***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: Aim In a r and omized double‐blind study the therapeutic effect of a novel zinc – aluminium ointment was compared with placebo in patients with faecal incontinence OBJECTIVES To examine skin health outcomes of an exercise and incontinence intervention . DESIGN R and omized controlled trial with blinded assessment s of outcomes at three points over 8 months . SETTING Four nursing homes ( NHs ) . PARTICIPANTS One hundred ninety incontinent NH residents . INTERVENTION In the intervention group , research staff provided exercise and incontinence care every 2 hours from 8:00 a.m. to 4:30 p.m. ( total of four daily care episodes ) 5 days a week for 32 weeks . The control group received usual care from NH staff . MEASUREMENTS Perineal skin wetness and skin health outcomes ( primarily blanchable erythema and pressure ulcers ) as measured by direct assessment s by research staff , urinary and fecal incontinence frequency , and percentage of behavioral observations with resident engaged in st and ing or walking . RESULTS Intervention subjects were significantly better in urinary and fecal incontinence , physical activity , and skin wetness outcome measures than the control group . However , despite these improvements , differences in skin health measures were limited to the back distal perineal area , which included the sacral and trochanter regions . There was no difference between groups in the incidence rate of pressure ulcers as measured by research staff , even though those residents who improved the most on fecal incontinence showed improvement in pressure ulcers in one area . CONCLUSION A multifaceted intervention improved four risk factors related to skin health but did not translate into significant improvements in most measures of skin health . Even if they had adequate staffing re sources , NHs might not be able to improve skin health quality indicators significantly if they attempt to implement preventive interventions on all residents who are judged at risk because of their incontinence status Context Previous studies report that pressure ulcer classification and differentiation from incontinence associated dermatitis are difficult . Incorrect classification and differentiation result in incorrect prevention and treatment . Education is important to spread evidence -based insights about this topic and to improve classification skills . Aim To assess the effectiveness of the  Pressure Ulcer Classification ( PUCLAS ) education tool . PUCLAS was developed by the PUCLAS Workgroup of the European Pressure Ulcer Advisory Panel . Design R and omised controlled trial . Setting and participants A convenience sample of 1217 Belgian , Dutch , British and Portuguese nurses . Outcome measure Correct classification of pressure ulcer photographs and differentiation from photographs of incontinence-associated dermatitis . Results Baseline , 44.5 % of the photographs were classified correctly . In the post-test , the results in the intervention group were significantly higher ( 63.2 % ) compared with the control group ( 53.1 % ; p<0.001 ) . The percentage of correct assessment s of incontinence associated dermatitis ( IAD ) was 70.7 % in the intervention group and 35.6 % in the control group ( p<0.001 ) . The skill to differentiate IAD from pressure ulcers was significantly associated with the experimental intervention ( OR 4.07 , 95 % CI 3.21 to 5.15 , p<0.001 ) . Conclusion The PUCLAS tool improved pressure ulcer classification and IAD differentiation significantly Background Most older adults with urinary incontinence use absorbent pads . Because of exposure to moisture and chemical irritating substances in urine , the perineal skin region is always at risk for development of incontinence-associated dermatitis ( IAD ) . The aim of this study was to examine the efficacy of an improved absorbent pad against IAD . Methods A cluster r and omized controlled design was used to compare the efficacy of two absorbent pads .  Female in patients aged ≥65 years who had IAD and used an absorbent pad or diaper all day were enrolled . Healing rate of IAD and variables of skin barrier function such as skin pH and skin moisture were compared between the usual absorbent pad group ( n = 30 ) and the test absorbent pad group ( n = 30 ) . Results Thirteen patients ( 43.3 % ) from the test absorbent pad group and 4 patients ( 13.3 % ) from the usual absorbent pad group recovered completely from IAD . Moreover , the test absorbent pad group healed significantly faster than the usual absorbent pad group ( p = 0.009 ) . On the other h and , there were no significant differences between the two groups in skin barrier function . Conclusion The test absorbent pad for older adults with urinary incontinence might be more efficacious against IAD than usual absorbent pad . Trial registration UMIN-CTR : Soap and water and a no-rinse cleanser , with and without a moisture barrier , were examined for their effects as cleansing regimens on the perineal skin of 10 older female residents of an extended care facility . Each cleansing regimen was used for 3 weeks , with two weekly measurements obtained for erythema , pH , and transepidermal water loss . Results indicated that soap and water was the least efficacious regimen unless used with a moisture barrier . The no-rinse cleanser was better than soap and water in terms of skin effects and cost savings . The findings suggest that a no-rinse cleanser in conjunction with a moisture barrier is a more skin-preserving and cost-effective incontinence care cleansing regimen than soap and water for older female nursing home residents with incontinence PURPOSE : The purpose of this study was to measure the effect of a structured skin care regimen for critically ill patients with fecal incontinence . DESIGN : A nonr and omized , quasi-experimental research design ( comparison cohort ) was used for data collection . SUBJECTS AND SETTING : Seventy-six patients with fecal incontinence , Bristol stool form 5 , 6 , and 7 , and Braden Scale score of 16 or less in the intensive care units ( ICUs ) at Samsung Medical Center in Seoul , South Korea , participated in the study . METHODS : Of the 76 subjects enrolled , 38 were assigned to the experimental group and 38 to the control group . Participants in the active intervention group were being cared for in an ICU ; participants in the comparison group were cared for on cardiac , thoracic surgery , general surgery , and neurosurgical ICUs . A structured skin care regimen was developed and implemented , which included the regular use of a no-rinse skin cleanser , application of a skin protectant , and an indwelling fecal drainage system when indicated . Stool consistency was evaluated via the Bristol stool chart . Nurses trained in data collection determined Incontinence-Associated Dermatitis and its Severity ( IADS ) scores and assessed the perianal and sacral skin for occurrence of pressure ulcers daily over a 7-day period . RESULTS : Patients in the intervention group had significantly lower IADS scores ( t = 4.836 , P < .001 ) than subjects in the control group and were less likely to develop a pressure ulcer than were patients in the control group ( 5 vs 19 , & khgr;2 = 11.936 , P = .001 ) . Patients with higher IADS scores were significantly more likely to develop a pressure ulcer ( OR = 1.168 , 95%CI = 1.074–1.271 ) . CONCLUSION : A structured skin care regimen  decreased IADS scores and occurrence of pressure ulcers . Higher IADS scores were associated with an increased risk for development of pressure ulcers Maintaining healthy , intact perineal skin in nursing home residents with incontinence is a challenge . Their condition puts them at risk for developing incontinence dermatitis , possibly predisposing them to develop pressure ulcers . To examine the cost-effectiveness of three perineal skin barriers ( a polymer-based barrier film and two petrolatum ointments ) used to prevent incontinence dermatitis , a 6-month descriptive study was conducted among residents ( N = 250 ) from four long-term care facilities ( nursing homes ) in the upper Midwestern US . All residents were incontinent and had intact perineal skin when they enrolled in the study . An economic analysis was performed using time-motion data from a convenience sample of enrolled residents and their caregivers . Residents had an average of 4.1 ( + /-2.307 ) incontinent episodes per day , the occurrence of incontinence dermatitis was 3.3 % and not significantly different between the different protocol s of care ( P = 0.4448 ) . Results of the economic analysis showed that daily barrier application costs ranged from $ 0.17 for the barrier film to $ 0.76 for the ointments evaluated . With labor included in the analysis , costs were also lower for the barrier film that required the least frequent application ( $ 0.26 ) compared to ointments that required more frequent application ( $ 1.40 ) . Results of this study suggest that the daily or three times weekly barrier film protocol s are affordable alternatives to using petrolatum ointments in the prevention of incontinence dermatitis PURPOSE : The purpose of this study was to compare 3 methods of bowel management to control fecal incontinence in adult critical care patients and their effect on incontinence-associated dermatitis , pressure ulcer prevalence , and clinician satisfaction . SUBJECTS AND SETTING : Fifty-nine adult patients in critical care with liquid fecal incontinence were recruited from 6 critical care units in a large Midwest healthcare system . METHODS : Subjects were r and omly assigned to 1 of 3 groups : bowel management system catheter , rectal/nasopharyngeal trumpet , or usual care . Subjects were assessed daily for incontinence-associated dermatitis , pressure ulcer prevalence , and other clinical data . Direct care nurse satisfaction with each method was evaluated by self-administered survey . RESULTS : Incontinence-associated dermatitis severity and pressure ulcer prevalence did not differ across groups at baseline . Over time , the change in incontinence-associated dermatitis severity score was significantly different across groups ( P < .001 ) . There were no significant differences in proportion of patients experiencing pressure ulcers during the study among groups . Clinicians reported significantly greater satisfaction with the bowel management system ( P = .007 ) and rectal trumpet ( P = .001 ) as compared to usual care . In addition , economic and safety benefits were identified with use of internal fecal devices . Specifically , an economic savings of $ 3100 to $ 3400 per 29 days of care was identified . Subjects experienced no adverse side effects when internal devices were used . CONCLUSION : Results of this r and omized controlled trial provide new information for the care of patients with fecal incontinence in the critical care setting .  Incontinence-associated dermatitis severity scores differed across groups over time , pressure ulcer prevalence did not differ across groups over time , use of an internal device or bowel management system improved clinician satisfaction , and the use of internal fecal methods was more cost-effective than usual care Purpose To determine the cost and efficacy of 4 different regimens of incontinence-associated dermatitis ( IAD ) prevention in nursing home residents . Methods A multi-site open-label quasi-experimental study was conducted in 16 nursing homes stratified by location in 1 of 4 regions of the United States and r and omly selected . In 3 of the 4 regimens , a moisture barrier ointment or cream of different compositions was applied after each episode of incontinence , and in 1 regimen , a polymer-based barrier film was applied 3 times per week . All regimens used a pH-balanced moisturizing cleanser . Time and motion measures were documented for the amount of skin care products used ; the number , type , and time of caregivers performing IAD prevention care ; and the number and type of supplies used . Rates of incontinence in each nursing home were determined during a 3-day surveillance period . Results A total of 1,918 nursing home residents were screened , and 51 % ( n = 981 ) qualified for prospect i ve surveillance of incontinence dermatitis ; the majority were female ( 80.1 % ) and elderly ( 96 % ≥ 65 years old ) . A total of 78.6 % ( 771/981 ) of the participants were incontinent of both urine and feces . Compared to the 3 regimens in which a barrier was applied after each episode of incontinence , the use of a regimen in which a barrier film was applied 3 times weekly had significantly lower costs for the barrier product , labor associated with barrier application , and total cost , which included products , labor , and supplies . There were also savings in total product ( cleanser and barrier ) and total labor costs . Conclusions The use of a defined skin care regimen that includes a cleanser and a moisture barrier is associated with a low rate of IAD in nursing home residents who are incontinent . Use of a polymer skin barrier film 3 times weekly is effective for preventing incontinence-associated skin breakdown and can provide significant cost savings 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 , 
    Output:
    
Findings from the other trials , all being of low to very low quality , suggest that applying a leave-on product ( moisturiser , skin protectant , or a combination ) might be more effective than not applying a leave-on product .
AUTHORS ' CONCLUSIONS Little evidence , of very low to moderate quality , exists on the effects of interventions for preventing and treating IAD in adults .
Soap and water performed poorly in the prevention and treatment of IAD .
Application of leave-on products ( moisturisers , skin protectants , or a combination ) and avoiding soap seems to be more effective than withholding these products .
The performance of leave-on products depends on the combination of ingredients , the overall formulation and the usage ( e.g. amount applied ) .