***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: Three variations in the mode of delivery of Dry Bed Training as a treatment for  nocturnal enuresis  were investigated . Twenty-three children , ranging in age from 4 to 14 , received dry bed training without the additional use of a urine alarm . Treatment variations included : ( a ) in-home training of parents and child , ( b ) office based training of parents and child , and ( c ) office based training of parents only . An additional 7 children served as a waiting list control during the first 8 weeks of the study . A wide variety of outcome measures showed improvement for the entire sample regardless of specific mode of delivery . Implication s for the treatment of enuresis using dry bed training and a number of critical method ological issues are discussed Abstract Bedwetting has been a major and unsolved problem for the severely retarded . To solve this problem , an intensive training program was design ed similar to a recently developed program for daytime toilet training of the retarded . Some distinctive features of the new procedure were frequent positive reinforcement for correct toileting , a negative reinforcer for accidents , positive practice in night time toileting , increased level of urination by forcing drinking , immediate detection of correct and incorrect toileting , and Positive Practice for accidents . Of twelve retarded adult bedwetters , the average bedwetter required only one night of intensive training . Several days of apparatus monitoring were used following the training but proved unnecessary for two-thirds of the trainees . Accidents were reduced by about 85 % during the first week after training , and almost entirely ( 95 % ) during the fifth week with no relapse during a 3 month follow-up . No reduction of accidents result ed when the same bedwetters were given a control procedure that provided no positive or negative reactions other than the sounding of an alarm upon bedwetting . The Dry-Bed procedure appears to be a very rapid solution to the problem of enuresis among the retarded and may be applicable to other difficult population s and also to normals Treatment of childhood enuresis requires a careful anamnesis , physical examination , urinalysis , and urine culture to determine if a subject is affected with functional or organic enuresis . Functional enuresis ( FE ) was present in the majority of our patients ( 168/204 ) . These 168 subjects , aged from 6 to 11 years , were r and omly divided into three therapy groups ( pharmacological therapy , behavioral therapy , and behavioral therapy with the aid of a personal computer ) . Our study shows that  behavioral therapy gave better results in FE than did pharmacological  therapy .  We point out the usefulness of combining bladder retention training and behavioral therapy to improve the general maturity and autonomous behavior of the child , and the result ant positive effects on his personality Ten years after continence training , 14 severely and profoundly mentally h and icapped individuals were found to have substantially maintained their improvements in bladder control . Completely independent self-initiated toileting had not been maintained , but the level of prompting to toilet was considerably less than before training . Those who had received intensive individual training fared much better than those who had received less intensive group training . Intensive individual training was found to be cost effective and result ed in very substantial savings in career time Abstract Enuresis has been treated with moderate effectiveness by the urine-alarm method which requires many weeks of training . The present procedure used a urine-alarm apparatus but added such features as training in inhibiting urination , positive reinforcement for correct urinations , training in rapid awakening , increased fluid intake , increased social motivation to be nonenuretic , self-correction of accidents , and practice in toileting . After one all-night training session , the 24 enuretic children averaged only two bedwettings before achieving fourteen consecutive dry nights and had no major relapses . Little or no reduction in bedwetting occurred within the first two weeks for matched-control enuretics who were given the st and ard urine-alarm training . The results of a control-procedure showed that the new procedure did not involve Pavlovian conditioning . The new method appears to be a more rapid , effective and different type of treatment for enuresis OBJECTIVE This study evaluated the impact of  child-focused information provision using a multimedia software package ' All About Nocturnal Enuresis ' and written leaflets containing the same information for bedwetting children . DESIGN A stratified cluster r and omized controlled trial with data on 270 children collected longitudinally . SETTING Fifteen school nurse-led community enuresis clinics in Leicestershire , UK . MAIN OUTCOME MEASURES The outcome measures were becoming and remaining dry and time to dry , non-attendance and dropout rates . The psychological measures completed by children were the impact of bedwetting and Coopersmith self-esteem scales . Parents completed the maternal tolerance scale . RESULTS No significant intervention effect was found for any of the outcome measures recorded during treatment , at discharge or six-months post discharge . CONCLUSIONS Multimedia educational programs and written leaflets are widely used to enable children to learn more about their health-related conditions . However , our result suggests that multimedia is no more effective than traditional material s at effecting health-related behavioural change Two experiments examined the significance of patient-therapist contact in the treatment of childhood nocturnal enuresis by behavioural methods . The first involving 45 enuretic children compared the effectiveness of the  st and ard urine-alarm conditioning procedure  when it is closely supervised as opposed to not supervised after the initial description of training . Results showed that adequate patient-therapist contact is necessary for the effective use of the  st and ard conditioning treatment .  One hundred and twenty children took part in the second experiment which compared st and ard conditioning with Dry-Bed Training ( DBT ) ( Azrin et al , 1974 ) administered under four different conditions — by the child 's parents at home , by a professional trainer at home , by a professional trainer in hospital and by the child 's parents without the adjunct of a conventional bed-buzzer device . DBT was superior to st and ard conditioning in terms of the proportion of bedwetters successfully treated and in terms of the speed of treatment .  DBT was equally effective under all conditions of administration except where it did not have the adjunct of a machine , in which case it was only marginally better than no treatment at all Three treatments for enuresis were evaluated : ( a ) immediate detection with a urine-sensing alarm with additional operant training procedures , ( b ) delayed detection with staff activating the alarm and conducting the procedures in the morning , and ( c ) yoked-schedule awakenings when the awakening times were determined by the performance of a r and omly matched participant from the immediate-detection group . Twenty seven people with mental retardation ( most profoundly or severely h and icapped ) , whose ages ranged from 13 to 29 years , participated . Nine of the participants were noncompliant with the linen changing and practice walks to the bathroom and thus did not receive consistent treatment . All 7 of the compliant members of the immediate-detection group improved , 2 of the delayed-detection group worsened while 2 improved , and 6 of 7 yoked awakenings participants improved . Improvement negatively correlated with the frequency of baseline bed-wetting . Several method ological issues are raised concerning enuresis treatment To extend availability of a behavioral treatment package for enuresis , two outcome studies compared the effectiveness of live versus videotape delivery . In Study 1,40 primary entireties were r and omly assigned to live or film delivery . Outcome was superior for the live delivery . Overall , pretreatment measures of family and child psychosocial adjustment failed to predict treatment response . The results were replicated with 18 children , and an impact assessment suggested that film delivery result ed in higher confidence of children in their parents but lower confidence of parents in their children . Delivery of treatments by videotape may provide a way to identify nonspecific factors in psychological interventions Two studies examined the effectiveness of the  body-worn alarm  in out-patient treatment of childhood nocturnal enuresis . The first involved 40 children , previously untreated by conditioning methods , treated with either the body-worn alarm or the traditional pad and bell alarm .  The second study compared the body-worn alarm with modified dry-bed training with 48 children previously resistant to treatment . Results of both studies indicated the body-worn alarm  was as effective as other methods in terms of the proportion of children successfully treated and was superior with respect to rapidity of response and consumer appeal . Such findings indicate that the body-worn alarm could become the treatment of choice for nocturnal enuresis 
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REVIEW ER 'S CONCLUSIONS Although DBT and FSHT were better than no treatment when used in combination with an alarm , there was insufficient evidence to support their use without an alarm .
An alarm on its own was also better than DBT on its own , but there was some evidence that combining an alarm with DBT was better than an alarm on its own , suggesting that DBT may augment the effect of an alarm .
There was also some evidence that direct contact with a therapist might enhance the effects of an intervention