***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 
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    Input: Background Hospitalized patients frequently have urinary catheters inserted for inappropriate reasons . This can lead to urinary tract infections and other complications . Objective To assess whether stop orders for indwelling urinary catheters reduces the duration of inappropriate urinary catheterization and the incidence of urinary tract infections . Design A r and omized controlled trial was conducted in three tertiary-care hospitals in Ontario , Canada . Patients with indwelling urinary catheters were r and omized to prewritten orders for the removal of urinary catheters if specified criteria were not present or to usual care . Participants Six hundred ninety-two hospitalized patients admitted to hospital with indwelling urinary catheters inserted for ≤48 h. Measurements The main outcomes included days of inappropriate indwelling catheter use , total days of catheter use , frequency of urinary tract infection , and catheter reinsertions . Results There were fewer days of inappropriate and total urinary catheter use in the stop-order group than in the usual care group ( difference −1.69 [ 95 % CI −1.23 to −2.15 ] , P < 0.001 and −1.34 days , [ 95 % CI , −0.64 to −2.05 days ] , P < 0.001 , respectively ) . Urinary tract infections occurred in 19.0 % of the stop-order group and 20.2 % of the usual care group , relative risk 0.94 ( 95 % CI , 0.66 to 1.33 ) , P = 0.71 . Catheter reinsertion occurred in 8.6 % of the stop-order group and 7.0 % in the usual care group , relative risk 1.23 ( 95 % CI , 0.72 to 2.11 ) , P = 0.45 . Conclusions Stop orders for urinary catheterization safely reduced duration of inappropriate urinary catheterization in hospitalized patients but did not reduce urinary tract infections PURPOSE To our knowledge risk factors for urinary tract infection associated with various drainage methods in patients with spinal cord injury have never been evaluated overall in the acute period . We identified the incidence and risk factors associated with urinary tract infection in spinal cord injured patients . MATERIAL S AND METHODS We prospect ively followed 128 patients at our spinal cord injury reference hospital for 38 months and obtained certain data , including demographic characteristics , associated factors , methods of urinary drainage , bladder type , urological complications and predisposing factors of each infection episode . Logistic regression modeling was done to analyze variables and identify risk factors that predicted urinary tract infection . RESULTS Of 128 patients 100 ( 78 % ) were male with a mean age plus or minus st and ard deviation of 32 + /- 14.52 years . All patients had a nonfatal condition by McCabe and Jackson guidelines , and 47 % presented with associated factors . The incidence of urinary tract infection was expressed as number episodes per 100 patients daily or person-days . The overall incidence of urinary tract infection was 0.68 , while for male indwelling , clean intermittent , condom and female suprapubic catheterization , and normal voiding the rate was 2.72 , 0.41 , 0.36 , 0 . 34 and 0.06 , respectively . The risk factors associated with urinary tract infection were invasive procedures without antibiotic prophylaxis , cervical injury and chronic catheterization ( odds ratio 2.62 , 3 and 4 , respectively ) . Risk factors associated with repeat infection were a functional independence measure score of less than 74 and vesicoureteral reflux ( odds ratio 10 and 23 , respectively ) . CONCLUSIONS Spinal cord injured patients with complete dependence and vesicoureteral reflux are at highest risk for urinary tract infection We surveyed the extensive literature regarding the development , therapy and prevention of  catheter-associated urinary tract infections ( UTIs ) .  We systematic ally search ed for meta-analyses of r and omised controlled trials available in Medline giving preference to the Cochrane Central Register of Controlled Trials and also considered other relevant publications , rating them on the basis of their quality . The studies ’ recommendations , rated according to a modification of the US Department of Health and Human Services ( 1992 ) , give a close-to- evidence based guideline for all medical disciplines , with special emphasis on urology where catheter care is an important issue . The survey found that the urinary tract is the commonest source of nosocomial infection , particularly when the bladder is catheterised ( IIa ) . Most catheter-associated UTIs are derived from the patient ’s own colonic flora ( IIb ) and the catheter predisposes to UTI in several ways . The most important risk factor for the development of catheter-associated bacteriuria is the duration of catheterisation ( IIa ) . Most episodes of short-term catheter-associated bacteriuria are asymptomatic and are caused by a single organism ( IIa ) . Further organisms tend to be acquired by patients catheterised for more than 30 days . The clinician should be aware of two priorities : the catheter system should remain closed and the duration of catheterisation should be minimal ( A ) . While the catheter is in place , systemic antimicrobial treatment of asymptomatic catheter-associated bacteriuria is not recommended ( A ) , except for some special cases . Routine urine culture in an asymptomatic catheterised patient is also not recommended ( C ) because treatment is in general not necessary . Antibiotic treatment is recommended only for symptomatic infection ( B ) . Long-term antibiotic suppressive therapy is not effective ( A ) . Antibiotic irrigation of the catheter and bladder is of no advantage ( A ) . Routine urine cultures are not recommended if the catheter is draining properly ( C ) . A minority of patients can be managed with the use of the non-return ( flip ) valve catheter , avoiding the closed drainage bag . Such patients may exchange the convenience of on-dem and drainage with an increased risk of infection .  Patients with urethral catheters in place for 10 years or more should be screened annually for bladder cancer ( C ) . Clinicians should always consider alternatives to indwelling urethral catheters that are less prone to causing symptomatic infection . In appropriate patients , suprapubic catheters , condom drainage systems and intermittent catheterisation are each preferable to indwelling urethral catheterisation ( B ) The Braden Scale for Predicting  Pressure Sore  Risk was developed to foster early identification of patients at risk for forming pressure sores . The scale is composed of six subscales that reflect sensory perception , skin moisture , activity , mobility , friction and shear , and nutritional status . Content and construct validity were established by expert opinion and empirical testing . Three studies of reliability are reported here , using raters who varied in level of educational preparation and geographic region . Two prospect i ve studies of predictive validity were completed to determine the scale 's sensitivity and specificity . Reliability ranged from r = .83 to r = .94 for nurses ' aides and licensed practical nurses ; when used by registered nurses , the reliability increased to r = .99 . Predictive validity was calculated for each cut-off point of the scale . Using a cutoff point of 16 , sensitivity was 100 % in both studies . Specificity ranged from 64 % to 90 % . This instrument has highly satisfactory reliability when used by RNs , and greater sensitivity and specificity than instruments previously reported The st and ard way to assess medical technologies is to conduct a r and omized clinical trial . Patients are r and omly assigned to groups receiving alternative treatments , and outcomes are monitored over a long period of time . For example , some victims of left main coronary artery disease may undergo coronary artery bypass surgery , and others may receive medical treatment with nitroglycerine and beta blockers . Comparison of five-year mortality and morbidity in the two groups helps to determine the relative appropriateness of the two procedures . In addition , information about quality of life and cost can also be collected and compared Background : Nosocomial infections occur in approximately 10 % of patients in intensive care units ( ICUs ) . Several studies have shown that a quality improvement initiative can reduce nosocomial infections , mortality , and cost . Context : Our hospital is located in Northern Mississippi and has a 28 bed Medical-Surgical ICU unit with 95 % occupancy . We joined the ICU collaborative with the IMPACT initiative of the Institute of Healthcare Improvement ( IHI ) in October 2002 . A preliminary prospect i ve before ( fiscal year ( FY ) 2001–2 ) and after ( FY 2003 ) hypothesis generating study was conducted of outcomes result ing from small tests of change in the management of ICU patients . Key measures for improvement : Nosocomial infection rates , adverse events per ICU day , average length of stay , and average cost per ICU episode . Strategy for change : Four changes were implemented : ( 1 ) physician led multidisciplinary rounds ; ( 2 ) daily “ flow ” meeting to assess bed availability ; ( 3 ) “ bundles ” ( sets of evidence based best practice s ) ; and ( 4 ) culture changes with a focus on the team decision making process . Effects of change : Between baseline and re-measurement periods , nosocomial infection rates declined for ventilator associated pneumonia ( from 7.5 to 3.2 per 1000 ventilator days , p = 0.04 ) and bloodstream infections ( from 5.9 to 3.1 per 1000 line days , p = 0.03 ) , with a downward trend in the rate of urinary tract infections ( from 3.8 to 2.4 per 1000 catheter days , p = 0.17 ) . There was a strong downward trend in the rates of adverse events in the ICU as well as the average length of stay per episode . From FY 2002 to FY 2003 the cost per ICU episode fell from $ 3406 to $ 2973 . Lessons learned : A systematic approach through collaboration with IHI ’s IMPACT initiative may have contributed to significant improvements in care in the ICU setting . Multidisciplinary teams appeared to improve communication , and bundles provided consistency of evidence based practice s. The flow meetings allowed for rapid prioritization of activity and a new decision making culture empowered team members . The impact of these changes needs to be assessed more widely using rigorous study design OBJECTIVES To compare the use of intermittent and indwelling catheterization in older female patients with urinary retention . METHODS A r and omized , 2-week prospect i ve study in a geriatric rehabilitation ward . Female patients of age 65 years and older with post-voiding residual urine volume ( PVRU ) persistently > or = 300 ml were r and omly assigned to one of the two groups : intermittent catheterization ( IMC group , n=36 ) and indwelling catheterization ( IDC group , n=45 ) . The primary outcome was the proportion of subjects being catheter-free and had a PVRU < 150 ml on day 14 . The secondary outcomes were the time to become catheter-free and the rate of bacteriuria on day 14 . RESULTS Sixteen out of 27 ( 59.3 % ) in the IMC group versus 27 out of 39 ( 69.2 % ) in the IDC group achieved the primary outcome on day 14 ( P=.403 ) without significant difference in the PVRU . The IMC and IDC groups took a mean of 8.6+/-3.3 and 9.2+/-4.0 days to become catheter-free , respectively ( P=.609 ) . Fourteen out of 22 ( 63.6 % ) in the IMC group versus 21 out of 34 ( 61.8 % ) in the IDC group had bacteriuria on day 14 ( P=.888 ) . CONCLUSION Given the similar success rate of regaining bladder voiding function , the similar rate of bacteriuria and considering that the IMC group only underwent a median of 3 times of intermittent catheterization , we believe that the approach of intermittent urinary catheterization when required would be justified in managing elderly female urinary retention in rehabilitation ward as the presence of indwelling catheters would hinder rehabilitation and adversely affect patient quality of life OBJECTIVES To compare condom and indwelling urinary catheters in terms of infection risk and patient satisfaction . DESIGN A prospect i ve , r and omized , unblinded , controlled trial . SETTING An academically affiliated Veterans Affairs Medical Center . PARTICIPANTS Hospitalized men aged 40 and older who required a urinary collection device . MEASUREMENTS The incidence of adverse outcomes ( bacteriuria , symptomatic urinary tract infection ( UTI ) , or death ) and patient device-related satisfaction as determined according to a question naire . Dementia status was recorded to assess effect modification by the presence of dementia . RESULTS Seventy-five subjects were r and omized : 41 receiving an indwelling catheter and 34 a condom catheter . The incidence of an adverse outcome was 131/1,000 patient-days with an indwelling catheter and 70/1,000 patient-days with a condom catheter ( P=.07 ) . The median time to an adverse event was 7 days in the indwelling group and 11 days in the condom group . After adjusting for other risk factors , it was found that condom catheter use reduced adverse outcomes ( P=.04 ) . Patients without dementia who had an indwelling catheter were approximately five times as likely to develop bacteriuria or symptomatic UTI or 
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In our experience as team members of the On the CUSP project and bedside clinicians caring for medical patients in university and Department of Veterans Affairs ( VA ) hospitals , urinary catheter use varies widely , even among clinicians and hospitals trying to implement similar appropriateness criteria ( 9 ) .
Specifically , in the On the CUSP project , urinary catheter use appears highest among hospitals in the Western United States ( 10 ) .