Ramsey Coote In Instruments Bell and Pad System
Overview • Some History – Bell & Pad • RCI Research • RCI Approach – include Validation of Cleaning Bed-pad • Conclusion & Questions
Ramsey Coote In Instruments Background • Established in 1956 – over 60 years old • Manufactured & Developed in Australia • Leading practitioner based treatment in ANZ • Since then have had many innovations • Voucher Grant from Victorian State Government to assist Research project 2012 • TGA approved - Class One Device ARTG No:164989 • FDA approved late 2010, CE Mark 2014 • Attended The Simon Foundation Engineering Challenge April 2013- First Prize for Abstract of interim results • Presentation of interim results at 2014 CFA/ICCS meeting in Cairns, 2016 Kyoto, 2016 ERIC UK – won scientific prize in Kyoto and top 3 presentation at ERIC • Publication in Journal of Pediatrics Feb 2018, 211-216 Apos Et al. • Here to collaborate with practitioners and sell Ramsey Coote Systems to help children become dry at night
The bir irth of f Bell and Pad • First reported in 1904 by a German physician Pfaundler • Earliest patent recorded in 1905 • 1938 Prof Mowrer (Harvard University) and his wife developed the first “elegant” bedwetting alarm which consisted of a bell and mat and was run on a simple battery • Early design of the pad caused patients to develop rashes on buttocks and thighs, in severe cases ulceration from contact with the pad.
Meanwhile back in in Australia some years la later.. .... • The Bell and Pad was first developed by Peter Coote in 1952-4 (His wife was a nurse and her maiden name Ramsey) They had a family of 4 children all with bed wetting!! Didn’t like design of international products so worked on redesigning and innovating the bell and pad • Further innovated by Gordon Marshall to the current Ramsey Coote – around 20 versions (K models to PB models). • Ramsey Coote Bed Pad was very different from the other bed pads and was adopted locally by practitioners • Used extensively by Aus and NZ practitioners but not much overseas.
Bell and Pad alarms elsewhere UK etc ….. • In the UK, in the 70’s and 80’s a variety of bell and pad alarms available; most randomized controlled studies carried out using these alarms 1 • Efficacy (success = less than 4 wet nights in a 28 day period) of 9 UK bell and pad alarms said to be comparable (~50% effective) but the bed pads and battery were not long lasting 1 . 1. Goel KM, Thomson RB, Gibb EM, McAinsh TF. Evaluation of nine different types of enuresis alarms. Arch Dis Child 1984;59: 748-53.
Bell and Pad alarms elsewhere UK etc ….. 1. Meadow R. Help for bedwetting. Edinburgh:Churchill Livingstone,1980. 2. Fordham KE, Meadow SR. Controlled trial of standard pad and bell alarm against mini alarm for nocturnal enuresis. Arch Dis Child. 1989;64(5):651- 656.
Ala larm rm Th Therapy In Internatio ionall lly – not t well accepted… • Although devices were available in the UK, Canada and US, reports in the 60s indicated they were not widely accepted by the medical fraternity and were considered a “barbarous contraption” • Considered “the last ditch effort for treating bedwetting” (Werry, 1966) • Late 80s, only 3% of US practitioners were using alarms (Foxman et al , 1986)
Body Worn Alarms • Early 1980s • Considered to be a ”revolution to the treatment of bedwetting”. • Only one randomized controlled study comparing the efficacy of a body worn alarm with a bell and pad (Fordham & Meadow, 1989) n = • Compared the Eastleigh alarm 29 with Mini Dri Night • Efficacy using both alarms over a 4 n = 27 month treatment period was similar (<50%) Fordham KE, Meadow SR. Controlled trial of standard pad and bell alarm against mini alarm for nocturnal enuresis. Arch Dis Child. 1989;64(5):651-656.
Body worn Alarms (cont’d) • Body Worn Alarms can be purchased directly by families usually for one treatment use • Caldwell et al 2015 - A randomised controlled trial of a code-word enuresis alarm • Of the 353 participants, 176 were assigned to the code-word alarm and 177 to control. • At 16 weeks, 54% in the experimental group and 47% in the control group had achieved a full response ( p=0.22) • (full response: ≥ 14 days dry)
Rese search: Enuresis is management in in Australi lian child ildren A retrospective review of 2861 patients treated with bell and pad alarm
Enuresis management in Australian children Dr S Gibb Royal Children’ s Hospital Melbourne RCH Ms S Whitaker Ballarat Health Service BHS Dr S Schuster & Dr E Apos Division of Health Sciences RMIT University RMIT Ms K Murphy Princess Margaret Hospital Perth PMH Dr John Golder Redlands Clinic, Brisbane Red Clinic Ms Beverley Leiper Craigieburn Community Health Service CHS Ms Linda Sullivan A Dry Bed – Private Nurse Practice ADB Prof. J Reece Australian College of Applied Psychology
Study Design • Retrospective multi-centre medical chart review • The study was approved by 4 HREC/IRBs (Primary HREC No: HREC/12/BHSSSJOG/111) • 7 clinical settings • 2 tertiary hospital outpatient clinics • 2 community continence clinics • a general practice • a private continence nurse practice • a university psychology teaching clinic
Study Design (cont’d) Population Study Outcomes • Healthy, developmentally normal • Primary outcome measure: • Time taken for children with children (male and female) between the ages of 6 and 15 years either primary or secondary NE to be dry for 14 11 months of age who: consecutive nights. This • Have no chronic medical measure is based on the ICCS conditions, guidelines. • Have no structural or neurological • Secondary outcome measure: bladder disorders, and • Determination of relapse rates • Have been treated for nocturnal enuresis using the Ramsey Coote bell and pad alarm treatment system .
Results • 72% of patients reported some hereditary link to NE. • Mean age at first treatment = 8.21 years. Boys slightly older than girls, but not significantly.
Results • Only 6% of patients reported some type of co-morbidity (ADD, autism, intellectual disability, conduct disorder). • Very few patients reported more than one co-morbidity
Results • Average number of days of alarm treatment across all 3671 treatments = 62.1 days • range 1 – 361 days • 8.8 weeks +/- 4.4weeks
SUCCESS RATE OVER MULTIPLE TREATMENTS No. of Patients Treatment with Outcome Success Data 2 nd 278 80% Treatment 3 rd 48 85.5% Treatment 4 th 11 54.6% Treatment 5 th 5 Treatment
Results SUCCESS RATE AND RELAPSE • 77% reported successful treatment after their first treatment • 23% relapse rate • Treatment time 8.8weeks +/- 4.4weeks • Can retreat using this system
Limitations of the Study • Retrospective so incomplete follow up with some patients. • Missing data from clinical records ~7% missing. • Assumption that families would return to the same clinic for treatment. • More research for base line treatment is required
Take Home Mess ssages for r Treatment with ith Ramsey Coote In Instruments Bell ll and Pad system • Very effective with no detrimental side effects • Worth persisting if 1 st treatment not successful • Not associated with age • Can be used effectively with children with LUTs and co morbidities
Conclusions fr from Research • The pad and bell conditioning alarm is widely used successfully in Australia • Large retrospective cohort study provides evidence for its efficacy in routine clinical practice. • Clinical guidelines will help to reduce variation in care pathways for alarm treatment for NE • Opportunity for international practitioners in NZ, USA, UK, IRE and others to purchase this proven treatment
Ramsey Coote Instruments Approach • For a successful treatment outcome the practitioner activities include: – Familiarisation with the alarm – Child-centered consultations – Using the alarm – Routine maintenance of alarm and bed-pad (cleaning) – Manufacturers repairs and servicing
Familiarisation of f Ramsey Coote System • Bell Control Unit – monitors the pad to detect the wetting by urine, the bell rings and the lights illuminate the bell’s position in the bedroom. • The PB timer also starts counting in seconds and minutes so will give the time it takes for the child to turn off the alarm. It is an objective outcome as the time decreases over the period of use of the alarm, until the child has dry nights.
Familiarisation of f Ramsey Coote System • The Bed-pad has braided nichrome wires and is the sensor for the bell. • The Battery charger is there to charge the batteries at least once a week. • Packaging – the box for the alarm control unit and battery charger and cover for the bed-pad.
Safety Rules ▪ Adult takes responsibility for charging the Alarm control unit. This can be done during the day for a period of up to 16 hours once a week. ▪ The charger be kept away from the child’s bedroom. ▪ The alarm will work once charged with out the charger attached. ▪ These rules ensure that the Alarm has no connection to electricity supply when in use
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