Evidence map›Paper›PMID 32839125›Full record

Trial reportJournal of the American Medical Directors Association2021

Nurse Decision-making for Suspected Urinary Tract Infections in Nursing Homes: Potential Targets to Reduce Antibiotic Overuse.

Anna Song Beeber, Christine E Kistler, Sheryl Zimmerman, Cassandra Dictus, Kimberly Ward, Claire Farel, Keith Chrzan, Christopher J Wretman, Marcella Boyton-Hansen, Michael Pignone and 1 more

Open access · greenAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of the American Medical Directors Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
2.0field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Review
  5. Review
  6. Article
  7. Article
  8. COVID-19 Vaccination and Implementation Science: How One Can Benefit the Other.Journal of the American Medical Directors Association · 2021
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 1 country.

Anna Song BeeberSchool of Nursing, University of North Carolina, Chapel Hill, NC, USA; The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA. Electronic address: asbeeber@email.unc.edu.
Christine E KistlerThe Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA; Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
Sheryl ZimmermanThe Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA; School of Social Work, University of North Carolina, Chapel Hill, NC, USA.
Cassandra DictusSchool of Nursing, University of North Carolina, Chapel Hill, NC, USA.
Kimberly WardThe Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA.
Claire FarelDepartment of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
Keith ChrzanSawtooth Analytics, Chesterton, IN, USA.
Christopher J WretmanThe Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA.
Marcella Boyton-HansenSchool of Public Health, University of North Carolina, Chapel Hill, NC, USA.
Michael PignoneSchool of Medicine, University of Texas, Austin, TX, USA.
Philip D SloaneThe Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA; Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
University of North Carolina at Chapel Hill · USThe University of Texas at Austin · US

Funding

INTERVENTIONS FOR PREVENTING &MANAGING CHRONIC ILLNESST32NR007091 · NINR · UNIV OF NORTH CAROLINA CHAPEL HILL · PI Cheryl L Giscombe, Cathi Barbra Propper · 1996 to 2026
$11.8M
Nurse and Physician Decision-making for Suspected Urinary Tract Infections in Nursing Homes: Potential Targets to Reduce Antibiotic OveruseR01HS024519 · AHRQ · UNIV OF NORTH CAROLINA CHAPEL HILL · PI KISTLER, CHRISTINE E · 2016 to 2018
$1.5M
AHRQ HHS R01 HS024519NINR NIH HHS T32 NR007091
6 · The paper itself

Abstract

objectivesTo determine what information is most important to registered nurses' (RNs) decisions to call clinicians about suspected urinary tract infections (UTIs) in nursing home residents.

designWeb-based discrete choice experiment with 19 clinical scenarios. SETTING AND

participantsOnline survey with a convenience sample of RNs (N = 881) recruited from a health care research panel.

methodsClinical scenarios used information from 10 categories of resident characteristics: UTI risk, resident type, functional status, mental status, lower urinary tract status, body temperature, physical examination, urinalysis, antibiotic request, and goals of care. Participants were randomized into 2 deliberation conditions (self-paced, n = 437 and forced deliberation, n = 444). The degree to which evidence- and non-evidence-based information was important to decision-making was estimated using unconditional multinomial logistic regression.

resultsFor all nurses (22.8%) and the self-paced group (24.1%), lower urinary tract status had the highest importance scores for the decision to call a clinician about a suspected UTI. For the forced-deliberation group, body temperature was most important (23.7%), and lower urinary tract status was less important (21%, P = .001). The information associated with the highest odds of an RN calling about a suspected UTI was painful or difficult urination [odds ratio (OR) 4.85, 95% confidence interval (CI) 4.16-5.65], obvious blood in urine (OR 4.66, 95% CI 3.99-5.44), and temperature at 101.5° (OR 3.80, 95% CI 3.28-4.42). For the self-paced group, painful or difficult urination (OR 5.65, 95% CI 4.53-7.04) had the highest odds, whereas obvious blood in urine (OR 4.39, 95% CI 3.53-5.47) had highest odds for the forced-deliberation group. CONCLUSIONS AND IMPLICATIONS: This study highlighted the importance of specific resident characteristics in nurse decision-making about suspected UTIs. Future antimicrobial stewardship efforts should aim to not only improve the previously studied overprescribing practices of clinicians, but to improve nurses' assessment of signs and symptoms of potential infections and how they weigh resident information.

Indexed as

Antimicrobial StewardshipUrinary Tract InfectionsAnti-Bacterial AgentsHumansNursing HomesUrinalysisAnti-Bacterial Agentsdecision-makingdiscrete choice experimentNursing carenursing homeurinary tract infection

Identifiers

PMID32839125
PMCPMC7944392
OpenAlexW3081057692

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.