25th May 2012 - A stepped care approach based on cognitive behavioral therapy appears to be suitable for widespread use by patients with tinnitus, according to results of a randomized, controlled trials in the 26th Can the number of the Lancet published."Up to 21% of adults have tinnitus, an audiological problems are more painful and debilitating," writes Rilana FF Cima, MSc, MTD, Clinical Science of Psychology, Maastricht University and the Rehabilitation of expertise and Audiology and Department of Audiology and Communication, the , Hoensbroek, Netherlands, and colleagues. "The lack of medical cures and common practices have led to expensive and prolonged treatment. Objective was to assess the effectiveness of a stepped care approach based on cognitive behavioral therapy compared with usual care in patients with tinnitus or less seriously."Between september 2007 and January 2011 in the Department of Audiology and Communication Forward, recruited scientists previously healthy Dutch speakers over 18 years of age account with untreated tinnitus.With a series of computer-generated assignment as a research assistant independently randomized patients in a 1:1 ratio for specialized treatment, focusing on cognitive behavioral therapy, retraining is sound, or receiving usual care. Randomization was stratified by severity of tinnitus and hearing, in block sizes of 4, and the patient and examiner were blinded.The primary endpoints in the study were using validated questionnaires before treatment and at 3, 8 and 12 months after the treatments given. It was health-related quality of life by the index value for the public health, the severity of tinnitus, as measured by the Tinnitus Questionnaire score, and disability, as measured by ringing Tinnitus Handicap Inventory score. The analysis was done by intention to treat multilevel mixed regression.741 patients were screened at 492 (66%) involving the investigation and treatment. The study was 12 months, 245 patients assigned intervention of cognitive behavioral therapy conferred significant improvements in all three endpoints in the study with 247 patients compared with usual care."The results are highly relevant to clinical practice because the best practices for tinnitus has not been defined, and current treatment strategies are fragmented and expensive," the authors write.Differences between groups were 0.059 for health-related quality of life (95% confidence interval [CI]: 0.025 to 0.094, Cohen's d effect size, 0.24, p = 0.0009), 8062 to the severity of tinnitus (95% CI -10.829 to -5.295, d = 0.43, p <0.0001) and -7.506 tinnitus impairment (95% CI, -4352 to -10661, d = 0, 45, p <.0001).Intervention Cognitive behavior therapy appears to be effective regardless of the first severity of tinnitus, and there were no adverse effects observed."Er, we have demonstrated the effectiveness of specialized care versus usual care, not only for the first 3 months after the initial phase of treatment but completed after the second step, an intensive treatment and 4 months without treatment," the authors conclude.Change in clinical practice and possible cure for tinnitus"Our findings may lead to a political consensus on best practices in the treatment of tinnitus result, the default options on the reference fuels lanes, and the use of standardized tinnitus evaluation and the results are more comparable."Limitations of this study include the inability to determine which of the elements of special treatment was on the overall effectiveness and possible lack of generalizability of health centers has helped some audiological rehabilitation clinic.An accompanying commentary by Berthold Langguth, MD, University of Regensburg in Germany, says that these results are not only convincing, but is also relevant for clinical practice."Although the improved care approach involved only a brief intervention for most patients, specialty care was significantly better than usual care for the entire sample," writes Dr. Langguth."For future research, we must not forget that the majority of patients with tinnitus, a cure for what should be the ultimate goal of research."The Netherlands Organisation for Health Research and Development supported this study. The study authors have NOTHING relevant financial relationships. Dr. Langguth has consulting fees, travel, housing payments, or lecture fees from AstraZeneca, Merz, Novartis, Servier, Pfizer, ANM and Magventure, research funding or equipment, Astra Zeneca, cerbomed received Magventure, American Tinnitus Association, the Deutsche Forschungsgemeinschaft and Tinnitus Research Initiative, and has patents for the treatment of tinnitus by transcranial magnetic stimulation neuronavigated with cyclobenzaprine and naltrexone.
Contact precautions, including gloves, gowns, and isolated rooms, have helped stem the transmission of hospital pathogens but have also had some negative consequences, according to findings from a new study. Healthcare worker (HCWs) visited patients on contact precautions less frequently than other patients and spent less time with those patients when they did visit, report Daniel J. Morgan, MD, from the University of Maryland School of Medicine and the Veterans Affairs (VA) Maryland Health Care System, Baltimore, and colleagues. Moreover, patients on contact precautions also received fewer outside visitors. "Less contact with HCWs suggests that other unintended consequences of contact precautions still exist," Dr. Morgan and coauthors write. "The resulting decrease in HCW contact may lead to increased adverse events and a lower quality of patient care due to less consistent patient monitoring and poorer adherence to standard adverse event prevention methods (such
My friend's sister used to suffer frequently from panic attacks. Such the seriousness of this disorder that we had to take her to a therapist who suggested Cognitive Behavioral Therapy for her. It made him learn how to deal with situations where he use have panic attacks. Today he is a confident young lady. Read More Visit couples counseling
ReplyDelete