The short-term effects of recorded ocean sound with and without alpha frequency binaural beats on tinnitus perception.

BACKGROUND: The dichotic presentation of two auditory stimuli with a small frequency difference in each ear produces the perception of a third, fused auditory image called a binaural beat. Neural activity has been found to synchronize with these perceived beats. It is for this reason that binaural beats are often used in an attempt to induce certain psychological states that are associated with particular cortical rhythms. The aim of this proof-of-concept study was to explore the short-term effects of a binaural beat on tinnitus, to ascertain if further trials are justified. METHOD: Twenty adults with constant tinnitus and symmetrical hearing underwent audiological assessment and psychophysical measures of tinnitus. Participants were presented with two auditory stimuli: ocean waves with and without alpha frequency (8 Hz) binaural beats. Arousal and tinnitus perception were measured prior to and following each sound stimuli using the Perceived Arousal Scale and tinnitus rating scales. RESULTS: Small improvements in tinnitus rating scores occurred with sound. Some individuals showed more improvement with the binaural beats than ocean waves alone. CONCLUSION: The addition of binaural beats at 8 Hz to an ocean sound showed no significant group benefits above the ocean sound alone.

Benefits of a Home Treatment Program Using Guided Imagery Relaxation Based on Audio Recordings for People With Fibromyalgia.

Despite the plethora of treatments available for patients with fibromyalgia, there is insufficient evidence to date as to what the ideal treatment approach is. This study sought to determine the effectiveness of a home program of audio-recorded guided imagery relaxation on people with fibromyalgia. This experimental 8-week longitudinal trial design was undertaken with 60 people diagnosed with fibromyalgia who were randomly assigned to either a guided imagery intervention group or a control group. Pain at tender points, anxiety, self-efficacy, quality of sleep, quality of life, and the impact of the fibromyalgia were determined at baseline, at 4 weeks, and at 8 weeks. After the guided imagery intervention, we found significant differences regarding trait anxiety, sleep quality, and tenderness at some of the tender points. There is a need, therefore, to develop and evaluate interventions that may enhance the quality of life of those affected by this disorder.

The Most Common Feedback Themes in Communication Skills Training in an Internal Medicine Residency Program: Lessons from the Resident Audio-Recording Project.

Individualized structured feedback is an integral part of a resident's learning in communication skills. However, it is not clear what feedback residents receive for their communication skills development in real patient care. We will identify the most common feedback topics given to residents regarding communication skills during Internal Medicine residency training. We analyzed Resident Audio-recording Project feedback data from 2008 to 2013 by using a content analysis approach. Using open coding and an iterative categorization process, we identified 15 emerging themes for both positive and negative feedback. The most recurrent feedback topics were Patient education, Thoroughness, Organization, Questioning strategy, and Management. The residents were guided to improve their communication skills regarding Patient education, Thoroughness, Management, and Holistic exploration of patient's problem. Thoroughness and Communication intelligibility were newly identified themes that were rarely discussed in existing frameworks. Assessment rubrics serve as a lens through which we assess the adequacy of the residents' communication skills. Rather than sticking to a specific rubric, we chose to let the rubric evolve through our experience.

Provider Recommendations in the Face of Scientific Uncertainty: An Analysis of Audio-Recorded Discussions about Vitamin D.

BACKGROUND: Little is known about how providers communicate recommendations when scientific uncertainty exists. OBJECTIVES: To compare provider recommendations to those in the scientific literature, with a focus on whether uncertainty was communicated. DESIGN: Qualitative (inductive systematic content analysis) and quantitative analysis of previously collected audio-recorded provider-patient office visits. PARTICIPANTS: Sixty-one providers and a socio-economically diverse convenience sample of 603 of their patients from outpatient community- and academic-based primary care, integrative medicine, and complementary and alternative medicine provider offices in Southern California. MAIN MEASURES: Comparison of provider information-giving about vitamin D to professional guidelines and scientific information for which conflicting recommendations or insufficient scientific evidence exists; certainty with which information was conveyed. RESULTS: Ninety-two (15.3 %) of 603 visit discussions touched upon issues related to vitamin D testing, management and benefits. Vitamin D deficiency screening was discussed with 23 (25 %) patients, the definition of vitamin D deficiency with 21 (22.8 %), the optimal range for vitamin D levels with 26 (28.3 %), vitamin D supplementation dosing with 50 (54.3 %), and benefits of supplementation with 46 (50 %). For each of the professional guidelines/scientific information examined, providers conveyed information that deviated from professional guidelines and the existing scientific evidence. Of 166 statements made about vitamin D in this study, providers conveyed 160 (96.4 %) with certainty, without mention of any equivocal or contradictory evidence in the scientific literature. No uncertainty was mentioned when vitamin D dosing was discussed, even when recommended dosing was higher than guideline recommendations. CONCLUSIONS AND RELEVANCE: Providers convey the vast majority of information and recommendations about vitamin D with certainty, even though the scientific literature contains inconsistent recommendations and declarations of inadequate evidence. Not communicating uncertainty blurs the contrast between evidence-based recommendations and those without evidence. Providers should explore best practices for involving patients in decision-making by acknowledging the uncertainty behind their recommendations.

Challenging stereotyping and bias: a voice simulation study.

Stigma is a barrier to mental health care access for patients with schizophrenia and can interfere with developing therapeutic relationships. This study demonstrates success of a voice simulation experience during orientation in changing the biases of nursing students and the effect on the development of the nurse-patient relationship. Ninety-four individuals participated; 52 received a voice simulation experience during orientation, and 42 received orientation with no voice simulation experience. The Medical Condition Regard Scale was administered before and after orientation. Posttest paired t test results show significant differences in attitudes toward patients with voice hearing experiences between the two groups. The themes of personal growth from the focus groups postorientation include Affective Experience, Physical Experience, and Empathy. Findings demonstrate that the orientation process should include methods to challenge stereotyping and bias to decrease stigma, improve service access, and enhance the ability to develop therapeutic relationships.

Understanding the breast cancer experience of Latina women.

Qualitative interviews were used to investigate the impact of breast cancer among Latina survivors. The findings revealed that Latina survivors were optimistic about their health, utilized cultural and religious recovery practices; and seemed to accept their diagnosis, fears and suffering as part of their personal journey. The survivors' narrative identified spirituality as central to their recovery and coping. Extended family and friends were the primary sources of support. Common issues were the impact of cancer on medical care problems, work concerns, the meaning of cancer, family well-being, emotional well-being, body image, and sexual health. Latina survivors, particularly those who are poor and speak limited English, often have inadequate insurance, receive unsatisfactory medical care, and experience poor physician-patient communication and relationship. These problems are directly related to health-care system factors as well as socio-ecological and language issues. In addition, many Latina survivors have inadequate resources and inaccurate beliefs that may affect their health care (e.g., delay, lack of follow-up), and overall quality of life. Results will inform a quantitative study with a larger sample of Latina breast cancer survivors.

A script for deep muscle relaxation.

Deep muscle relaxation has been used as an adjunct to many somatic and psycho-therapies since its introduction by Jacobsen in 1929. It is a therapeutic technique which is taught as a motor skill through the use of instruction, practice, and feedback about progress. The material in this paper provides a script for preparing a relaxation tape for clients to use between or in addition to regular therapy sessions.