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Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols

PURPOSE: We quantified patient record documentation of sacral neuromodulation (SNM) threshold testing and programming parameters at our institution to identify opportunities to improve therapy outcomes and future SNM technologies. METHODS: A retrospective review was conducted using 127 records from...

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Autores principales: Hornung, Christopher M., Vasdev, Ranveer, Hanson, Kate A., Gotlieb, Rachael, Fok, Cynthia S., Fischer, John, Nakib, Nissrine A., Nelson, Dwight E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Continence Society 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9537436/
https://www.ncbi.nlm.nih.gov/pubmed/36203255
http://dx.doi.org/10.5213/inj.2244084.042
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author Hornung, Christopher M.
Vasdev, Ranveer
Hanson, Kate A.
Gotlieb, Rachael
Fok, Cynthia S.
Fischer, John
Nakib, Nissrine A.
Nelson, Dwight E.
author_facet Hornung, Christopher M.
Vasdev, Ranveer
Hanson, Kate A.
Gotlieb, Rachael
Fok, Cynthia S.
Fischer, John
Nakib, Nissrine A.
Nelson, Dwight E.
author_sort Hornung, Christopher M.
collection PubMed
description PURPOSE: We quantified patient record documentation of sacral neuromodulation (SNM) threshold testing and programming parameters at our institution to identify opportunities to improve therapy outcomes and future SNM technologies. METHODS: A retrospective review was conducted using 127 records from 40 SNM patients. Records were screened for SNM documentation including qualitative and quantitative data. The qualitative covered indirect references to threshold testing and the quantitative included efficacy descriptions and device programming used by the patient. Findings were categorized by visit type: percutaneous nerve evaluation (PNE), stage 1 (S1), permanent lead implantation, stage 2 (S2) permanent impulse generator implantation, device-related follow-up, or surgical removal. RESULTS: Documentation of threshold testing was more complete during initial implant visits (PNE and S1), less complete for S2 visits, and infrequent for follow-up clinical visits. Surgical motor thresholds were most often referred to using only qualitative comments such as “good response” (88%, 100% for PNE, S1) and less commonly included quantitative values (68%, 84%), locations of response (84%, 83%) or specific contacts used for testing (0%). S2 motor thresholds were less well documented with qualitative, quantitative, and anatomical location outcomes at 70%, 48%, and 36% respectively. Surgical notes did not include specific stimulation parameters or contacts used for tests. Postoperative sensory tests were often only qualitative (80%, 67% for PNE, S1) with quantitative values documented much less frequently (39%, 9%) and typically lacked sensory locations or electrode-specific results. For follow-up visits, <10% included quantitative sensory test outcomes. Few records (<7%) included device program settings recommended for therapy delivery and none included therapy-use logs. CONCLUSIONS: While evidence suggests contact and parameter-specific programming can improve SNM therapy outcomes, there is a major gap in the documentation of this data. More detailed testing and documentation could improve therapeutic options for parameter titration and provide design inputs for future technologies.
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spelling pubmed-95374362022-10-14 Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols Hornung, Christopher M. Vasdev, Ranveer Hanson, Kate A. Gotlieb, Rachael Fok, Cynthia S. Fischer, John Nakib, Nissrine A. Nelson, Dwight E. Int Neurourol J Original Article PURPOSE: We quantified patient record documentation of sacral neuromodulation (SNM) threshold testing and programming parameters at our institution to identify opportunities to improve therapy outcomes and future SNM technologies. METHODS: A retrospective review was conducted using 127 records from 40 SNM patients. Records were screened for SNM documentation including qualitative and quantitative data. The qualitative covered indirect references to threshold testing and the quantitative included efficacy descriptions and device programming used by the patient. Findings were categorized by visit type: percutaneous nerve evaluation (PNE), stage 1 (S1), permanent lead implantation, stage 2 (S2) permanent impulse generator implantation, device-related follow-up, or surgical removal. RESULTS: Documentation of threshold testing was more complete during initial implant visits (PNE and S1), less complete for S2 visits, and infrequent for follow-up clinical visits. Surgical motor thresholds were most often referred to using only qualitative comments such as “good response” (88%, 100% for PNE, S1) and less commonly included quantitative values (68%, 84%), locations of response (84%, 83%) or specific contacts used for testing (0%). S2 motor thresholds were less well documented with qualitative, quantitative, and anatomical location outcomes at 70%, 48%, and 36% respectively. Surgical notes did not include specific stimulation parameters or contacts used for tests. Postoperative sensory tests were often only qualitative (80%, 67% for PNE, S1) with quantitative values documented much less frequently (39%, 9%) and typically lacked sensory locations or electrode-specific results. For follow-up visits, <10% included quantitative sensory test outcomes. Few records (<7%) included device program settings recommended for therapy delivery and none included therapy-use logs. CONCLUSIONS: While evidence suggests contact and parameter-specific programming can improve SNM therapy outcomes, there is a major gap in the documentation of this data. More detailed testing and documentation could improve therapeutic options for parameter titration and provide design inputs for future technologies. Korean Continence Society 2022-09 2022-09-30 /pmc/articles/PMC9537436/ /pubmed/36203255 http://dx.doi.org/10.5213/inj.2244084.042 Text en Copyright © 2022 Korean Continence Society https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Hornung, Christopher M.
Vasdev, Ranveer
Hanson, Kate A.
Gotlieb, Rachael
Fok, Cynthia S.
Fischer, John
Nakib, Nissrine A.
Nelson, Dwight E.
Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols
title Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols
title_full Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols
title_fullStr Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols
title_full_unstemmed Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols
title_short Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols
title_sort data gap in sacral neuromodulation documentation: call to improve documentation protocols
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9537436/
https://www.ncbi.nlm.nih.gov/pubmed/36203255
http://dx.doi.org/10.5213/inj.2244084.042
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