IntroductionHarm from catheter-associated urinary tract infections is a common, potentially avoidable, healthcare complication. Variation in catheter prevalence may exist and provide opportunity for reducing harm, yet to date is poorly understood. This study aimed to determine variation in the prevalence of urinary catheters between patient groups, settings, specialities and over time.MethodsA prospective study (July 2012 to April 2016) of National Health Service (NHS) patients surveyed by healthcare professionals, following a standardised protocol to determine the presence of a urinary catheter and duration of use, on 1 day per month using the NHS Safety Thermometer.Results1314 organisations (253 NHS trusts) and 9 266 284 patients were included. Overall, 12.9% of patients were catheterised, but utilisation varied. There was higher utilisation of catheters in males (15.7% vs 10.7% p<0.001) and younger people (18–70 year 14.0% vs >70 year 12.8% p<0.001), utilisation was highest in hospital settings (18.6% p<0.001), particularly in critical care (76.6% p<0.001). Most catheters had been in situ <28 days (72.9% p<0.001). No clinically significant changes were seen over time in any setting or specialty.ConclusionCatheter prevalence in patients receiving NHS-funded care varies according to gender, age, setting and specialty, being most prevalent in males, younger people, hospitals and critical care. Utilisation has changed only marginally over 46 months, and further guidance is indicated to provide clarity for clinicians on the insertion and removal of catheters to supplement the existing guidance on care.
If code is law then standards bodies are governments. This flawed but powerful metaphor suggests the need to examine more closely those standards bodies that are defining standards for the Internet. In this paper we examine the International Telecommunications Union, the Institute for Electrical and Electronics Engineers Standards Association, the Internet Engineering Task Force, and the World Wide Web Consortium. We compare the organizations on the basis of participation, transparency, authority, openness, security and interoperability. We conclude that the IETF and the W3C are becoming increasingly similar. We also conclude that the classical distinction between standards and implementations is decreasingly useful as standards are embodies in code -itself a form of speech or documentation. Recent Internet standards bodies have flourished in part by discarding or modifying the implementation/standards distinction. We illustrate that no single model is superior on all dimensions. The IETF is not effectively scaling, struggling with its explosive growth with the creation of thousands of working groups. The IETF coordinating body, the Internet Society, addressed growth by reorganization that removed democratic oversight. The W3C, initially the most closed, is becoming responsive to criticism and now includes open code participants. The IEEE SA and ITU have institutional controls appropriate for hardware but too constraining for code. Each organization has much to learn from the others.
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