Established soft contact lens wearers' awareness of and initial experiences with orthokeratology.

OBJECTIVES: To understand the initial awareness of and experience with orthokeratology in a group of adult, symptomatic, soft contact lens (CL) wearers. METHODS: This was a prospective, 3-month, open-label study of symptomatic soft CL wearers who were between the ages of 18 and 45 years. Baseline measurements were taken and then all subjects were treated with orthokeratology. A dry eye evaluation was completed at baseline prior to orthokeratology treatment. This same dry eye evaluation was completed 1 week and 1 month after orthokeratology treatment. An investigator-designed questionnaire that aimed to understand the subject's initial awareness of and experience with orthokeratology was also administered at the baseline, 1-week, 1-month and 3-month visits (perceptions, knowledge, tolerance and ability to apply and remove orthokeratology lenses). RESULTS: Twenty-nine out of 40 subjects completed this study. Completed subjects (age = 24.28 ± 3.75 years) had significant improvements in ocular comfort over the course of the study compared to their soft CLs. Most subjects were unfamiliar with orthokeratology before the study, were able to quickly adapt to the treatment and were likely to recommend orthokeratology to friends or children for myopia management. CONCLUSIONS: This study found that few subjects knew about orthokeratology before learning about it through this investigation, suggesting that patients should be offered this treatment more regularly. This conclusion is supported by the ability of the subjects to learn and adapt to orthokeratology with ease, and their likelihood to recommend it to a friend or child.

Treating Uncomfortable Contact Lens Wear With Orthokeratology.

OBJECTIVES: Many contact lens (CL) users permanently discontinue wear because of ocular dryness and discomfort. This study aimed to determine whether refitting symptomatic soft CL wearers in to orthokeratology could improve ocular symptoms and signs. METHODS: This was a prospective, 3-month, open-label study of symptomatic (Contact Lens Dry Eye Questionnaire [CLDEQ-8] ≥12) soft CL wearers who were between the ages of 18 and 45 years. All subjects were refit into orthokeratology CLs (Emerald, Euclid Systems). The following tests were completed: CL history, Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaire, CLDEQ-8, CLDEQ-4, logarithm of the minimum angle of resolution visual acuity, pupil size, refractive error, slit-lamp biomicroscopy, noninvasive tear break-up time, tear meniscus height, phenol red thread, conjunctival staining, corneal aesthesiometry, and corneal topography. RESULTS: Twenty-nine of 40 qualifying subjects (age=24.43±4.62 years) completed the study. No significant differences were detected between completed and noncomplete subjects. Completed subjects had significantly better CLDEQ-8, CLDEQ-4, and SPEED scores at 3 months compared with baseline. Completed subjects had significantly better conjunctival staining scores and flatter keratometry values at 1 month compared with baseline. CONCLUSIONS: Although not all symptomatic soft CL wearers were able to be refit into orthokeratology, subjects who were wearing orthokeratology at 3 months had a significant and clinically meaningful improvement in ocular symptoms. Additional work is needed to determine the mechanism leading to improved comfort because few clinical signs were changed after switching to orthokeratology.

Life satisfaction and health related quality of life among low-income medical patients: the mediating influence of self-esteem.

This study investigated the relationship between life satisfaction, self-esteem, and perceived health for an ethnically diverse, low SES sample of primary care patients. Results indicated that several specific domains of health-related quality of life (HRQL), including health perception, social functioning, mental health, and energy/fatigue, significantly predicted life satisfaction in this sample of 60 patients. Self-esteem mediated this relationship, partially with health perception and fully with the remaining three domains. The results of this study underscore the importance of healthcare interventions that consider the bidirectional relationship between physical and emotional well-being.

Urothelial cancers after renal transplantation.

OBJECTIVE: After solid organ transplantation, risk of cancer varies significantly based on cancer type. In this study, we determine the incidence of urothelial cancers (bladder and kidney) after renal transplantation from a single high-volume transplantation institution. In addition, we analyze the risk factors and review outcomes from the patients. MATERIALS AND METHODS: We performed a retrospective review of all patients in the University of Alabama at Birmingham (UAB) transplant database to identify all patients who received renal transplants at UAB between January 1, 1990, and January 1, 2010. We further identified transplant patients diagnosed with bladder, urothelial of other cancers in the same time period. We also examined tumor-specific variables such as presentation, clinical and pathologic staging, treatment type, recurrence, progression, interval to recurrence and progression, cancer-specific mortality, and interval from time to diagnosis to death. RESULTS: Review of the transplant database confirmed 5,920 renal transplants. Thirteen patients underwent the diagnosis of urothelial cancer, providing an incidence of 0.2%. Eight patients had bladder cancer for an incidence of 0.13%, compared to an incidence of 0.02% among the general population. Patients diagnosed with bladder cancer after renal transplantation were younger than those in the general population and frequently present with more advanced and aggressive disease. CONCLUSIONS: Patients are at an elevated risk of urothelial cancers after renal transplantation probably from immune suppression.

Referent group proximity, social norms, and context: alcohol use in a low-use environment.

OBJECTIVE: The purpose of this study was to investigate the relationship between perceived normative use of alcohol and reported consumption in an environment where relatively little alcohol use occurs. PARTICIPANTS: A total of 585 undergraduate students completed an online survey on alcohol use in March 2006. METHODS: Participants reported personal alcohol use and perceptions of use by "friends," "the average student," and "the average student who drinks." RESULTS: Due to the large number of students reporting zero alcohol use, zero-inflated negative binomial regression was used to analyze the data. Results showed that perceptions of use and beliefs about the acceptability of use by proximal groups were strongly and positively correlated with personal alcohol use. Perceptions of distal groups were either not correlated or were correlated negatively with personal use. CONCLUSION: These findings suggest that the use of distal referent groups for a social norms campaign in a low-use environment may have paradoxical effects.

Salvage therapy for prostate cancer recurrence after radiation therapy.

Radiotherapy has been successful in treating localized prostate cancer; however, a subset of patients will experience disease recurrence. Determination of the recurrence location must be made using pretreatment and posttreatment clinical variables, imaging, and postradiotherapy biopsy. Patients presumed to have local-only recurrence, optimal clinical risk factors, and an extended life expectancy may be considered for salvage local treatment. Current options include salvage surgery, cryoablation, and brachytherapy. Although they are associated with higher morbidity than primary therapy, salvage treatments can be effective and can still provide patients with a good oncologic and functional outcome. As these modalities continue to improve and patient selection is optimized, better results will evolve.

Current decision-making in prostate cancer therapy.

PURPOSE OF REVIEW: Prostate cancer continues to be the most prevalent cancer among American men. Localized prostate cancer is commonly diagnosed because of improved screening practices nationwide. Several options exist for the treatment of localized prostate cancer, and this review discusses the decision-making process facing patients diagnosed with this disease. RECENT FINDINGS: No one treatment for localized prostate cancer has proven superior to date. For this reason patients have been found to use a number of resources to make an informed decision. These include physicians, spouses, family, friends, and different media. Urologists serve as the primary and most influential physicians and play an important role in the decision-making process. Patients, however, are assuming a more active role in this process as time evolves, especially with ease of access to multiple information resources. SUMMARY: In deciding on a treatment for localized prostate cancer, patients must weigh the risks and benefits of each option. Urologists must provide patients with up-to-date information on these options and be aware of the different influences that surround these men during the decision-making process.