115TRIAL WITHOUT CATHETER: THE ROLE OF BLADDER FILLING PRIOR TO REMOVAL OF URETHRAL CATHETERS. A SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS
Bibliographic record
Abstract
Scope: Urinary catheters are commonly used with hospital prevalence highest in patients over 70. In acute care, the risk of catheter-associated urinary tract infections significantly rises after two days with associated risks of sepsis, death, and estimated NHS costs of £1700/episode.[1] New initiatives are needed to minimise catheter-related harm including delirium and functional decline in older adults. Bladder filling with fluid prior to catheter removal presents a possible technique to facilitate early removal. However the clinical effectiveness of this procedure remains unclear. Search Methods: A systematic review of four databases (MEDLINE, EMBASE, CINAHL and The Cochrane Central Register) was conducted in February 2018 for RCTs of bladder filling procedures prior to catheter removal in adults, compared to standard care. Risk of bias was estimated using Cochrane guidelines and quality of evidence was assessed using the GRADE criteria. Results: 5893 studies were identified, four met eligibility criteria. All studies were small, indications for catheterisation were exclusively peri-operative or acute urinary retention. The majority of included patients were male. Age was documented in two studies, one reported a range of 45–87, the other a median of 70.5. We found some evidence to suggest that bladder filling procedures reduced the time to decision of TWOC outcome. There was inconsistent evidence regarding re-catheterisation rates and time to discharge. All studies had a high risk of bias with reported outcomes assessed to be of very low quality. Conclusion: There is no definitive evidence that bladder filling is superior to standard catheter removal procedures. Given the number of patients requiring this procedure, many of whom are older, defining the optimal protocol is important for quality, safety and cost. Further randomised controlled trials in relevant hospital and community populations are required.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.040 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.011 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.008 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".