Biofeedback training for lower urinary tract symptoms: factors affecting efficacy.

PURPOSE: Biofeedback therapy is a valuable modality in children with dysfunctional voiding. However, it is unclear what factors contribute to the outcome. To define who may or may not benefit from biofeedback therapy we reviewed our experience with this treatment. MATERIALS AND METHODS: We retrospectively reviewed the charts of 77 children referred between July 2005 and September 2008 for biofeedback therapy. An MR 20 Synergy trainer (Prometheus Group, Dover, New Hampshire) provided nonanimated and animated biofeedback. Uroflowmetry was performed at the start and end of each session. A total of 67 females and 10 males with a mean age of 9.0 years (range 4.8 to 18.2) comprised the cohort group. The primary referral diagnosis was nonfebrile urinary tract infection in 52 patients (67.5%), daytime and nighttime wetting in 47 (61%), voiding postponement in 14 (18.2%) and daytime incontinence in 10 (13%). Children were categorized by an outcome of success, improvement or failure. Results were analyzed using the chi-square, Fisher exact probability and Student t tests. RESULTS: Success, improvement and failure were achieved in 22 (26.8%), 29 (37.7%) and 26 cases (33.7%), respectively. Age and gender were not statistically significant predictors of outcome. A median of 3.0 sessions (range 1 to 8) was administered. Children with 3 or greater sessions were more likely to succeed (p <0.005). The improvement in urinary tract infections was statistically significant (p <0.001). Of 37 children 20 (54%) transformed a staccato voiding pattern to a normal one on uroflowmetry. CONCLUSIONS: Biofeedback therapy can be effective in children with dysfunctional voiding and urinary tract infection. Children with a staccato voiding pattern may require a minimum of 3 visits to improve the voiding pattern. Children who complete 3 sessions are more likely to succeed.

Implementation of an established algorithm and modifications for the identification of epilepsy patients in the veterans health administration.

Identification of epilepsy patients from administrative data in large managed healthcare organizations is a challenging task. The objectives of this report are to describe the implementation of an established algorithm and different modifications for the estimation of epilepsy prevalence in the Veterans Health Administration (VHA). For the prevalence estimation during a given time period patients prescribed anti-epileptic drugs and having seizure diagnoses on clinical encounters were identified. In contrast to the established algorithm, which required inclusion of diagnoses data from the time period of interest only, variants were tested by considering diagnoses data beyond prevalence period for improving sensitivity. One variant excluded data from diagnostic EEG and LTM clinics to improve specificity. Another modification also required documentation of seizures on the problem list (electronic list of patients' established diagnoses). Of the variants tested, the one excluding information from diagnostic clinics and extending time beyond base period of interest for clinical encounters was determined to be superior. It can be inferred that the number of patients receiving care for epilepsy in the VHA ranges between 74,000 and 87,000. In the wake of the recent implementation of ICD-10 codes in the VHA, minor tweaks are needed for future prevalence estimation due to significant efforts presented. This review is not only beneficial for researchers interested in VHA related data but can also be helpful for managed healthcare organizations involved in epilepsy care aiming at accurate identification of patients from large administrative databases.

Characteristics of Veterans diagnosed with seizures within Veterans Health Administration.

The purpose of this report is to describe the demographics of Veterans diagnosed with seizures and taking antiepileptic drugs (AEDs) within the Veterans Health Administration (VHA) during fiscal year (FY) 2011 (October 1, 2010, to September 30, 2011), particularly with regard to comorbid traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). Information collected included age; sex; Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn (OIF/OEF/OND) status; and relevant encounter diagnosis codes for seizures, TBI, and PTSD. During FY11, 87,377 Veterans with seizures on AEDs were managed within the VHA. Prevalence was 15.5 per 1,000, and annual incidence was 148.2 per 100,000. The percentages of comorbid TBI and PTSD were 15.8% and 24.1%, respectively. For OIF/OEF/OND Veterans, these percentages increased to 52.6% and 70.4%, respectively. PTSD and TBI are risk factors for both epilepsy and psychogenic nonepileptic seizures. Within the VHA, many Veterans experiencing seizures cannot be successfully treated with AEDs. The VHA Epilepsy Centers of Excellence promotes a multidisciplinary approach to increase and improve access to both epilepsy and mental health specialists for the care of epileptic and nonepileptic seizures.