Researchers using functional MRI (fMRI) have found that neurofeedback training has the potential to reduce the severity of tinnitus or even eliminate it, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

Tinnitus is the perception of noise, often ringing, in the ear. The condition is very common, affecting approximately one in five people. As sufferers start to focus on it more, they become more frustrated and anxious, which in turn makes the noise seem worse. The primary auditory cortex, the part of the brain where auditory input is processed, has been implicated in tinnitus-related distress.

For the study, researchers looked at a novel potential way to treat tinnitus by having people use neurofeedback training to turn their focus away from the sounds in their ears. Neurofeedback is a way of training the brain by allowing an individual to view some type of external indicator of brain activity and attempt to exert control over it.

“The idea is that in people with tinnitus there is an over-attention drawn to the auditory cortex, making it more active than in a healthy person,” said Matthew S. Sherwood, Ph.D., research engineer and adjunct faculty in the Department of Biomedical, Industrial and Human Factors Engineering at Wright State University in Fairborn, Ohio. “Our hope is that tinnitus sufferers could use neurofeedback to divert attention away from their tinnitus and possibly make it go away.”

The researchers gave the participants techniques to help them do this, such as trying to divert attention from sound to other sensations like touch and sight.

“Many focused on breathing because it gave them a feeling of control,” Dr. Sherwood said. “By diverting their attention away from sound, the participants’ auditory cortex activity went down, and the signal we were measuring also went down.”

A control group of nine individuals were provided sham neurofeedback — they performed the same tasks as the other group, but the feedback came not from them but from a random participant. By performing the exact same procedures with both groups using either real or sham neurofeedback, the researchers were able to distinguish the effect of real neurofeedback on control of the primary auditory cortex.

PCPs Deliver Best Inpatient Care, Study Suggests

Amid the steady rise of the hospitalist model, inpatients cared for by their own primary care physicians experience lower length of stay and reduced mortality compared to hospitalists and covering generalists, according to a study published by JAMA Internal Medicine.

These findings appear to contradict previous research suggesting that hospitalists delivered more efficient and higher quality care, which authors of the new study allege faced substantial limitations. Previous studies, for example, did not differentiate among nonhospitalist physicians based on prior knowledge of the patient.

The study compared patient outcomes among three types of inpatient care delivery:

  • PCPs with existing relationships with the patients
  • Hospitalists with extensive knowledge of the hospital
  • Generalists without previous familiarity with the patients or the hospital
"Our study is the first to distinguish between these two different types of outpatient physicians compared with hospitalists," wrote Jennifer P. Stevens, MD, MS, from Beth Israel Deaconess Medical Center in Boston, and colleagues in their report. 

What practical tools can I use to redesign care?

Decent Summary.....

The framework below illustrates the key steps an organization must address to improve health and lower costs for people with complex health and social needs. Whether you have an existing care model or are just beginning to plan a program for your complex needs population, we encourage you to work through this process to refine and focus your care interventions.

FDA OKs Epinephrine Auto-Injector for Small Children

The FDA has approved the first epinephrine auto-injector specifically designed for infants and small children weighing 16.5-33 pounds, kaléo, the device's manufacturer, announced Monday.

The AUVI-Q 0.1 mg device is "specifically designed for the treatment of life-threatening allergic reactions, including anaphylaxis, in infants and small children weighing 16.5 to 33 pounds (7.5 to 15 kilograms) who are at risk for or have a history of serious allergic reactions," the company said in a press release. The device has a shorter needle and lower dose of epinephrine compared with injectors currently on the market. It also includes electronic voice instruction and visual cues to help with administration.

"Until now, healthcare practitioners and caregivers to infants and small children have not had an epinephrine auto-injector with an appropriate dose of epinephrine available to them, potentially causing some delay in the administration of epinephrine in a life-threatening allergic emergency," said Vivian Hernandez-Trujillo, MD, a pediatric allergist at Nicklaus Children's Hospital in Miami, in the release. "Having an epinephrine auto-injector with a needle length and dose specifically designed for infants and small children should help alleviate concerns around hitting the bone or injecting too much epinephrine."

More children are getting treated for anaphylaxis, the company noted, citing a study that found a 129.8% increase in emergency department visits for the condition by children age 4 and younger between 2005 and 2014.

"The approval of an epinephrine auto-injector specifically designed for infants and small children is timely, especially given the recent changes to guidelines recommending that certain high-risk infants, as young as 4 to 6 months old, be introduced to peanut-containing foods," said Eleanor Garrow-Holding, president and CEO of the Food Allergy & Anaphylaxis Connection Team, in the press release.

"We are pleased that the pediatric allergy healthcare community and parents of infants and small children with life-threatening allergies will have the ability to obtain an FDA-approved epinephrine auto-injector in the event of an allergic emergency."

The device is expected to become available to patients in the first half of 2018, according to the company, which is based in Richmond, Virginia.

COPD: Why Appropriate Device Selection is Important


Device selection for the administration of long-acting bronchodilators is an important factor for the treatment of people diagnosed with COPD. At the American Thoracic Society International Conference in Washington, D.C., we talked to some of the investigators presenting data on this subject.

I am your host, Dr. Prathima Setty and I would like to welcome my three guests to the program. Speaking with me today are Dr. Sidney Braman, a pulmonologist and Professor at Mount Sinai Health System; Dr. Donald Mahler, a pulmonologist and Emeritus Professor of Medicine at the Geisel School of Medicine at Dartmouth; and Dr. Nicola Hanania, a pulmonologist and Associate Professor of Medicine at the Baylor College of Medicine Airways 
Clinical Research Center.

Doctors, thank you for being here to share your insights on delivery devices for long-acting bronchodilators for COPD.

How to Survive the Holidays with EI and (Possibly) Not End Up Alone or Wanting to Give Your Family the Boot

For those of us with EI (environmental illnesses), the holidays are especially brutal.  What were once happy times surrounded by family and friends become increasingly isolating experiences.  Depending on how bad off we are with things like fragrance sensitivity (which, next to fruit cake is the worst part about inviting Aunt Betty) or severe fatigue (where you just want to curl up into a ball under the dinner table), more and more we are faced with having to choose between trying to brave a family gathering only to end up sick in bed for weeks or convincing ourselves we will just stay home and write that novel.

In response to a heart-felt plea for help from one newly aware Canary who was torn between wanting to accommodate her family and fear of going overboard and getting sick, I wanted to reach out to her and give her some advice I wish someone had told me.  This is more or less what I said:

This cluster of conditions that we call EI is an insidious one, for so many reasons.  None of which are your fault.  And understanding the underlying cruel irony of what is at play will help you really believe that.  This is what I think you should keep in mind: 

1: It is invisible so we are constantly having to “convince” people of its authenticity. 

2: It puts us in the position of having to ask other people to help prevent us from getting sick, in other words, potentially putting them at an imposition which feels very awkward. 

3: We long for the lives we had before we got sick. When we were “normal” and could move through the world with any level of anonymity we wanted just like everyone else. 

4: We have to announce to the world our personal health information while bracing for the possibility that we will be ridiculed for it. 

5: We never know when fragrance is going to jump out and hit us so we often hope for the best and maybe don’t say something as often as we should in the prayer that it won’t happen. But living on this kind of edge all the time is extremely stressful. 

6: We feel forced into a position of having to apologize for our very existence on a regular basis.

Too many women with PCOS go undiagnosed

Polycystic Ovarian Syndrome (PCOS) is the most common hormonal disorder in women of reproductive age. It can put those affected at risk for serious health conditions including high blood pressure, heart disease and diabetes. PCOS can also cause infertility, a loss of hair on the scalp, excess body hair, acne and weight gain.

The disorder affects between 7 and 10 percent of women of childbearing age.

I am one of them.

During my sophomore year of college, I noticed I was getting more acne around my chin and jawline, but attributed the breakouts to high levels of stress, abnormal sleep habits, poor diet and alcohol. My teenage years were plagued by irregular, heavy periods and obvious mood swings.

Sitting in my doctor’s office, alongside my mother, I was diagnosed with PCOS after a dermatologist with the disorder suggested I get an ultrasound. I was 19. I was told I would face fertility issues. To reduce side effects, I was prescribed birth control. That was it. The conversation ended there.

I wasn’t informed of the common mental-health issues associated with PCOS. I didn’t know depression and anxiety — both of which I experienced a few years later — are reported by women with the disorder at a higher rate.

I didn’t know the unwanted facial hair under my chin was a common symptom. Instead I joked the hair was a reflection of my grandmotherly habits.

The number one issue facing women with PCOS is awareness, or lack thereof, says Megan Stewart, founder of the PCOS Awareness Association. Stewart says the absence of information surrounding the disorder comes from staunch disagreements among those within the medical profession.

“A lot of medical professionals aren’t well versed [with PCOS],” says Stewart. “So when they see the symptoms, they may equate it to thyroid complications, or even Hashimoto’s disease.” She also attributes the more than 50 percent of women with PCOS who go undiagnosed to the same disconnect.

FDA Approves Benralizumab for Severe Asthma

The FDA has approved AstraZeneca's biologic drug benralizumab (Fasenra) for the add-on maintenance treatment of patients age 12 years and over with severe asthma with an eosinophilic phenotype, the drugmaker announced late Tuesday.

Approval was based on pivotal trials showing up to a 51% reduction in the annual asthma exacerbation rate versus placebo in patients with uncontrolled, severe asthma and high levels of eosinophilia. The drug also showed an overall adverse event profile similar to that of placebo in the trials, and users had median 75% reductions in daily oral corticosteroid use.

We heard you — incontinence affects men too. Here’s what you need to know

As men age, the simple act of urinating can get complicated. Prostate surgery often leaves men vulnerable to leakage when they cough, sneeze, or just rise from a chair. Or the bladder may become impatient, suddenly demanding that you find a bathroom right now. “Thousands of years ago, it was not as much of an issue,” observes Dr. Anurag Das, a urologist at Harvard-affiliated Beth Israel Deaconess Medical Center. “There were lots of trees, and you could just find one and go.”

But tricky bladders can be whipped into shape. The first step is a careful assessment of what triggers those difficult moments. Often your doctor can suggest helpful strategies and possibly medication to improve urinary control.

Urinary incontinence means the accidental or involuntary loss of urine from the bladder. Many cases involve slight “dribbling.” The most common types are urge incontinence and stress incontinence. The usual causes of urge incontinence in men are involuntary contractions of the bladder muscles (overactive bladder). This is sometimes related to long-term blockage from an enlarged prostate. “You feel the urge to go but you start leaking before you make it,” Dr. Das says. “It could be a few drips, or it could be a larger amount if you can’t find the bathroom in time.” Many men notice that certain triggers set off their urge incontinence, such as hearing running water, entering a cold room, rising after sitting, or even just inserting the key in your home’s door lock.

Stress incontinence refers to urine leakage that occurs when coughing, sneezing, lifting a heavy object, or other activity. In men, this is usually caused by problems in the rings of muscle, or sphincters, that squeeze closed to seal off the bladder.

“If they are weak or damaged, then coughing, sneezing, running, or jumping can cause leakage,” Dr. Das says. In men, the most common cause of stress incontinence is sphincter damage after prostate surgery. Radiation treatment for prostate cancer can also cause it. The doctor will ask questions to figure out what may be causing the problem and how severe it is. You may be asked to go home and keep a voiding diary, which is a careful record of how often you need to urinate and the circumstances or triggers that lead to leakage.

Here’s what you can do

Scientists save child’s life by growing him new skin

Doctors created enough skin to cover 80 percent of the body of a seven-year-old boy with a genetic disease — and it saved his life.

This isn’t the first time that doctors have used genetic engineering to grow new skin, but past attempts only grew a little bit. This time, doctors were able to cover nine square feet of the patient’s body. The boy, who has a genetic skin disease called junctional epidermolysis bullosa (JEB), had been expected to die. Now, two years after the surgery, he lives a normal life and is able to play sports and exercise, the doctors say. The results were published today in the journal Nature.

People with JEB have a genetic mutation that makes their skin blister easily and makes them more likely to develop cancer. (About 500,000 people worldwide have the condition.) The boy in today’s study developed a bacterial infection that made him lose skin on over two-thirds of his body, leaving him bright red and raw. He was sent to the burn unit at the Germany’s Children’s Hospital at Ruhr University. He was in a lot of pain, and doctors “had a lot of trouble keeping this kid alive,” Tobias Rothoeft, a doctor at the hospital, said in a press briefing.

As a final attempt, the doctors contacted Michele de Luca, director of the Center for Regenerative Medicine at the University of Modena and Reggio Emilia in Italy. de Luca had previously done a similar skin graft on legs, but nothing of this scale. First, his team took skin cells from the boy, including some stem cells, the immature cells that have the ability to develop into many different types of cells and keep growing. Next, they used a harmless virus to deliver a normal version of the gene into the skin cells, so that the genetically engineered cells did not have the mutation anymore. The engineered skin cells and stem cells were then used to grow skin in the lab. The skin was finally grafted back onto the kid's body.

The boy was in the hospital for more than eight months, but now he is healthy. The regenerated skin is good quality, says Rothoeft, and it allows him to do things like normal kids, without the painful blisters he had before. The study shows that just a few long-living stem cells can grow and maintain skin for a long time, de Luca said in the press briefing, which is hopeful for future skin grafts. Now, he is initiating further clinical trials for the therapy.