from neurological injury such as suprapontine, supra sacral and sacral aetiologies was included. All bladder management types, including reflex voiding, time voiding, indwelling and intermittent catheterization were eligible for this review.

Studies comparing probiotics to placebo, no treatment or other non‐antibiotic prophylaxis was included. Studies comparing probiotics with antibiotics or in combination with antibiotics were excluded

Summary estimates of effect were obtained using a random‐effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) or standardised mean difference (SMD) and 95% CI were planned for continuous outcomes.

Results: Summarize the following in paragraph form.

What are the given findings?

How was data collected?

Are the findings supported by graphs and charts?

What does the analysis of data state?

The studies established five different measures of hygiene behavior, immunization, cranberry juice, Canephrone and ascorbic acid as approaches to prevent UTI in pregnancy. The studies were retrieved from CINAHL, AMED, BNI, PubMed, EMBASE and PsycINFO databases. Graphs and tables were used to analyze the data. The study indicates that non-antibiotic measures using cranberry juice and maintaining hygiene can be used to manage UTI in pregnant women.

The risk ratio of patients who needed antibiotic treatment was lower in the RGHP group (RR, 0.3; 95% CI, 0.09 to 0.98). RGHP provided greater symptom relief than placebo (mean adjusted change in the global symptom score from baseline: -5.27 vs. 0.40; p

Cranberry prophylaxis was less effective than TMP-SMX prophylaxis, but the differences in clinical outcomes were not statistically significant. Costs after 12 months in the cranberry group were statistically significantly higher than in the TMP-SMX group (mean difference €249, 95% confidence interval 70 to 516). Cost-effectiveness planes and cost-effectiveness acceptability curves showed that cranberry prophylaxis to prevent UTIs is less effective and more expensive than (dominated by) TMP-SMX prophylaxis.

72/133 (54%) women assigned to diclofenac and 96/120 (80%) assigned to norfloxacin experienced symptoms of resolution at day three.

Different lactobacilli strains show different results in the prevention of recurrent UTIs. Intravaginal suppositories with Lactobacillus crispatus in premenopausal women and oral capsules with Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 in postmenopausal women are promising. Ascorbic acid (vitamin C) cannot be recommended for the prevention of UTIs. Cranberries are thought to contain proanthocyanidins that can inhibit adherence of P-fimbriated E. coli to the uroepithelial cell receptors. Cranberry products decreased UTI recurrences about 30%–40% in premenopausal women with recurrent UTIs, but are less effective than low-dose antimicrobial prophylaxis. However, the optimal dose of cranberry product has still to be determined. Initially OM-89, a vaccine with 18 heat-killed E. coli extracts, seemed promising, but this was not confirmed in a recently randomized trial

Lactobacillus and cranberry juice supported the management of UTI in patients diagnosed with the condition.

In the research, cranberry products and probiotics are effective in preventing recurrent UTIs but their benefit becomes less clear when they are compared with antibiotics.

The findings clearly showed the potential use of cranberries for the clinical condition of urinary tract infection. Cranberry products significantly reduced the incidence of urinary tract infections as indicated by the weighted risk ratio (0.6750, 95% CI 0.5516–0.7965, p <0.0001). The results of subgroup analysis demonstrated that patients at some risk for urinary tract infections were more susceptible to the effects of cranberry ingestion.

Women with recurrent UTI have an increased susceptibility to vaginal colonization with uropathogens due to a greater propensity for them to adhere to their epithelial cells. Risk factors include frequent sexual intercourse, spermicide use, first UTI at an early age, and maternal history of UTI. Effectiveness of continuous or post-coital prophylaxis with low-dose antimicrobials or intermittent self-treatment with antimicrobials in management of recurrent uncomplicated UTIs in women has been demonstrated.

Analysis of Oximacro® revealed a high total PAC content (372.34 mg/g ±2.3) and a high percentage of PAC-A dimers and trimers (86.72% ±1.65). After 7 days of Oximacro® administration, a significant difference was found between the placebo and Oximacro® groups for both females (Mann-Whitney U-test = 875; P < .001; n = 60) and males (Mann-Whitney U-test = 24; P = .016; n = 10). When the female and male age ranges were analysed separately, the female age range 31-35 showed only slightly significant differences between the placebo and Oximacro® groups (Mann-Whitney U-test = 20.5; P = .095; n = 10), whereas all other female age ranges showed highly significant differences between the placebo and Oximacro® groups (Mann-Whitney U-test = 25; P = .008; n = 10). Furthermore, colony forming unit/mL counts from the urine cultures showed a significant difference (P < .001) between the experimental and the placebo groups (SD difference = 51688; df = 34, t = -10.27; Dunn-Sidak Adjusted P < .001, Bonferroni Adjusted P < .001).

While initial symptomatic treatment with ibuprofen reduced the overall number of antibiotic treatment courses in women with uncomplicated urinary tract infection by 67%, compared with immediate antibiotic treatment with fosfomycin, this strategy resulted in higher burden of symptoms and more cases of pyelonephritis.

Two thirds of the women in the ibuprofen group, however, recovered without antibiotic treatment.

Factors predisposing people to UTIs analyzed

Participants in the intervention group achieved remarkable outcomes in the decrease of uropathogens that causes UTI.

 Different lactobacilli strains (in either oral or suppository formulation) were utilized and they demonstrated varying efficacy in the prevention of recurrent UTIs. Using a random-effects model, pooled risk ratio of at least one recurrent UTI episode during the entire study duration was 0.684 (95% CI 0.438 to 0.929, p < 0.001), per-protocol analysis

This review includes a total of three studies (one cross‐over and two parallel RCTs) which involved 110 participants. All three studies looked at intravesical instillation of a low virulent Escherichia coli (E. coli) strain in reducing the risk of symptomatic UTI in participants with neuropathic bladder, predominantly from SCI. Two studies used the E. coli 83972 strain and one study used the E. coli HU2117 strain.

We did not find any RCTs involving other probiotics or other routes of administration for preventing UTI in people with neuropathic bladder.

There was consistency in definition of symptomatic UTI in all three studies. Symptoms that all studies considered were relevant to diagnose UTI were adequately defined. All three studies defined microbiological diagnosis of symptomatic UTI.

Asymptomatic bacteriuria was not considered an outcome measure in any of the included studies; however it was defined in two studies to establish successful inoculation.

It is uncertain if the risk of symptomatic UTI is reduced with bladder inoculation using E. coli because the certainty of the evidence is very low (3 studies, 110 participants: RR 0.32, 95% CI 0.08 to 1.19; I2 = 82%).

Conclusion: Summarize in paragraph form.

What is the summary of the study?

What is the conclusion of the hypothesis?

What are the questions for future research?

UTI can be managed through alternative approaches. The article established that hygiene and other measures such as the use of ascorbic acid and cranberry juice supported the evidence to use non-antibiotic remedies to address UTI in pregnant women. Future research needs to concentrate on strengthening the evidence for improved reporting on ascorbic acid and immunization to address UTI in expectant women.

RGHP was more effective than placebo in improving UTI symptoms and reduced the need for rescue antibiotic treatment.

In premenopausal women with recurrent UTIs, cranberry prophylaxis is not cost-effective compared to TMP-SMX prophylaxis. However, it was not possible to take into account costs attributed to increased antibiotic resistance within the framework of this randomized trial; modeling studies are recommended to investigate these costs. Moreover, although we based the dosage of cranberry extract on available evidence, this may not be the optimal dosage. Results may change when this optimal dosage is identified.

Symptomatic treatment is inferior to antibiotic treatment for women with uncomplicated lower UTI in an ambulatory setting, as it increases median symptom duration by two days and is likely to be associated with an increased risk of clinically diagnosed pyelonephritis. The observed clinically relevant reduction in antibiotic use, which would likely contribute directly to decreasing resistance rates in the affected population, suggests that alternative approaches of combining symptomatic treatment with deferred, selective antibiotic use should be developed and tested in future trials.

Increasing antimicrobial resistance has stimulated interest in non-antibiotic prophylaxis of recurrent UTIs. Prophylaxis with non-antimicrobial agents does not result in an increase of antimicrobial resistance of the commensal flora. Therefore, the use of topical vaginal estrogen, oral capsules with L. rhamnosus GR-1 and L. reuteri RC-14 in post-menopausal women, and cranberry prophylaxis or intravaginal Lactobacillus crispatus in premenopausal women have been considered. Further research is needed to define the optimal dosage of cranberry products. In addition, further study of d-mannose, acupuncture, or vaccination is needed. Based on available evidence, ascorbic acid (vitamin C) cannot be recommended to prevent recurrences.

Recurrent urinary tract infections (UTIs) are common, especially in women. Low-dose daily or postcoital antimicrobial prophylaxis is effective for prevention of recurrent UTIs and women can self-diagnose and self-treat a new UTI with antibiotics. The increasing resistance rates of Escherichia coli to antimicrobial agents has, however, stimulated interest in nonantibiotic methods for the prevention of UTIs. This article reviews the literature on efficacy of different forms of nonantibiotic prophylaxis. Future studies with lactobacilli strains (oral and vaginal) and the oral immunostimulant OM-89 are warranted.

A number of nonantibiotic-containing alternatives are available for the prevention of recurrent UTIs. For the majority of these alternatives, contradictory results have been published. These can be, at least partially, explained by variation in doses administered and duration of treatment. Selection of patients more likely to benefit from these interventions seems to be a realistic approach from a clinical-practice perspective, as well a worthwhile focus for future research.

The results of the current study could be used by physicians to recommend cranberry ingestion to decrease the incidence of urinary tract infections, particularly in individuals with recurrent urinary tract infections. This would also reduce the administration of antibiotics, which could be beneficial since antibiotics can lead to the worldwide emergence of antibiotic resistant microorganisms.

Antibiotics are the main driving force in development of antibiotic resistance and can lead to resistance of not only the causative microorganisms, but also the commensal flora. The increasing prevalence of Escherichia coli isolates (the most prevalent uropathogen) that are resistant to antimicrobial agents has stimulated interest in non-antibiotic methods for prevention of UTIs.

Careful determination of the total PAC content using the BL-DMAC method and the authentication of PACs-A with mass spectrometry in cranberry extracts are necessary to prepare effective doses for UTI prevention. A dose of 112 mg Oximacro® containing 36 mg PACs-A was found to be effective in preventing UTIs when used twice per day for 7 days.

We have to reject the hypothesis of non-inferiority of initial symptomatic treatment, and we cannot generally recommend the ibuprofen first approach. This treatment option, however, can be discussed with women with mild to moderate symptoms in a shared decision making approach or within a strategy of delayed prescription. Future research is needed to identify patients for whom symptomatic treatment is sufficient as it has the potential to considerably reduce the number of antibiotic prescriptions for women with mild to moderate symptoms of urinary tract infection, in particular those with negative results on culture.

Genetic factors related to diabetes, hypertension and HIV/AIDs predispose people to risk of UTI.

Therefore, cranberry may be a promising nonantibiotic option for decreasing the risk of recurrent UII in otherwise healthy women. Although less expensive studied, certain beneficial live microorganisms, also known as probiotics, have been suggested as alternatives to antibiotics in the prevention of uncomplicated UTIs; however, data on oral intake of probiotics, particularly vie food are limited.

Although data are limited for cranberry as a treatment for UTI, the evidence for cranberry products in preventing recurrence of uncomplicated UTI is positive. Future studies should focus on the benefits of live microorganisms (probiotics) as an alternative in the management of uncomplicated UTI.

It is uncertain if probiotics prevent urine infections in people with bladder dysfunction after a nervous system injury. Further robustly designed studies are necessary.

References

What are the total number of references used in the study?

List two of the references used.

40.

Hillier, S., Roberts, Z., Dunstan, F., Butler, C., Howard, A., & Palmer, S. (2007). Prior antibiotics and risk of antibiotic-resistant community-acquired urinary tract infection: a case–control study. Journal of antimicrobial chemotherapy, 60(1), 92-99.

Petersen, I., Gilbert, R., Evans, S., Ridolfi, A., & Nazareth, I. (2010). Oral antibiotic prescribing during pregnancy in primary care: UK population-based study. Journal of antimicrobial chemotherapy, 65(10), 2238-2246.

Foxman, B. (2003). Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Disease-a-month, 49(2), 53-70.

Hickling, D. R., & Nitti, V. W. (2013). Management of recurrent urinary tract infections in healthy adult women. Reviews in urology, 15(2), 41.

35.

Burton, A., Billingham, L. J., & Bryan, S. (2007). Cost-effectiveness in clinical trials: using multiple imputation to deal with incomplete cost data. Clinical Trials, 4(2), 154-161.

McMurdo, M. E., Argo, I., Phillips, G., Daly, F., & Davey, P. (2009). Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women. Journal of antimicrobial chemotherapy, 63(2), 389-395.

41.

Bassler D, Briel M, Montori VM, et al. STOPIT-2 Study Group. Stopping randomized trials early for benefit and estimation of treatment effects: systematic review and meta-regression analysis. JAMA2010;359:1180-7.

Little P, Moore MV, Turner S, et al. Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. BMJ2010;359:c199

46.

Singh, R.; van, N.E.; Nieuwdorp, M.; van, D.B.; ten Berge, I.J.; Geerlings, S.E.; Bemelman, F.J. Donor feces infusion for eradication of Extended Spectrum beta-Lactamase producing Escherichia coli in a patient with end stage renal disease. Clin. Microbiol. Infect. 2014, 20, 977–978.

Wagenlehner, F.M.; Ballarini, S.; Pilatz, A.; Weidner, W.; Lehr, L.; Naber, K.G. A Randomized, Double-Blind, Parallel-Group, Multicenter Clinical Study of Escherichia coli—Lyophilized Lysate for the Prophylaxis of Recurrent Uncomplicated Urinary Tract Infections. Urol. Int. 2015, 95, 167–176.

38.

Trautner, B.W., Gupta, K. The advantages of second best: comment on “Lactobacilli vs antibiotics to prevent urinary tract infections”. Arch Intern Med. 2012;172:712–714.

Schulman, C.C., Corbusier, A., Michiels, H. et al, Oral immunotherapy of recurrent urinary tract infections: a double-blind placebo-controlled multicenter study. J Urol. 1993;150:917–921

Lee, B.S., Bhuta, T., Simpson, J.M. et al, Methenamine hippurate for preventing urinary tract infections. Cochrane Database Syst Rev. 2012.

Schulman, C.C., Corbusier, A., Michiels, H. et al, Oral immunotherapy of recurrent urinary tract infections: a double-blind placebo-controlled multicenter study. J Urol. 1993;150:917–921

Hooton TM (2001) Recurrent urinary tract infection in women. Int J Antimicrob Agents 17: 259–268.

Gupta K (2003) Emerging antibiotic resistance in urinary tract pathogens. Infect Dis Clin North Am 17: 243–259.

Aune A, Alraek T, LiHua H, Baerheim A. Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women. Scand J Prim Health Care 1998;16:37–39.

Howell AB, Botto H, Combescure C, Blanc-Potard AB, Gausa L, Matsumoto T, et al. Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study. BMC Infect Dis 2010; 10:94.

Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, et al. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998;280:605–613.

Tammen H. The German Urinary Tract Infection Study Group. Immunobiotherapy with Uro-Vaxom in recurrent urinary tract infection. Br J Urol 1990; 65:6–9.

38.

Little P, Stuart B, Hobbs FDet al.DESCARTE investigators.  Antibiotic prescription strategies for acute sore throat: a prospective observational cohort study. Lancet Infect Dis.

Giesen LG, Cousins G, Dimitrov BD, van de Laar FA, Fahey T.  Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs. BMC Fam Pract 2010;11: 78.

18.

Neal DE Jr (2008) Complicated urinary tract infections. Urol Clin North Am 35: 13–22; v.

Malterud K, Baerheim A (1999) Peeing barbed wire. Symptom experiences in women with lower urinary tract infection. Scand J Prim Health Care 17: 49–53.

23.

Howell AB, Botto H, Combescure C, Blanc-Potard AB, Gausa L, et al. (2010) Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study. BMC Infect Dis 10: 94.

Aston JL, Lodolce AE, Shapiro NL (2006) Interaction between warfarin and cranberry juice. Pharmacotherapy 26: 1314–1319.

21.

Francesco Montorsi, Giorgio Gandaglia, Andrea Salonia, Alberto Briganti, Vincenzo Mirone

Effectiveness of a Combination of Cranberries, Lactobacillus rhamnosus, and Vitamin C for the Management of Recurrent Urinary Tract Infections in Women: Results of a Pilot Study

European Urology, Volume 70, Issue 6, 2016, pp. 912-915.

Mostafa Hosseini, Mahmoud Yousefifard, NeamatollahAtaei, Alireza Oraii, Jalaledin Mirzay Razaz, Anahita Izadi

The efficacy of probiotics in prevention of urinary tract infection in children: A systematic review and meta-analysis

Journal of Pediatric Urology, Volume 13, Issue 6, 2017, pp. 581-591

25.

Willan AR, Briggs AH, Hoch JS (2004) Regression methods for covariate adjustment and subgroup analysis for non-censored cost-effectiveness data. Health Econ 13: 461–475.

Foxman B (2010) The epidemiology of urinary tract infection. Nat Rev Urol 7: 653–660.

Part 3: Synthesis of Research Studies

Introduction of the Identified Subtheme

Urinary tract infections (UTIs) comprise of pathogenic conditions that affects the urinary system. The conditions are considered the most common bacterial infections that readily affects healthy women. The illnesses results in economic burden to patients due to increased cost associated with the comorbidities of the condition (Occhipinti, Germano & Maffei, 2016). Basically, uncomplicated UTI is more common in women than men and affects the lower urinary tract found in the cystitis. A healthy female gender has 50% risk of developing episodes of cystitis related to UTI in her lifetime (Toh et al., 2017). Nonetheless, 20% to 30% of women are likely to develop recurrent UTI within a year following past exposure to the illness.

The widespread use of antibiotics to treat UTI has not yielded a bundle of evidence due to the increased occurrence of Escherichia coli. In this context, the bacteria increases resistance to the therapies administered. The microorganism is resistant to β-lactams and fluoroquinolones which are medications potentially used to treat UTI. The pathogens use the prescription drugs as agents to grow and this results in the recurrence of UTI (Luís, Domingues & Pereira, 2017). With this, an alternative therapeutic option is warranted to address UTI and manage associated comorbidities of the condition. Moreover, UTI as a benign condition can have negative consequences which in overall compromises the quality of life for the patients.

Alternative non-antibiotic measures have been developed to offer therapy to the condition. Cranberries are the selected options used in primary care to prevent the complications of UTI. The mechanism for the use the juice is based on the presence of fructose and type A proanthocyanidins (PACs). The presence of the latter in urine inhibits the adherence of type 1 and P fimbriae of E coli onto the uroepithelial cell receptors. Cranberries are linked to the treatment of UTI by using extracts from the fruit, juices and capsules. These components prevent the recurrence of the condition especially in women. Accordingly, cranberry juice reduces the complications of UTI in pregnant women and is a cost-effective prophylaxis in responding to the symptoms of the condition.

On the other hand, probiotic lactobacilli strain can be as an alternative for treating UTI. The non-antibiotic approach is based on the premise that Lactobacillus spp. contain products that can prevent the recurrent UTI especially on females. Besides, minimum levels of harms are reported when the probiotics are used as alternatives for treating the condition. The use of the option is can also be undertaken for UTI patients diagnosed with neuropathic bladder condition.

Summary of the Research Questions Posed by the Studies

The research questions of many of the articles selected addressed the non-antibiotic strategies in managing UTI and the recurrent episodes of the condition. According to the studies, non-antibiotic approaches have been used in the management of complications linked to urinary tract infections. Particularly, cranberries and probiotics have been used as putative mechanisms to decrease uropathogens in the microbiome for managing UTI. With this argument, the research studies analyzes the effectiveness of the use of the alternative therapies to treat UTI. However, the benefit of the use of cranberries and probiotics require further investigations to warrant evidence of adoption in clinical setting.

In another research question, the benefit of treatment of the symptoms of uncomplicated urinary tract infection is analyzed. Specifically, the use of ibuprofen as an adjunct therapy to reduce the rates of antibiotic prescription is examined. Based on the question, the use of antibiotics is withdrawn except the administration of ibuprofen. The aim of the intervention is to assess the significant increase in symptoms as well as the recurrences or complications of UTI upon use of a single NSAID drug. The outcomes denote that use of non-antibiotics for the management of UTI can be effective upon the withdrawal of other prescription medication. However, the administration of non-antibiotic therapy is only warranted in the case of uncomplicated UTI. This means that prescription medications are the only standard methods of care approved for the treatment of the condition. Guided by this argument, use of non-antibiotic strategies remain concepts that are under review and the effectiveness of the therapies in reducing episodes of recurrence should be clearly stated.

The use of probiotics as a non-antibiotic strategy remain a pertinent aspect in the management of UTIS. Research questions assess the best routes of administration and criticizes the use of oral form of intake. The conventional intake of probiotics along with food raises concerns of effective utilization of the approach in treating uncomplicated urinary tract infection. This is based on the premise that oral intake encourages the colonization of probiotics by the enzymes in the alimentary canal. With this, the effectiveness of probiotics in managing bladder dysfunctions related to UTI remains a puzzle riddled by uncertainties of effectiveness (Toh et al., 2017). As such, future should focus on the invasion of probiotics by the enzymes in the alimentary canal and how such a colonization can be minimized to optimize the utilization of the live microorganisms in the management of UTI.

Summary of the Sample Populations used

The study was divided into two categories. In the first approach, literature materials were reviewed to establish their relevance for the research. As for the second method, research was conducted to analyze outcomes on the effectiveness of non-antibiotic approaches in care. In all of the cases, study participants were selected based on the prevalence of the UTI condition in the population group. Particularly, the study used women at their reproductive age as the most susceptible to developing UTI. In this context, about 30% of women experience the symptoms of UTI in their lifetime. Besides, as compared to men, women find the main symptoms of UTI as indeed very painful and bothersome which can yield a negative impact in the quality of their life.

The study also selected premenopausal women as prime targets for the research. Often, the population are likely to encounter recurrent episodes of UTI even after treatment. As with the target population, low-dose antibiotic prophylaxis is recommended (Kim, 2014). Besides, the drug resistance is commonly reported as the causative microorganism use the prescription medication as an indigenous flora to proliferate. Treating the UTI therefore becomes complicated and therefore non-antibiotic approaches are recommended.

In one study, patients visiting a care facility were randomly screened for to assess the symptoms of UTI. Specifically, changes such as dysuria, urine organoleptic changes and suprapubic pain were examined. As for these participants, baseline symptoms of UTI were recorded in a scale of 0 to 3 in which 0 was equivalent to none while 1 represented mild symptoms. 2 was assigned moderate status while 3 indicated severe complications of UTI. The eligible participants received non-antibiotic interventions to address the UTI complications. Participants were also blinded to assess their response to the non-antibiotic approaches in the management of the condition (Behzadi, 2018). However, treatment with non-antibiotic interventions was discontinued for the participants if symptoms of the UTI worsened or became severe. For patients experiencing persistent UTI symptoms, additional investigations were undertaken to determine the depth of their condition. Specifically, urine culture was requested to rule out other infections in the urine other than UTI. This guides decision on intervention in a bid to identify the effectiveness of non-antibiotic interventions.

Summary of the Limitations of the Studies

The studies had a host of limitations which altered the final results. In one study, the measurements of UTI was not done in a reliable manner. For instance, absenteeism among women workers was presumed to be related to the complications of UTI. However, the women fail to report to work as scheduled as they were not paid duly (Kronenberg et al., 2017). Besides, extrapolation of the results was made in order to predict the pattern of outcomes. This approach led to inconsistencies in outcomes as the overall outcome depended on a multiplying factor. In this approach, the outcomes were not accurate meaning that they may not be used as standalone approaches to guide decisions on care.

On the other hand, missing data was another challenge in retrieving information from the studies. For instance, in one study involving non-antibiotic interventions, only 38% of the participants in a cranberry group returned all the 12 monthly questionnaires based on the 12 months follow-up (Ghouri, Hollywood & Ryan, 2018). Besides, about 61% of women in a cranberry group returned 10 questionnaire. The implication of these outcomes are based on the premise that not all information will be captured during final analysis.

All the studies selected were those published in English. The approach aimed at comprehensive analysis of information presented in each case. However, use of English meant that options about non-antibiotic approaches in UTI treatment from other languages were not identified. The differing nature of interventions were also not resolved since the study was specific to outcomes based on a single language. With this, diverse opinion about alternative approaches in the management of UTI were not factored in the final outcome (Occhipinti, Germano & Maffei, 2016). Besides, complexities based on the use of the non-antibiotic approaches were not identified as the studies were only limited to one language and recommendations from other sources were excluded.

Summary of the Conclusions and Recommendations for Further Research

The studies analyzed non-antibiotic approaches in the management of urinary tract infections. From the articles, it is evident that alternative approaches can be used to address the complexities of UTI in both adults and children. Apparently, as per the findings, UTI affects women more than men and this indicates a gender bias in the development of complication. Besides, the rates of recurrent of the condition following two years of treatment is also higher in women than in men. Based on these arguments, safe approaches are required to reduce the prevalence of the complication in women. In the preceding literature, it is important for women to maintain hygiene of the reproductive organs. This applies to women who are sexually active, those in the premenopausal state and the post-menopause.

The studies indicate the benefits of the non-antibiotic strategies in the management of UTI. Specifically, the use probiotics and cranberry juice have been highlighted as the latest strategies to address the complications. Use of the approaches guarantee quality outcomes to patients especially those with recurrent incidences of UTI. Besides, use of non-antibiotic approaches is cheaper than the conventional approaches in treating urinary tract infections. Particularly, cranberry juice is readily available and as such, can be used effectively in the management of the complications. Nonetheless, the side effects in the use of the cranberry juice is limited when compared to conventional methods involving prescription drugs.

As per the analysis presented, the use of non-antibiotic strategies is limited to UTI without complications. With this, future studies need to focus on the use of the approaches in severe cases of UTI and especially those that present associated complications. This will guide decision on future practice especially with regard to the administration of the medication to improve quality outcomes in patients.

The colonization of probiotics with the enzymes in the alimentary canal is an important aspect of consideration which need to be addressed. The routes of administration of the non-antibiotic agents should be clearly defined to ensure that they are effective in preventing bladder infection related to UTI. However, robust studies need to be developed to provide evidence on the implications of the non-antibiotic agents in the nervous system. This is important as it provides information about the negative effects of probiotics and cranberries in the management of the complications of the urinary tract infections. Besides, dosage administration should also be defined to guide evidence on application of the antibiotic agents.

References

Beerepoot, M., & Geerlings, S. (2016). Non-antibiotic prophylaxis for urinary tract infections. Pathogens, 5(2), 36. DOI: 10.3390/pathogens5020036.

Behzadi, P. (2018). Introductory Chapter: An Overview on Urinary Tract Infections, Pathogens, and Risk Factors. In Microbiology of Urinary Tract Infections: Microbial Agents and Predisposing Factors. IntechOpen. DOI: 10.5772/intechopen.82230.

Bosmans, J. E., Beerepoot, M. A., Prins, J. M., ter Riet, G., & Geerlings, S. E. (2014). Cost-effectiveness of cranberries vs antibiotics to prevent urinary tract infections in premenopausal women: a randomized clinical trial. PloS one, 9(4), e91939. DOI: 10.1371/journal.pone.0091939.

Costantini, E., Giannitsas, K., & Illiano, E. (2017). The role of nonantibiotic treatment of community-acquired urinary tract infections. Current opinion in urology, 27(2), 120-126. DOI: 10.1097/MOU.0000000000000366.

Gágyor, I., Bleidorn, J., Kochen, M. M., Schmiemann, G., Wegscheider, K., & Hummers-Pradier, E. (2015). Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomized controlled trial. bmj, 351, h6544. DOI: 10.1136/bmj.h6544.

García-Larrosa, A., & Alexe, O. (2016). Efficacy and Safety of a Medical Device versus Placebo in the Early Treatment of Patients with Symptoms of Urinary Tract Infection: A Randomized Controlled Trial. Clin Microbiol 5: 233. doi: 10.4172/2327-5073.1000233 Page 2 of 5 Clin Microbiol ISSN: 2327-5073 CMO, an open access journal Volume 5• Issue 1• 1000233. Figure, 1, 3. DOI: 10.4172/2327-5073.1000233.

Geerlings, S. E., Beerepoot, M. A., & Prins, J. M. (2014). Prevention of recurrent urinary tract infections in women: antimicrobial and nonantimicrobial strategies. Infectious Disease Clinics, 28(1), 135-147. DOI: 10.1016/j.idc.2013.10.001.

Ghouri, F., Hollywood, A., & Ryan, K. (2018). A systematic review of non-antibiotic measures for the prevention of urinary tract infections in pregnancy. BMC pregnancy and childbirth, 18(1), 99. DOI: 10.1186/s12884-018-1732-2.

Kim, K. H. (2014). Non-Antibiotic Prophylaxis for Recurrent Urinary Tract Infections. The Korean Journal of Urogenital Tract Infection and Inflammation, 9(1), 9-13. DOI: 10.14777/kjutii.2014.9.1.9.

Kronenberg, A., Bütikofer, L., Odutayo, A., Mühlemann, K., da Costa, B. R., Battaglia, M., … & Jüni, P. (2017). Symptomatic treatment of uncomplicated lower urinary tract infections in the ambulatory setting: randomised, double blind trial. bmj, 359, j4784. DOI: 10.1136/bmj.j4784.

Liska, D., Derrig, L., & Mah, E. (2018). Urinary Tract Infection: Should Cranberry and Probiotics Be Considered?. Nutrition Today, 53(5), 207-212. DOI: 10.1097/NT.0000000000000297.

Luís, Â., Domingues, F., & Pereira, L. (2017). Can cranberries contribute to reduce the incidence of urinary tract infections? A systematic review with meta-analysis and trial sequential analysis of clinical trials. The Journal of urology, 198(3), 614-621. DOI: 10.1016/j.juro.2017.03.078.

Ng, Q. X., Peters, C., Venkatanarayanan, N., Goh, Y. Y., Ho, C. Y. X., & Yeo, W. S. (2018). Use of Lactobacillus spp. to prevent recurrent urinary tract infections in females. Medical hypotheses, 114, 49-54. DOI: 10.1016/j.mehy.2018.03.001.

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. DOI: 10.1029.uj/article/view/3190.

Toh, S. L., Boswell‐Ruys, C. L., Lee, B. S. B., Simpson, J. M., & Clezy, K. R. (2017). Probiotics for preventing urinary tract infection in people with neuropathic bladder. Cochrane Database of Systematic Reviews, (9). DOI: 10.1002/14651858.CD.010723.pub2.

Grand Canyon University DNP-820 Implementation Into Practice – Step-By-Step Guide

How to Research and Prepare for DNP-820 Implementation Into Practice

How to Write the Introduction for DNP-820 Implementation Into Practice

Need a high-quality paper urgently?

How to Write the Body for DNP-820 Implementation Into Practice

How to Write the Conclusion for DNP-820 Implementation Into Practice

How to Format the References List for DNP-820 Implementation Into Practice

Stuck? Let Us Help You

Sample Answer for DNP-820 Implementation Into Practice

Topic, Supporting Research, and Desired Outcomes

ALSO READ:

The Extent of Research Implementation

Possible Barriers to Implementation

Possible Ways to Overcome the Barriers

Resources Available on the Site

Conclusion

References

DNP 820 Week 4 Introduction to the Literature Review Assignment FINAL

Struggling with this assignment?