Designing clinical trials for assessing the effectiveness of interventions for tinnitus

In the face of finite resources, allocations of research and healthcare funding are dependent upon high-quality evidence. Historically, tinnitus has been the poor cousin of hearing science, with low-quality clinical research providing unreliable estimates of effect, and with devices marketed for tinnitus without strong evidence for those product claims. However, the tinnitus field is changing. Key opinion leaders have recently made calls to the field to improve the design, implementation and reporting of clinical trials, and there is growing intersectoral collaboration. The Tonndorf Lecture presented at the 1st World Tinnitus Congress and 12th International Tinnitus Seminar in Warsaw, Poland provided an opportunity to reflect on the present and future progress of tinnitus research and treatment and what is needed for the field to achieve success. The content of that lecture is summarised in this review article. The main debate concerns the selection and reporting of outcomes in clinical trials of tinnitus. Comprehensive reviews of the literature confirm the diversity of the personal impact of tinnitus, and illustrate a lack of consensus in what aspects of tinnitus should be assessed and reported in a clinical trial. An innovative project is described which engages the global tinnitus community (patients and professionals alike) in working together. This project seeks to improve future tinnitus research by creating an evidence-based consensus about minimum reporting standards for outcomes in clinical trials of a tinnitus intervention. The output will be a core set of important and critical outcomes to be measured and reported in all clinical trials

In the Gray Zone in the Fragile X Gene: What are the Key Unanswered Clinical and Biological Questions?

Smaller expansions (41–54 CGG repeats) in the fragile X mental retardation 1 (FMR1) gene are termed “gray zone” alleles. Only recently has interest in these expansions increased due to reporting of phenotypes unique to gray zone carriers or similar to those seen in individuals with larger expansions. As minimal research has focused on gray zone expansions, this paper asks several questions related to this topic. These include the following: What is the definition of the gray zone? Is there a risk of developing neurological signs in these carriers? Are there secondary gene effects that impact gray zone alleles or a biologic advantage to carrying these repeats? How do we counsel patients with gray zone expansions? The answers to these questions will help to determine the significance of these expansions and provide needed information to the research community and clinicians

Tinnitus in Adults, a Health Problem: Implications for the Society and the Scientific Community

Tinnitus is a phantom sound perceived in the absence of external acoustic stimulation, which is only heard by the affected person. It is described in a variety of ways and can be a single sound or combination of different sounds. Tinnitus is related to many other conditions and has an impact in the quality of life of the affected person. However, pathophysiological mechanisms underlying tinnitus and their basic biological remains unknown. One of the major challenges, concerning the heterogeneity of the tinnitus condition, is the lack of standardization in research and clinical management. For this, the TINNET, a European Cost Action for research, has the main objective to develop better strategies for diagnosis and management. The establishment of guidelines for clinical diagnosis, treatment, neuroimaging assessments and outcome assessment, through the identification of clinically meaningful tinnitus subtypes, provides an important basis for the standardization of clinical research and management of tinnitus

Family physician\u27s adoption of innovations in distance learning

The aim of this study was to investigate the use and receptivity of distance education to meet the Continuing Medical Education needs of family physicians in Tennessee. The researcher conducted a survey of the entire population of members of the Tennessee Academy of Family Physicians. She collected a measure of specific outcomes using a Liket scale, along with demographic data. A chi-square analysis was used to determine association and significance. A response rate of 55 % was achieved. Most responding family physicians perceived that CME activities affect their practice of medicineThe data found that the CME activity must be relevant, applicable, and the content and quality important to the learner for participation by distance education. Respondents indicated that the most widely accepted and most utilized modality was audiotapes for distance education for CME. Computer usage via the Internet, CD ROM and email are emerging; they are being used more frequently and have a higher degree of receptivity by family physicians then non-computer generated modalities. The researcher concluded that specialized marketing efforts, additional development of online web-based courses, CD ROMs, and other modes of distance education delivery could change the level of interest in using distance education as a viable option for CME

The ecology and control of typha capensis in the wetlands of the Cape flats, South Africa

Includes bibliographies.Typha capensis is indigenous to the Cape, but is thought to be threatening Cape Flats wetlands through invasion and encroachment. This thesis establishes the extent of such encroachment and investigates aspects of the phenology, life-history, growth, production and decomposition of the species in a Cape Flats wetland. The process of invasion by indigenous species rather than by alien species is discussed and the view that wetlands are threatened by mismanagement rather than by encroachment per se is examined. Finally, control methods particularly suited to local environmental and economic conditions are evaluated. T. capensis was shown to be typical of invasive plant species and is spreading in some wetlands. Encroachment is usually associated with the stabilisation of seasonal water-level fluctuations and under these conditions stands were spreading at 1.5m month. Demographic methods used to measure growth, production and decomposition made it possible to quantify leaf fragmentation and shoot collapse, processes that are generally ignored during decomposition studies. Results showed that the structure of Typha stands is related to flood regime, and that flood regime has an important effect on production, litter formation and decomposition

A transpersonal approach in a case of dissociative identity disorder

Psychoanalysis, behaviorism, and the humanistic movement have, in the latter years of the twentieth century, been joined by a fourth psychological force, Transpersonal psychology. This study utilized a Qualitative methodology, Social-Constructivist orientation, Case Study design, and Dual Narrative format to explore the feasibility of utilizing a transpersonal approach in a case of Dissociative Identity Disorder. Sub-units of the investigation were (a) the treatment of Dissociative Identity Disorder by traditional, psychoanalytic/medical model psychotherapy, (b) the functions of the altered states of consciousness within the client\u27s personality system, (c) the functions of the Internal Self Helper in the integration of the client\u27s fractured self, and (d) the theoretical orientation of the therapist and its impact upon the treatment process

Subtyping somatic tinnitus: a cross-sectional UK cohort study of demographic, clinical and audiological characteristics

Somatic tinnitus is the ability to modulate the psychoacoustic features of tinnitus by somatic manoeuvres. The condition is still not fully understood and further identification of this subtype is essential, particularly for the purpose of establishing protocols for both its diagnosis and treatment. This study aimed to investigate the characteristics of somatic tinnitus within a large UK cohort using a largely unselected sample. We believe this to be relatively unique in comparison to current literature on the topic. This was investigated by using a total of 608 participant assessments from a set of recognised tinnitus and audiology measures. Results from a set of chi-square tests of association found that amongst the individuals with somatic tinnitus, a higher proportion had pulsatile tinnitus (different from heartbeat), were under the age of 40, reported variation in the loudness of their tinnitus and reported temporomandibular joint (TMJ) disorder. The same pattern of results was confirmed using a multivariate analysis of the data based on logistic regression. These findings have strong implications towards the profiling of somatic tinnitus as a distinct subtype of general tinnitus