***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To use the Minimum Data Set ( MDS ) to describe the frequency and correlates of potentially treatable causes of urinary incontinence among a representative sample of American nursing home residents . To describe current management practice s of urinary incontinence in the same population . DESIGN Cross-sectional study using the data set that was part of the Health Care Financing Administration ( HCFA ) evaluation of the MDS . SETTING 270 Medicaid-certified nursing homes in 10 states . PARTICIPANTS A total of 2014 nursing home residents 60 years or older ( mean = 84.3 + /- 8.7 ) , 75.5 % women , 81.9 % white , who lived in a nursing home during the fall of 1990 were r and omly selected to sample a fixed number of residents for each facility based on facility size . MEASUREMENTS Incontinence was defined as the presence of at least two episodes of urinary leakage per week in the previous 2 weeks . Management techniques ( toileting , pads/briefs , catheters ) were those listed in the MDS . Potentially remediable causes of urinary incontinence available in the MDS were : medications ( antipsychotics , antidepressants , and antianxiety/hypnotics ) ; congestive heart failure ; diabetes mellitus ; pedal edema ; delirium ; depression ; and impairments in activities of daily living ( ADLs ) ( transferring , locomotion , dressing , toileting ; bedrails ; trunk restraints ; and chair restraints ) . RESULTS Forty-nine percent of residents were incontinent . Of these , 84.0 % were managed by pads/briefs , 38.7 % by scheduled toileting , 3.5 % by indwelling catheter , and 1.2 % by external catheter . Of the potentially reversible causes , bivariate analysis revealed associations ( P < .1 ) with use of antidepressants , antipsychotics , and antianxiety/hypnotics ; delirium ; bedrails ; trunk restraints ; chair restraints ; and ADL impairment . Dementia was also associated with incontinence ( P < .1 ) . Multivariate analysis revealed that urinary incontinence was independently associated with impairment in ADLs ( OR = 4.2 ; CI = 3.2,5.6 ) , dementia ( OR = 2.3;CI = 1.8,3.0 ) , restraints-trunk ( OR = 1.7 ; CI = 1.5,2.0 ) , chair ( OR = 1.4 ; CI = 1.2,1.6 ) , bedrails ( OR = 1.3 ; CI = 1.1,1.5 ) , and use of antianxiety/hypnotic medications  ( OR = .7;CI = .5,1.0 ) ( all P < .04 ) . CONCLUSIONS Current management practice s for urinary incontinence are inconsistent with advocated guidelines . These data also confirm the association between incontinence and several potentially remediable conditions and suggest that , even in the nursing home setting , urinary incontinence may respond to efforts to improve conditions not directly related to bladder function . This study underscores the need to examine the impact on urinary incontinence of strategies to address such conditions Background and Purpose — Urinary incontinence ( UI ) is a common and distressing problem after stroke . Although there is evidence of new , effective UI poststroke rehabilitation intervention , it is unknown whether occupational therapists ( OTs ) ’ and physical therapists ( PTs ) ’ actual practice s reflect best practice s. We sought to determine the extent to which OTs and PTs identify , assess , and treat UI after stroke and to identify personal and organizational predictors of UI problem identification , best- practice assessment , and intervention . Methods — Six hundred sixty-three OTs ( 93 % participation rate ) and 656 PTs ( 87 % participation rate ) working in stroke rehabilitation in Canada were r and omly selected and interviewed with a telephone-administered question naire . Each responded to a series of open-ended questions related to a generated case ( vignette ) of a typical client with stroke who was experiencing UI . Results — Only 39 % of OTs and 41 % of PTs identified UI after stroke as a problem . Fewer than 20 % of OTs and 15 % of PTs used  best- practice assessment s , and only 2 % of OTs and 3 % of PTs used  best- practice interventions .  Working in Ontario , having allocated learning time , and doing university teaching were among the variables explaining between 6 % and 9 % of the variability in UI identification and assessment . Conclusions — Canadian OTs and PTs do not routinely identify poststroke UI as a problem , and best- practice assessment s and interventions are underused OBJECTIVE To determine whether urinary incontinence per se and different types of urinary incontinence individually are associated with an increased risk of falls in those aged 70 years and over . To investigate whether the presence of urinary symptoms , poor quality of life and physical limitations in this population with urinary incontinence is associated with falls . DESIGN Study using data from the cross-sectional postal question naire undertaken in the Leicestershire Medical Research Council Incontinence Study . SETTING Leicestershire . PARTICIPANTS A total of 5,474 people aged 70 years or more living in the community r and omly selected from general practitioners ' lists . RESULTS Urinary incontinence and both urge and stress incontinence were positively related to falls ( P < 0.0001 , P < 0.001 and P = 0.007 , respectively ) . The larger the volume of urine lost , the greater the risk of falls ( P < 0.0001 ) . Falls were associated with the presence of urinary symptoms ( P = 0.01 or less ) , physical limitations ( P = 0.001 or less ) and having a poorer quality of life ( P = 0.004 or less ) in respondents with urinary incontinence . CONCLUSIONS An association has been shown between falling and urinary leakage including the previously unreported association with stress leakage . Falling and urinary incontinence were found to be associated with physical limitations and had an impact on quality of life Background Research evidence underpins best practice , but is not always used in healthcare . The Promoting Action on Research Implementation in Health Services ( PARIHS ) framework suggests that the nature of evidence , the context in which it is used , and whether those trying to use evidence are helped ( or facilitated ) affect the use of evidence . Urinary incontinence has a major effect on quality of life of older people , has a high prevalence , and is a key priority within European health and social care policy . Improving continence care has the potential to improve the quality of life for older people and reduce the costs associated with providing incontinence aids . Objectives This study aims to advance underst and ing about the contribution facilitation can make to implementing research findings into practice via : extending current knowledge of facilitation as a process for translating research evidence into practice ; evaluating the feasibility , effectiveness , and cost-effectiveness of two different models of facilitation in promoting the uptake of research evidence on continence management ; assessing the impact of context ual factors on the processes and outcomes of implementation ; and implementing a pro-active knowledge transfer and dissemination strategy to diffuse study findings to a wide policy and practice community . Setting and sample Four European countries , each with six long-term nursing care sites ( total 24 sites ) for people aged 60 years and over with documented urinary incontinence Methods and design Pragmatic r and omised controlled trial with three arms ( st and ard dissemination and two different programmes of facilitation ) , with embedded process and economic evaluation . The primary outcome is compliance with the continence recommendations . Secondary outcomes include proportion of residents with incontinence , incidence of incontinence-related dermatitis , urinary tract infections , and quality of life . Outcomes are assessed at baseline , then at 6 , 12 , 18 , and 24 months after the start of the facilitation interventions . Detailed context ual and process data are collected throughout , using interviews with staff , residents and next of kin , observations , assessment of context using the Alberta Context Tool , and documentary evidence . A realistic evaluation framework is used to develop explanatory theory about what works for whom in what circumstances . Trial registration Current Controlled Trials IS RCT N11598502 Background Urinary incontinence following acute stroke is common , affecting between 40%-60 % of people in hospital after a stroke . Despite the availability of clinical guidelines for urinary incontinence and urinary incontinence after stroke , national audit data suggest incontinence is often poorly managed . Conservative interventions ( e.g. bladder training , pelvic floor muscle training and prompted voiding ) have been shown to have some effect with participants in Cochrane systematic review s , but have not had their effectiveness demonstrated with stroke patients . Methods / Design A cluster r and omised controlled pilot trial design ed to assess the feasibility of a full-scale cluster r and omised trial and to provide preliminary evidence of the effectiveness and cost-effectiveness of a systematic voiding programme for the management of continence after stroke . Stroke services will be r and omised to receive the systematic voiding programme , the systematic voiding programme plus supported implementation , or usual care . The trial aims to recruit at least 780 participants in 12 stroke services ( 4 per arm ) . The primary outcome is presence/absence of incontinence at six weeks post-stroke . Secondary outcomes include frequency and severity of incontinence , quality of life and cost-utility . Outcomes will be measured at six weeks , three months and ( for participants recruited in the first three months ) twelve months after stroke . Process data will include rates of recruitment and retention and fidelity of intervention delivery . An integrated qualitative evaluation will be conducted in order to describe implementation and assist in explaining the potential mediators and modifiers of the process . Trial Registration IS RCT N : IS RCT Urinary incontinence occurring at least once weekly was found in 32 % of residents in 30 Local Authority Residential Homes for the Elderly . Incontinence was significantly commoner among female residents . One hundred and seventy-four incontinent residents were r and omly selected in order to assess the effect of medical intervention ( study group ) . A further 104 incontinent residents were selected to act as  controls  ( control group ) . The vast majority of the study group showed evidence of chronic brain failure  and 40 % had  impaired mobility . Almost half had been incontinent since admission . Urodynamic studies were required for management in only two ( 1.1 % ) . Most ( 93 % ) were managed in accordance with a clinical diagnosis of an unstable bladder . There was a reduction in daytime incontinence in 40 % of the study group , but this was matched by a reduction in 29 % of the control group and the difference was not significant . The reduction in nocturnal incontinence in 41 % of the treatment group was significantly different from 23 % of the control group ( P = 0.016 ) Background The case has been made for more and better theory-informed process evaluations within trials in an effort to facilitate insightful underst and ings of how interventions work . In this paper , we provide an explanation of implementation processes from one of the first national implementation research r and omized controlled trials with embedded process evaluation conducted within acute care , and a proposed extension to the Promoting Action on Research Implementation in Health Services ( PARIHS ) framework . Methods The PARIHS framework was prospect ively applied to guide decisions about intervention design , data collection , and analysis processes in a trial focussed on reducing peri-operative fasting times . In order to capture a holistic picture of implementation processes , the same data were collected across 19 participating hospitals irrespective of allocation to intervention . This paper reports on findings from data collected from a purposive sample of 151 staff and patients pre- and post-intervention . Data were analysed using content analysis within , and then across data sets . Results A robust and uncontested evidence base was a necessary , but not sufficient condition for practice change , in that individual staff and patient responses such as caution influenced decision making . The implementation context was challenging , in which individuals and teams were bounded by professional issues , communication challenges , power and a lack of clarity for the authority and responsibility for practice change . Progress was made in sites where processes were aligned with existing initiatives . Additionally , facilitators reported engaging in many intervention implementation activities , some of which result in practice changes , but not significant improvements to outcomes . Conclusions This study provided an opportunity for reflection on the comprehensiveness of the PARIHS framework . Consistent with the underlying tenant of PARIHS , a multi-faceted and dynamic story of implementation was evident . However , the prominent role that individuals played as part of the interaction between evidence and context is not currently explicit within the framework . We propose that successful implementation of evidence into practice is a planned facilitated process involving an interplay between individuals , evidence , and context to promote evidence -informed practice . This proposal will enhance the potential of the PARIHS framework for explanation , and ensure theoretical development both informs and responds to the evidence base for implementation . Trial registration IS RCT N18046709 - Peri-operative Implementation Study Evaluation ( PoISE ) One hundred thirty-three incontinent women in seven nursing homes were assigned r and omly to a 13-week behavior therapy program for urinary incontinence or to a control group that received usual incontinence-related care . The therapy became effective after 6 weeks of training . By the final month of training , the treatment women 's wet episodes had been reduced by 0.6 episodes per day , a 26 % reduction over baseline . This reduction in the number of wet episodes was statistically significant , both with respect to this group 's baseline levels of incontinence and in comparison with the performance of the control women . The number of wet episodes in the control group remained about the same throughout training and the 22-week follow-up period . The treatment women improved partly because they learned to request help , a response prompted and reinforced by the program . Trainees with a high frequency of incontinence during baseline , the more cogn 
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Urinary incontinence was the primary outcome in three review s with factors associated with the management of urinary incontinence the primary outcome for the other review s. CONCLUSION Toileting programmes , in particular prompted voiding , with use of incontinence pads are the main conservative behavioural approach for the management of incontinence and promotion of continence in this population with evidence of effectiveness in the short term .