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The bell and pad conditioning alarm for nocturnal enuresis in Australia: a multicentre audit
Susie Gibb, MBBS, FRACP1, Shirley Whitaker, RN, B.Nursing, Grad. Cert. Health-Adv. Continence2, Sharynn Schuster, Ph.D, MAPS3, Kerry Murphy, RN Dip.Continence Post Grad Paediatrics (Cert.)4, Esther Apos, Ph.D3.
1Royal Children's Hospital, Melbourne, Australia, 2Ballarat Health Services, Ballarat, Australia, 3RMIT University, Melbourne, Australia, 4Princess Margaret Hospital for Children, Perth, Australia.

BACKGROUND: Bedwetting or Nocturnal Enuresis (NE) is a common and distressing condition that can impact negatively on a young person’s self esteem and social participation.
An enuresis alarm is the initial treatment of choice for children with uncomplicated NE in Australia. Our multi centre audit was designed to evaluate specifically the use of the bell and pad alarm for the treatment of children with Nocturnal Enuresis (NE) aged 6 to16 years.
METHODS: This is a retrospective chart review. 1500 clinical records have been analysed to date. The total study will involve 3000 records across a variety of clinical settings: hospital outpatients, a community continence clinic, a general practice and a psychology clinic. We aim to evaluate both the treatment protocols used and the results of bell and pad treatment.
RESULTS: We will present the results from the first 1500 (61.5% male, 38.5% female) records. 318 records are from a community continence service and the remainder from a hospital outpatient service. The overall success rate ( 14 consecutive dry nights) of the bell and pad treatment was 73% and the relapse rate was 19% (8% incomplete records). After a second treatment course the success rate was 87%. We will present data comparing treatment response across sub groups: age, gender, NE type, concurrent bowel dysfunction and comorbidities including attention deficit disorder, autism spectrum disorder and intellectual disability. Data also allows a comparison of clinical practice between healthcare settings and analysis will determine whether this has an impact on outcome.
CONCLUSIONS: This large retrospective audit will inform the development of evidence-based guidelines with prognostic information and practical tools to assist practitioners and families in their use of bell and pad treatment. This will be a valuable resource to assist in delivering a standardised care pathway. This will in turn assist in the design of future prospective comparative treatment trials.

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