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Cranberry is a very tart red berry used for sauce or juice. Extracts obtained from cranberries growing on numerous shrubs of genus Vaccinium are used for various purposes such as for the treatment of infections. One of the most important advantages of American cranberry extract (Vaccinium macrocarpon) is its use in preventing urinary tract infections (UTIs). It is one of the cost-effective treatment options for young and pregnant women. It can also help in decreasing pyuria and bacteriuria in elderly women (Barnoiu et al., 2015).
Significance
UTI is among the most commonly encountered infections originating in hospitals; therefore it is an important issue to consider by nurses. These infections are particularly found in catheterized patients including the patients of nephrostomy, bladder catheter, or urethral stent. Presence of catheters usually requires treatment with antibiotics; therefore, medical experts and researchers recommend prophylactic treatment of catheter-associated UTIs (Barnoiu et al., 2015).
Several natural products or foods have also been studied in the treatment of UTIs. Those products may include American cranberry, garlic, rice vinegar, preparation having horseradish and nasturtium, and Salvia Plebeia, a sage herb commonly found in Asia. American cranberry is among the best-studied natural preventative and therapeutic products for UTIs. However, studies showed mixed results of effectiveness of cranberry for UTIs. Various researchers have used different dosages as well as formulations on a small number of participants (Foxman & Buxton, 2013).Therefore, the beneficial effects of cranberry extract supplements in addition to prophylactic treatment for UTIs require more studies as it could be one of the cost-effective ways having less severe adverse effects as compared to antibiotics and other such therapeutic strategies (Barnoiu et al., 2015).
In order to study the effects of cranberry juice and its extracts on catheter-associated UTIs search was done on Google Scholar and PubMedCentral. Search terms for the research were “American cranberry”, “cranberry extract”, “prophylactic treatment”, and “catheter-associated UTI”. Studies that were published in and after 2012 were considered for this research. After performing the search, paper of Barnoiu et al., is reviewed (2015).
Research Study Summary
The study was performed to know the UTI rate of patients having a double-J stent (JJ) and going through the prophylactic treatment with cranberry extract. The amount of the extract given to the patients was 120mg per day, orally, until the removal of the catheter. In order to work on the patients, researchers performed a prospective trial on 62 patients. They compared the UTI rate of 31 patients having double-J catheter and getting American cranberry (120 mg) along with routine prophylactic therapy (i.e. treatment group) with the UTI rate of 31 patients having JJ catheter and getting routine prophylactic therapy (i.e. control group). Researchers also analyzed certain variables such as the number of days of the placement of catheter in the urinary tract, and the diagnosis and type of surgery performed (Barnoiu et al., 2015).
After performing the study, researchers found that the cranberry supplemented patient group had lower percentage of UTI as compared to the other group. However, cranberry extract is less effective as compared to antibiotic prophylaxis in premenopausal women, and shows few differences in other elderly women. Researchers concluded that American cranberry has an adjuvant effect in preventing UTI in patients having JJ catheter after surgery (Barnoiu et al., 2015).
Research Critique
Research by Barnoiu et al. (2015) is among the first studies to know the benefits of cranberry extract supplements along with prophylactic treatment with antibiotics. In the study, researchers have provided sufficient explanation in the abstract, and described the materials and methods in a good detail that can also help other researchers. They have also noted the statistical tests to validate the results.
The study also had some limitations. One of the limitations of the study was that it was open and single-center study in which there was no masking of the treatments. This could be the reason for less external validity, when taking the data for general population. Here, validity shows the accuracy of test measures. If the treatments are open and obvious, it can result in more placebo effects; thereby affecting the final outcomes and this could affect the validity. In this case, “construct validity” is especially affected, which is used to ensure that the outcomes are according to the intended measures (i.e. the construct) and not affected by other variables (University of Northern Iowa, 2006). In the study, researchers have not discussed the reliability. The study was performed on patients from December 2012 to September 2013, but the number of patients was small that is one of the reasons for decreased reliability of the outcomes of the study. Moreover, researchers have not performed any correlation (tests) to get correlation coefficients that is also decreasing the reliability of the results.
Another most important limitation of the study was that it was performed on a small number of people; thereby, decreasing its value to generalize the results for a larger population. Most of the participants of the study were older in age, whereas we can find the cases where patients of catheter-associated UTI can be of younger ages. This problem can also become a hindrance in the generalizability of the results.
In order to analyze the data, researchers used chi-square test to work on hypothesis. They also performed mean standard deviation as well as regression analysis for quantitative variables and frequency distribution for qualitative variables. They have also provided p-values for different variables. These statistical analyses are appropriate for performing the study and getting the results.
For determining the efficacy of cranberry extract supplement in catheter-associated UTIs, it is important to find evidence that can help in making clinical decisions, i.e. evidence based medicine. Researchers and experts have developed a system of classifying evidence, and that classification is referred to as the levels of evidence. Health care experts including physicians and nurses are, usually, encouraged getting the highest level of evidence for getting the answer of their clinical questions. For therapeutic studies, there are five levels of evidence in which first, second, and third level of evidence are further divided into sublevels (Burns, Rohrich, & Chung, 2011). In the present study, researchers worked with participants in an open clinical trial, and there was a controlled and randomized distribution of patients. Therefore, this study has “1B” level of evidence in which there is a randomized controlled trial having narrow confidence interval of 95% (Barnoiu et al., 2015).
Conclusion
Conclusively, this study shows that cranberry extract supplement can help the patients of catheter-associated UTIs, if it is given to the patients along with prophylactic treatment with antibiotics. However, it is important to consider that only cranberry juice or extracts are of little help in the treatment of infections.
Literature survey is also showing that further studies are required to know the efficacy of cranberry juice in a larger population, so that the results could be generalized. Studies can also be performed to know the effect of cranberry juice with various other antibiotics and treatment strategies. Research have also to be done to know the side effects or adverse effects that may result from the use of cranberry juice or extracts.
Implications for Nursing Practice
Nurses are among the most important health care providers in a society as they are in direct contact with most of the patients and their family members. Therefore, nurses have to consider all the possible and effective ways of dealing with the problems of patients. One of the most commonly encountered problems in hospitals is that of catheter-associated UTIs; so, nurses have to know the optimum way of dealing with this problem. Although studies on the efficacy of cranberry juice in the treatment of UTIs require more studies, but nurses can use it along with other evidence based medicines for increasing the efficiency of treatment. With the administration of cranberry extracts to patients, nurses can also reduce the incidences of UTIs, improve the health of patients, and eventually, decreasing the costs for healthcare structures (Cai et al., 2014).
References
Barnoiu, O., del Moral, J. S.-G., Sanchez-Martinez, N., Díaz-Molina, P., Flores-Sirvent, L., & Baena-González, V. (2015). American cranberry (proanthocyanidin 120mg): Its value for the prevention of urinary tract infections after ureteral catheter placement. Actas Urológicas Españolas (English Edition), 39(2), 112-117.
Burns, P. B., Rohrich, R. J., & Chung, K. C. (2011). The levels of evidence and their role in evidence-based medicine. Plastic and reconstructive surgery, 128(1), 305.
Cai, T., Caola, I., Tessarolo, F., Piccoli, F., D’Elia, C., Caciagli, P., . . . Mazzoli, S. (2014). Solidago, orthosiphon, birch and cranberry extracts can decrease microbial colonization and biofilm development in indwelling urinary catheter: a microbiologic and ultrastructural pilot study. World journal of urology, 32(4), 1007-1014.
Foxman, B., & Buxton, M. (2013). Alternative approaches to conventional treatment of acute uncomplicated urinary tract infection in women. Current infectious disease reports, 15(2), 124-129.
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