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r if bacterial infection is present in the lower respiratory tract (LE III-V). In patients with hip fracture and urinary tract infection (UTI), delaying surgery may provoke further complications (LE I). However, diabetic or immunocompromised patients may benefit from immediate antibiotic treatment. Cite this article Bone Joint Res 2020;9(12)884-893. We describe the item development and cognitive evaluation process used in creating the Prevention of Lower Urinary Tract Symptoms Bladder Health Instrument (PLUS-BHI). Questions assessin