***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: A clinical r and omized study ( posttest design ) was conducted to examine whether patient-centered care ( PCC ) impacts  patient satisfaction , perception of nursing care , and quality of care . Differences were seen in 2 of 3 subscales within the Baker and Taylor Measurement Scale .  The PCC group rated satisfaction ( P = .04 ) and quality of services ( P = .03 ) higher than controls .  PCC may impact patients ' perception of the level of satisfaction and quality of care received BACKGROUND Bathing assistance is a core element of essential care in nursing homes , yet little is known for quality of assisted bathing or its determinants . AIM To explore differences in completeness of assisted bathing in relation to bathing method and resident characteristics . METHODS Secondary analysis of a cluster r and omised trial including 500 nursing home residents design ed to compare traditional bathing methods for skin effects and cost-consequences ; GlinicalTrials.gov ID [ NCT01187732 ] . Logistic mixed modelling was used to relate resident characteristics and bathing method to bathing completeness . RESULTS Bathing completeness was highly variable over wards . Apart from a large effect for ward , logistic mixed modelling indicated bathing was more often complete in case of washing without water ( using disposable skin cleaning and caring material s ; estimate 2.55 , SE 0.17 , P < 0.0001 ) and less often complete in residents with dementia ( estimate -0.22 , SE 0.08 , P = 0.0040 ) . CONCLUSIONS Introduction of washing without water is likely to lead to more bathing completeness in nursing homes . However , inequity in care was also identified with a view to highly variable bathing completeness over wards and more incomplete bathing by care staff in residents with dementia . IMPLICATION S FOR PRACTICE Monitoring the performance of assisted bathing in nursing homes is indicated for the identification of undesirable variation in essential care and poorly performing teams . The introduction of washing without water could serve the promotion of bathing completeness in nursing homes overall , but will not solve inequity issues for residents PURPOSE The aim of this study was to explore the potential contribution to skin damage caused by st and ard washing and drying techniques used in nursing . DESIGN An experimental cohort design was used , with healthy volunteers ( n = 15 ) receiving 6 different washing and drying techniques to the volar aspect of the forearm . Subjects underwent 3 washing and drying techniques on each arm ; each technique was repeated twice , separated by a 2-hour rest period . METHODS Skin integrity was assessed by measuring transepidermal water loss ( TEWL ) , skin hydration , skin pH , and erythema . Comparisons were made between washing with soap or water alone , and drying using a towel ( rubbing and patting ) or evaporation . The significance of any difference was assessed by nonparametric analysis . The study was approved by the local research ethics committee , and all volunteers gave informed consent . RESULTS TEWL was seen to increase following each type of wash , and increased further following repeated washing . Drying of the skin by patting with a towel increased TEWL to give readings identical to those obtained from wet skin . There was an increase in skin pH with all washing and drying techniques , particularly when soap was used . Erythema also increased with repeated washing , particularly when soap was used . No significant changes were observed in skin hydration as measured by a corneometer , although there was a tendency for the values to decrease with washing . CONCLUSIONS These data suggest that washing with soap and water and towel drying has a significant disrupting effect on the skin 's barrier function . There is tentative evidence to suggest that a cumulative effect may exist with damage increasing as washing frequency increases . Drying the skin by patting with a towel offers no advantage to conventional gentle rubbing as it leaves the skin significantly wetter and at greater risk of frictional damage The objective of this study was to evaluate a new way for applying bed baths and reducing the risk for dry skin by comparing the effect of two washing methods on skin hydration . A cluster r and omized trial was conducted . Skin hydration was measured before and after implementation of disposable wash gloves , using a MoistureMeter SC at three skin sites . Total skin hydration did not differ between residents at the start of the study in both groups . After implementation , the post minus pre hydration scores were higher for the intervention group than the control group at all skin sites . However , the difference was only significant at cheek site . The use of disposable wash gloves does not increase the risk for dry skin in comparison with traditional washing methods . These results may encourage the introduction of disposable wash gloves as an innovation in daily skin care practice PURPOSE When cognitively impaired nursing home residents exhibit agitated and aggressive behaviors during bathing , nursing home caregivers are in a unique position to improve residents ' experience . This report addresses whether certified nursing assistants ( CNAs ) who received training in a person-centered approach with showering and with the towel bath showed improved caregiving behaviors ( gentleness and verbal support ) and experienced greater preparedness ( confidence and ease ) and less distress ( hassles ) when assisting residents with bathing . DESIGN AND METHODS We used a crossover design and r and omized 15 nursing homes into two treatment groups and a control group of 5 facilities each . In one treatment group , CNAs received person-centered training , first with showering for 6 weeks ( Time 1 ) and then with the towel bath for 6 weeks ( Time 2 ) . We reversed the treatment order in the other treatment group . Control group CNAs used usual showering procedures without person-centered training . We collected observational and self-report data at baseline and at the end of Time 1 and Time 2 on five caregiving outcomes . We analyzed data from 37 CNAs assisting 69 residents by using 3x2 repeated measures analyses of variance to compare the three groups on change from baseline . RESULTS Compared with the control group , treatment groups significantly improved in the use of gentleness and verbal support and in the perception of ease . IMPLICATION S A person-centered approach with showering and with the towel bath improved not only how care is given to residents who become agitated and aggressive during bathing but also how CNAs perceive their experience when bathing these residents OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND No-rinse disposable wash gloves are increasingly implemented in health care to replace traditional soap and water bed baths without proper evaluation of ( cost ) effectiveness . OBJECTIVES To compare bed baths for effects on skin integrity and resistance against bathing and costs . DESIGN Cluster r and omized trial . SETTING Fifty six nursing home wards in the Netherl and s. Participants : Five hundred adult care-dependent residents and 275 nurses from nursing home wards . METHODS The experimental condition ' washing without water ' consists of a bed bath with disposable wash gloves made of non-woven waffled fibers , saturated with a no-rinse , quickly vaporizing skin cleaning and caring lotion . The control condition is a traditional bed bath using soap , water , washcloths and towels . Both conditions were continued for 6 weeks . Outcome measures were prevalence of skin damage distinguished in two levels of severity : any skin abnormality/lesion and significant skin lesions . Additional outcomes : resistance during bed baths , costs . RESULTS Any skin abnormalities/lesions over time decreased slightly in the experimental group , and increased slightly in the control group , result ing in 72.7 % vs 77.6 % of residents having any skin abnormalities/lesions after 6 weeks , respectively ( p=0.04 ) . There were no differences in significant skin lesions or resistance after 6 weeks . Mean costs for bed baths during 6 weeks per resident were estimated at € 218.30 ( 95%CI 150.52 - 286.08 ) in the experimental group and € 232.20 ( 95%CI : 203.80 - 260.60 ) in the control group ( difference € 13.90 ( 95%CI : -25.61 - 53.42 ) . CONCLUSION Washing without water mildly protects from skin abnormalities/lesions , costs for preparing and performing bed baths do not differ from costs for traditional bed bathing . Thus , washing without water can be considered the more efficient alternative OBJECTIVES To evaluate the effectiveness of the Bathing Without a Battle intervention in reducing physical and verbal aggressive behaviors for nursing home residents with dementia . DESIGN A r and omized crossover diffusion study , with one group receiving the intervention after one round of baseline observations and a delayed intervention group receiving the intervention after two rounds of baseline observations . SETTING Six nursing home facilities in the state of New York . PARTICIPANTS Nursing home residents with dementia ( N = 240 ) . INTERVENTION The Bathing Without a Battle educational program , design ed for direct-care staff members responsible for bathing residents diagnosed with dementia and implemented through a train-the-trainer model . MEASUREMENTS Rates of verbal and physical aggressive and agitated behaviors were measured using the Care Recipient Behavior Assessment ; secondary measures of effect included bath duration , bath modality , and antipsychotic medication use . RESULTS In spite of implementation obstacles ( consent delays and change in leadership at one facility ) , a significant change was observed in how residents were bathed that translated into a significant reduction in the rate of aggressive and agitated behaviors , particularly verbal , during residents ' baths . The use of in-bed baths increased 17 % , and average bath duration decreased significantly ( average 1.5 minutes less ) in the postintervention period , particularly for in-bed baths . Verbal behaviors declined 17.8 % ( P = .008 ) , combined verbal and physical behaviors declined 18.6 % ( P = .004 ) , and antipsychotic use declined 30 % ( P = .002 ) after the intervention . CONCLUSION The Bathing Without a Battle educational program , delivered through a train-the-trainer format , is an effective means of improving the bathing experience of residents with dementia in nursing homes . This research supports broadly adopting this intervention , especially for nursing homes serving many residents with dementia BACKGROUND Nosocomial infections are a marked burden on the US health care system and are linked to a high number of patient deaths . OBJECTIVE To identify and quantify bacteria in patients ' bath basins and evaluate the basins as a possible reservoir for bacterial colonization and a risk factor for subsequent hospital-acquired infection . METHODS In a prospect i ve study at 3 acute care hospitals , 92 bath basins , including basins from 3 intensive care units , were evaluated .  Sterile culture sponges were used to obtain sample s from the basins . The culture sponges were sent to an outside laboratory , and qualitative and quantitative microbial tests were conducted and the results reported . RESULTS Some form of bacteria grew in 98 % of the sample s ( 90 sponges ) , either by plating or on enrichment ( 95 % confidence interval , 92%-99.7 % ) . The organisms with the highest positive rates of growth on enrichment were enterococci ( 54 % ) , gram-negative organisms ( 32 % ) , Staphylococcus aureus ( 23 % ) , vancomycin-resistant enterococci ( 13 % ) , methicillin-resistant S aureus ( 8 % ) , Pseudomonas aeruginosa ( 5 % ) , C and ida albicans ( 3 % ) , and Escherichia coli ( 2 % ) . Mean plate counts , in colony-forming units , were 10 187 for gram-negative organisms , 99 for E coli , 30 for P aeruginosa , 8 
    Output:
    
The results of these high quality studies show that washing without water performed better than the traditional bed bath regarding skin abnormalities and bathing completeness .
Conclusions There is limited moderate to high quality evidence that washing without water is not inferior to the traditional bed bath .