Response to OKN-007 and NAC in a Patient with Unilateral Hearing Loss and Chronic Tinnitus from Vestibular Schwannoma.

BACKGROUND: Tinnitus is the perception of sound in the absence of external acoustic stimulation. Being one of the most common diseases of the ear, it has a global prevalence ranging from 4.1 to 37.2%. To date, it has been difficult to treat tinnitus as its pathophysiology is poorly understood and there are limited treatment options. OBJECTIVE: To investigate the effect of OKN-007 (also known as HPN-07), a nitrone-based investigational drug, in combination with oral N-acetylcycsteine (NAC), for the treatment of hearing loss and chronic tinnitus under an individual expanded access protocol. PATIENT CASE: We report the case of a patient who presented with left-sided ear fullness, mild tinnitus, and mild high frequency sensorineural hearing loss with 100% word recognition. A large enhancing mass seen on MRI revealed a vestibular schwannoma. He underwent subtotal resection of the tumor resulting in a moderate-to-profound sensorineural hearing loss and catastrophic tinnitus. The patient was treated with intravenous OKN-007 at 60 mg/kg dosed three times per week and oral NAC 2500 mg twice daily. RESULTS: Post-treatment audiometric testing revealed an average of 16.66 dB in hearing threshold improvement in three frequencies (125, 250 and 500 Hz) with residual hearing in the affected left ear. His tinnitus loudness matching improved from 90 dB to 19 dB post-treatment. His Tinnitus Handicap Inventory improved from 86/100 (Catastrophic) to 40/100 (Moderate). He also experienced improvements in sleep, concentration, hearing, and emotional well-being, and reported significantly decreased levels of tinnitusrelated distress. CONCLUSIONS: This case report highlights the feasibility and therapeutic potential of the combination of OKN-007 and NAC in treating hearing loss and tinnitus that warrants further investigation.

Commonalities of the EMS Education Workforce (2004) in the United States.

OBJECTIVES: The purpose of the State of EMS Education Research Project was to quantify the characteristics of those recognized as EMS instructors, what infrastructure supports exist to facilitate the learning process, and what are the attributes and common practices embraced by the profession. The collection of EMS education system data will assist in the continued development and implementation of the EMS Education Agenda for the Future: A Systems Approach. The first phase of the study identified characteristics of the individual educators and their workplace. Based on data collected from a national survey of individuals identified as EMS educators. Phase II of the project utilized a panel of experts to identify common practices in EMS education derived from the data analysis in Phase I. Based on the consensus and description of the common practices, a set of recommendations were developed which would facilitate the transition to future curricula designs and educational delivery methods. METHODS: The methods used in this study replicated those used by Witkin and Trochim (1997 as a formalized group-oriented concept mapping process. The concept statements were derived from data generated by Ruple et al., which attempted to identify and describe the various aspects of the EMS educational process. After a comprehensive listing of the aspects, a reduction and grouping exercise resulted in the identification of 43 concepts. The unstructured sorting task replicated procedures described by Rosenburg and Kim, Trochim, and Weller and Romney. The 13 participants of the technical team (a subset of the task force) were then tasked with individually rating each of the 43 concepts. Cronbach's alpha, as well as, principal component analysis was used to analyze the data and then concept mapping theory was employed to convert the data into concept statements. After the ratings were generated, the concepts were consolidated and reduced to 21 concept statements. A Spearman Rank Order Correlation Coefficient was computed comparing the rank of the top 10 most important concepts with the frequency of citation by the subgroup members and was found to be +0.92 [t(18) = 10.08, p < 0.0005]. The technical team's concept ratings were then validated by the full SEERP Task Force consisting of a national panel of experts in EMS education, administration, state regulation and certification. CONCLUSIONS: There is a need to increase the theory and knowledge base of EMS educators, to prepare the infrastructure for change, and to improve evaluation procedures for student performance and outcomes and the integration of educational technologies. Integration of resources, development of support systems, coordination of initial and continuing education requirements, alliances with professional accreditation services, and partnership building with other allied health and medical academic education systems are priorities for improving the working conditions for EMS educators nationally. Recommendations by the panel are the appropriate response to the current condition of the EMS education setting and a basis on which to begin a seamless transition to the vision of the EMS Education Agenda for the Future: A Systems Approach.

The state of EMS education research project: characteristics of EMS educators.

OBJECTIVES: The preparation of emergency medicine practitioners occurs at a variety of levels, via individuals with various levels of experience and training, and through a variety of oversight organizations. The purpose of this study was to quantify the characteristics of those recognized as prehospital emergency medical services (EMS) educators, the type and amount of infrastructure available to facilitate the learning process, and what attributes and common practices the profession values. METHODS: The respondents (n = 1,691) were generated randomly from a nationwide systematic sample of all known EMS instructors. The sample was adequate to generalize to the 15,000 EMS educators. Face validity and content validity were assured through use of a 24-member focus group of EMS educators, practitioners, and administrators, who reviewed the questionnaire. Reliability estimates were generated via Cronbach's alpha and Kuder-Richardson 20 and 21 and ranged from 0.59 to 0.83, with a grand mean for the seven study constructs of 0.70. Factor analysis with varimax rotation explained 40% to 66% of the respective construct variance, with a grand mean of 56% of the response variance explained. RESULTS: The respondents were satisfied with their teaching experience (98%), expected to continue (80%), and taught because of a perceived dearth of qualified instructors. Only half of the respondents utilized federally generated curricular materials, and approximately 20% were uncomfortable in assessing psychomotor skills. The relationship of testing to assessment and skill performance appeared to be the most significant pedagogic challenge. CONCLUSIONS: The respondents were a senior group of educators committed to the training of new providers who will comprise the foundation of future EMS educational efforts at the national level.