***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIDA is an interactive educational diabetes simulator that is useful for recreating clinical ly realistic diabetes situations . It is available without charge from http://www.2aida.org on the Web . This paper describes a prospect i ve , clinical r and omised-controlled trial ( RCT ) run at the Ospedale di Marino ( Italy ) for evaluating the educational utility of AIDA in small group teaching sessions . Twenty-four volunteers ( 12 male and 12 female ) with Type 1 diabetes of more than 6-year duration , aged 19 - 48 years , who gave written informed consent , were r and omly assigned to one of two study groups , each receiving different teaching interventions . Group A was exposed to the AIDA diabetes simulator , while Group B ( the control group ) received conventional lessons with slides and transparencies . Six lessons were held for each group ( one per week ) . At the end of the conventional lessons , after a ' washout ' period of 4 weeks , Group B entered a partial cross-over phase with the simulator during a further 6-week block of lessons . Before and after the 6 weeks of lessons , twice for Group A and 3 times for Group B , all subjects had their HbA1c measured . The subjects also carefully documented the incidence of any symptomatic hypoglycaemic episodes ( ' hypos ' ) , whether mild ( sweating , dizziness ) , moderate ( nausea , vomiting ) , or severe ( requiring assistance ) . All data were analysed using non-parametric statistics ( Wilcoxon signed rank tests ) . HbA1c levels in Group A dropped significantly from 7.2 % to 6.4 % after lessons with the diabetes simulator ( p = 0.01 ) . No significant changes in HbA1c were observed in Group B between baseline ( 7.1 % ) and the end of the control lessons ( 7.0 % ) , or the end of the cross-over phase lessons ( 6.8 % ) . The number of ' hypos ' decreased significantly from 31 to 14 in Group A ( p = 0.03 ) after AIDA lessons , but did not change significantly in Group B from baseline ( n = 20 ) to after the control lessons ( n = 22 ) . However , the number of ' hypos ' did decrease significantly ( to n = 10 ) in Group B after exposure to the simulator during the cross-over phase ( p = 0.03 vs 6-week data ) . Larger trials involving more patients in more centres are clearly needed , but this proof-of-concept ( pilot ) study does demonstrate the feasibility of using a prospect i ve RCT approach for the evaluation of educational diabetes simulation software such as AIDA OBJECTIVES Indwelling urinary catheters are the leading source of nosocomial urinary tract infections ( NUTIs ) . The Bardex I.C. catheter is a hydrogel latex Foley catheter with a monolayer of silver metal applied to the inner and outer surfaces of the catheter . We investigated the Bardex I.C. catheter for its ability to decrease the NUTI rate in critical care units . METHODS Five hospitals participated in a blind prospect i ve study , exchanging the st and ard latex Foley catheter for the Bardex I.C. Foley catheter . The device use rate and NUTI rate were monitored . Data were collected and analyzed using Wilcoxon rank sum test and four-way analysis of variance . A cost analysis was also performed . RESULTS The baseline period , intervention period , and number of device days was similar for both periods . The unadjusted catheter-associated infection rate during the baseline and intervention periods was 7.1 and 4.5 infections per 1000 catheter days , respectively ( P < 0.01 ) . The adjusted catheter-associated infection rate during the baseline and intervention periods was 8.1 and 4.9 infections per 1000 catheter days , respectively . This was not statistically significant ( P = 0 . 13 ) . CONCLUSIONS A trend toward a reduction in NUTIs with the use of the hydrogel/silver-coated catheter was noted in all intensive care units at each institution as shown by the unadjusted and adjusted catheter-associated infection rates . One hospital demonstrated a statistically significant reduction in NUTIs . However , statistical significance was not met when the results were adjusted . The cost analysis at one institution demonstrated cost savings with the use of the silver-coated catheter . Future analysis may require a double-blind , prospect ive-controlled study of longer duration to reach statistical significance Catheter-associated urinary tract infection ( CAUTI ) is the most common and most costly healthcare-associated infection , and possibly the most preventable ( Salgado et al , 2003 ) . The Cochrane Review of silver alloy-coated Foley catheters concluded that they are successful at reducing the rate of this healthcare-associated infection , which can be potentially fatal ( Brosnahan et al , 2004 ) . This article discusses the merits of using the silver alloy-coated Foley catheter in reducing the risk of CAUTI in an acute general hospital . A pre- and post-intervention design was used to audit CAUTI rates . During the pre-intervention period of 10 weeks , the Trust 's st and ard catheters were used and CAUTI rates captured . Silver alloy-coated Foley catheters were introduced and their use monitored for a further period of 10 weeks . A total of 117 newly catheterized patients were actively monitored for signs and symptoms of CAUTI . The audit met and exceeded its aim of reducing the CAUTI rate by 20&. The CAUTI risk rate and device rate fell during the evaluation period . The use of the silver alloy-coated Foley catheters proved to be cost-effective given the recognized additional costs of CAUTI and prolonged in-patient stay ( Plowman et al , 1999 ) . Given the results of this audit it is recommended that the silver alloy-coated Foley catheter be the catheter of choice for use with acute patient admissions requiring short-term catheterization OBJECTIVE Nosocomial infection ( NI ) is one of the most serious healthcare issues currently influencing healthcare costs . This study estimates the impact of NI on costs in intensive care units ( ICUs ) . DESIGN Prospect i ve surveillance by a retrospective cohort study . SETTING A medical ICU , a surgical ICU , and a mixed medical and surgical ICU in a large tertiary referral medical center . METHODS Surveillance for NIs was conducted for all patients admitted to adult ICUs from 2003 through 2005 . Retrospective chart review was conducted for each patient . The generalized linear modeling approach was used to assess the relationship of NIs to the increase in variable costs in individual ICUs and in all ICUs . RESULTS A total of 401 NIs occurred in 320 of 2,757 screened patients . The incidence rate was 12.1 % in the medical ICU , 14.7 % in the surgical ICU , and 16.7 % in the mixed medical and surgical ICU ( P>.05 ) . All of the mean variable costs were significantly higher for patients with NI than they were for patients without NI , after controlling for covariates . The medical ICU had the greatest increase in mean cost ( $ 13,456 , which was 3.52 times [ 95 % confidence interval { CI } , 2.94 - 4.22 times ] the mean cost for patients without NI ) , followed by the mixed medical and surgical ICU ( $ 6,748 , which was 2.74 times [ 95 % CI , 2.33 - 3.22 times ] the mean cost for patients without NI ) and the surgical ICU ( $ 5,433 , which was 2.46 times [ 95 % CI , 1.99 - 3.05 times ] the mean cost for patients without NI ) . Mean cost increases according to the site of NI were $ 6,056 for bloodstream infection ( 2.36 times [ 95 % CI , 1.97 - 2.84 times ] the mean cost for patients without NI ) , $ 4,287 for respiratory tract infection ( 1.91 times [ 95 % CI , 1.57 - 2.32 times ] the mean cost for patients without NI ) , $ 1,955 for urinary tract infection ( 1.42 times [ 95 % CI , 1.18 - 1.72 times ] the mean cost for patients without NI ) , and $ 1,051 for surgical site infection ( 1.23 times [ 95 % CI , 0.90 - 1.68 times ] the mean cost for patients without NI ) . CONCLUSIONS The medical ICU had the lowest rate of NI and the largest excess costs , the surgical ICU had the lowest excess costs , and the mixed medical and surgical ICU had the highest rate of NI . The cost is largely attributable to bloodstream infection and respiratory tract infection OBJECTIVE To determine the additional direct costs of hospitalization attributable to catheter-associated urinary tract infection ( CAUTI ) in 1,497 newly catheterized patients . DESIGN Prospect i ve observational and laboratory study . SETTING University hospital . METHODS Data were collected on risk factors for CAUTI  ( defined as > 10(3 ) colony-forming units [CFU]/mL ) , severity of illness , and diagnostic and therapeutic interventions in consenting newly catheterized patients . Daily urine cultures were obtained from each newly catheterized patient , but the results of these cultures were not revealed to his or her physician . During the study , one of the investigators ( DGM ) review ed each patient 's record and made a judgment as to which of the diagnostic tests and treatments ordered and what incremental length of stay could reasonably be ascribed to his or her CAUTI . The total hospital costs for each patient were also obtained . RESULTS Overall , 235 patients acquired CAUTIs during the study ; most of the CAUTIs were completely asymptomatic , and only 52 % were diagnosed by the patients ' physicians using the hospital laboratory . Only 1 patient with a CAUTI had a secondary bloodstream infection . Thirty-three ( 13 % ) of the CAUTIs were caused by Escherichia coli ; 63 ( 25 % ) by Klebsiella , Enterobacter , Citrobacter , Pseudomonas aeruginosa , or other antibiotic-resistant , gram-negative bacilli ; 87 ( 35 % ) by enterococci or staphylococci ; and 67 ( 27 % ) by C and ida species . The 123 CAUTIs diagnosed by the hospital laboratory were judged to have been responsible for an additional $ 20,662 in extra costs of diagnostic tests and $ 35,872 in extra medication costs , a mean of $ 589 ( median , $ 356 ) per CAUTI . CAUTIs caused by E. coli cost considerably less than infections caused by other gram-negative bacilli ( $ 363.3 + /- $ 228.2 vs $ 690.4 + /- $ 783.7 ; P = .02 ) or yeasts ( $ 821.2 + /- $ 2,169.9 ) . There were less striking differences in the costs per CAUTI caused by staphylococci or enterococci ( $ 387.1 + /- $ 434.8 ) . CONCLUSIONS The extra direct costs associated with nosocomial CAUTI found in this prospect i ve study , which was done in the era of managed care during the late 1990s , are substantially lower than those reported in the largest comparable studies done more than 15 years ago , most of which were retrospective , reflecting the powerful impact of cost-containment measures that are now implemented in managed care To clarify the financial incentives for hospitals to prevent nosocomial infections , we analyzed 9423 nosocomial infections identified in 169 526 admissions selected r and omly from the adult admissions to a r and om sample of US hospitals . By classifying each admission into a baseline diagnosis related group ( DRG ) ( after first excluding all diagnoses of nosocomial infection ) and a final DRG ( after including these diagnoses ) , we found that only 5 % to 18 % of nosocomial infections would have caused the admission to be reclassified to a higher-paying DRG , depending on the extent to which physicians recorded nosocomial infection diagnoses in patients ' medical records . The extra payment from the reclassification , averaged over all nosocomial infections , would have been no more than $ 93 per infection ( in 1985 reimbursement rates ) , constituting only 5 % of the hospitals ' costs for treating these infections . Thus , at least 95 % of the cost savings obtained from preventing nosocomial infections represents financial gains to the hospital In a prospect i ve study carried out in June 1979-April 1981 , 134 of 1,458 adult in patients at New Engl and Deaconess Hospital , Boston , Massachusetts , acquired 136 urinary tract infections during 1,474 indwelling bladder catheterizations . Multiple logistic regression analysis identified nine factors that were significantly associated with acquisition of infection : duration of catheterization , lack of systemic antibiotic during short catheter courses , lack of urinemeter drainage , female sex , diabetes mellitus , microbial colonization of the drainage bag , serum creatinine greater than 2 mg/dl at the time of catheterization , the reason for catheterization , and the use of catheters with sealed collection junctions when no antibiotic was administered . When potential risk factors were considered individually , without adjusting for the influence of 
    Output:
    
Conclusions : The cost of a CAUTI ranges widely depending on population , patient acuity , and cost perspective .