Background and Objectives Tinnitus retraining therapy (TRT) is a well-known effective method for tinnitus management by retraining the brain to achieve habituation of tinnitus. The mobile device based TRT can let both clinicians and patients be free from time and space limitations and secure cost-effectiveness. The study aimed to investigate whether the mobile-based TRT is inferior or not to the conventional TRT in treatment outcomes for chronic subjective tinnitus.Subjects and Method A prospective randomized controlled trial was conducted in a single tertiary hospital. Adult patients with chronic subjective tinnitus were enrolled. Pure tone audiometry, State-Trait Anxiety Inventory [(STAI), axis1 and axis2], Beck Depression Inventory, Pittsburgh Sleep Quality Index, and a survey for TRT were evaluated. Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS) of tinnitus, and Tnnitogram were compared at the start, then at one month and three months of the treatment. The mobile group was subdivided into the treatment effective group and the refractory group. Demographics, baseline tinnitus severity, and therapy compliance were comparatively analyzed.Results A total of 19 patients for the mobile-based TRT and 21 patients for the conventional TRT were enrolled. THI scores and Tinnitus scores using VAS were significantly reduced in the mobile group after the treatment. Furthermore, THI and STAI were significantly more improved in the conventional group than in the mobile-based TRT at one and three months of the treatment. Also, the effective group of the mobile device based TRT was statistically younger than the refractory group and had a higher understanding of the treatment method.Conclusion The mobile-based TRT could improve THI and VAS scores of tinnitus at one and three months of treatment. However, the conventional TRT showed better outcome than the Mobile-based TRT with respect to THI scores. The mobile-based TRT can be one of different potential options that clinicians can apply to tinnitus patients who cannot follow the conventional TRT or limited candidate. Further improvement of the mobile device based TRT would be needed.
opioid antitussive prescribing among UC and ED visits with respiratory diagnoses in a large health system.Methods: This is an IRB-approved cross-sectional study of visits to seven EDs and six UCs in the greater Chicago area. We included all ICC visits and discharged ED visits from July 2017 through June 2019 with a primary ICD-10 diagnosis of a nonbacterial upper or lower respiratory issue. We describe demographic and clinical visit characteristics with means, medians, or proportions. The primary descriptive outcome was the proportion of visits with an antibiotic or antitussive prescription with 95% confidence intervals (95% CI).Results: There were 26,304 visits for non-bacterial respiratory diagnoses during the study period (9,523 ED, 16,781 UC). Median wait time was 15 and 4 minutes for ED and UC visits, respectively; median length of stay was 162 and 42 minutes, respectively. UC visits reflected an older patient population that was more frequently commercially insured and White, with a lower prevalence of co-morbidities (Table ). Among all ED visits, 33.4% (95% CI: 32.4-34.3%) were prescribed an antibiotic and 13.1% (95% CI: 12.4-13.8%) an antitussive; 6.1% (95% CI 5.7-6.6%) were prescribed an opioid. Among all UC visits, 60.8% (95% CI: 60.1-61.6%) were prescribed an antibiotic and 23.9% (95% CI: 23.3-24.6%) an anti-tussive; 11.1% (95% CI: 10.6-11.5%) were prescribed an opioid. Among antibiotics prescribed from ED and UC visits, penicillins (39.6% and 46.0%, respectively) and macrolides (42.2% and 36.5%, respectively) were most common. Among antitussives prescribed from ED and UC visits, benzonatate (44.4% and 55.7%, respectively) and opioids (46.8% and 46.2%, respectively) were most common. The most frequently prescribed opioid was codeine (56.9% and 87.5% of all opioids, respectively).Conclusion: Antibiotics and opioid antitussives are frequently prescribed for ED and UC visits with non-bacterial respiratory diagnoses, despite their lack of clinical utility and associated risks. These findings suggest that greater attention is warranted to the appropriateness of antibiotic and antitussive prescribing in both settings. Furthermore, specific guidelines relating to codeine prescribing may be beneficial, given the high incidence of codeine prescribing found in this study.
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