Donor, Recipient, and Operative Factors Associated with Graft Success in the Cornea Preservation Time Study.

Purpose: To associate donor, recipient, and operative factors with graft success 3 years after Descemet stripping automated endothelial keratoplasty (DSAEK) in the Cornea Preservation Time Study (CPTS).

Design: Cohort study within a multicenter, double-masked, randomized clinical trial.

Participants: One thousand ninety individuals (1330 study eyes) with a median age of 70 years undergoing DSAEK for Fuchs endothelial corneal dystrophy (94% of eyes) or pseudophakic or aphakic corneal edema (PACE; 6% of eyes).

The reality of adherence to rhinitis treatment: identifying and overcoming the barriers.

Medical advances have allowed many patients with chronic diseases to lead relatively normal lives, but disparity between patient perceptions of "normal" and therapeutically defined disease control contributes to lowered adherence to treatment. This disconnect is greatest in diseases such as allergic rhinitis (AR) in which patients experience varying symptom severity over time-from asymptomatic periods to episodes of severe illness. This study was designed to evaluate the concept of adherence as applied to patients with AR.

Comparison of hand-sewn, linear-stapled, and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass.

Background: There is no consensus on the ideal gastrojejunostomy anastomosis (GJA) technique in laparoscopic Roux-en-Y gastric bypass (LRYGB). We reviewed our experience with three GJA techniques (hand-sewn (HSA), linear-stapled (LSA), and 25-mm circular-stapled (CSA)) to determine which anastomosis technique is associated with the lowest early (60-day) anastomotic complication rates.

Methods: From November 2004 through December 2009, 882 consecutive patients underwent LRYGB using three GJA techniques: HSA, LSA, and CSA.

Exhaled nitric oxide as a tool in managing and monitoring difficult-to-treat asthma.

Most patients diagnosed with asthma maintain control reasonably well and do not experience asthma exacerbations; however, on average, 30% of patients achieve suboptimal control, have severe or difficult-to-treat asthma, and are relatively nonresponsive to the same medications that achieve and maintain asthma control for most patients. This small patient population of difficult-to-treat or severe asthma accounts for 80% of asthma medical costs. This study was designed to determine the potential U.

The Obama dilemma: allergic rhinitis (animal dander allergy)-the great burden of illness.

Allergic rhinitis is one of the most common chronic diseases with over 600 million people affected worldwide. More than 200 million of them also suffer from concomitant asthma. Allergic rhinitis is generally under-diagnosed and under-treated.

A review of the effects of martial arts practice on health.

Martial arts are ancient forms of combat, modified for modern sport and exercise. Participation in the martial arts is increasing, particularly for youth. Martial arts provide health-promoting and meaningful exercise for millions of practitioners.

Airflow limitation, asthma, and Chlamydia pneumoniae-specific heat shock protein 60.

Background: Chlamydia pneumoniae has been associated with asthma. It has also been suggested that C pneumoniae infection may lead to lung remodeling in a subset of asthmatic patients. Seroreactivity against Chlamydia trachomatis heat shock protein 60 (hsp60), a highly conserved, immunoreactive chaperone protein, is associated with immunopathologic abnormalities, leading to blinding trachoma and tubal infertility.

Written emotional disclosure: a controlled study of the benefits of expressive writing homework in outpatient psychotherapy.

The current study investigated the extent to which outpatient psychotherapy clients benefited from Pennebaker's expressive writing protocol (Pennebaker & Beall, 1986) adapted for use as a homework intervention. Participants were randomly assigned to written emotional disclosure or writing control conditions. Pre- and postintervention outcome measures were collected for three consecutive therapy sessions.

Is there a role for antibiotics in the treatment of asthma?: involvement of atypical organisms.

Emerging evidence suggests an association between some asthma and pulmonary infection by the atypical organisms Chlamydia pneumoniae and Mycoplasma pneumoniae, but a causal role for infection remains unproven and controversial. Most acute exacerbations of asthma are triggered by acute infections that are due to viral respiratory pathogens, not to bacteria or atypical organisms. Administration of antibiotics for acute exacerbations of asthma has been shown to be ineffective.

Asthma end points and outcomes: what have we learned?

In spite of the wide prevalence of asthma and its substantial consequences, the diagnosis and assessment of asthma has not been standardized, and the goals of therapy currently are not being achieved. Our purpose is to help delineate what the most important asthma end points are and what kinds of strategies we should use to guide therapy. Comparison of numerous studies reveals that asthma measures used routinely in the clinic, such as spirometric lung function, do not uniformly correlate with asthma control.

Secondary outcomes of a pilot randomized trial of azithromycin treatment for asthma.

Objectives: The respiratory pathogen Chlamydia pneumoniae (C. pneumoniae) produces acute and chronic lung infections and is associated with asthma. Evidence for effectiveness of antichlamydial antibiotics in asthma is limited.

The economic burden associated with prior authorizations in an allergist office.

Costs for managed care organizations to process prior authorizations (PAs) for nonformulary medications have been estimated to be dollars 20-25 per request. Costs for physicians to process these requests have not been studied extensively. A data collection tool was developed and used by physicians and nurses to document time spent on processing PAs.

Asthma rescue and allergy medication use among asthmatic children with prior allergy prescriptions who initiated asthma controller therapy.

Background: Asthma and allergic rhinitis are frequently comorbid conditions. Montelukast is effective in treating both diseases and may reduce total medication use among children with asthma and allergic rhinitis.

Objective: To determine the differences in respiratory and allergy medication use and costs, as proxies for control, in pediatric patients with asthma and allergy who initiated asthma controller therapy.

Feasibility of a practical clinical trial for asthma conducted in primary care.

Background: Practical clinical trials (PCTs) are essential to generate relevant evidence-based information to improve patient health. Primary care physicians' experience performing randomized controlled trials (RCTs) on representative patient populations is limited. We implemented a pilot practice-based asthma PCT to answer the following feasibility questions: (1) Was clinician interest initiated and maintained? (2) Did clinicians enroll patients into an RCT and complete follow-up? (3) Was an interactive voice-response (IVR) telephone system useful to collect patient-reported data?

Methods: The protocol included (1) broadly representative adult asthma eligibility criteria, (2) self-reported patient-oriented outcomes, and (3) use of IVR to collect these data.

Evaluation of parental preference for the treatment of asthmatic children aged 6 to 11 years with oral montelukast or inhaled cromolyn: a randomized, open-label, crossover study.

The objective of this study was to evaluate parental preference for the treatment of asthmatic children with oral montelukast sodium or inhaled cromolyn sodium. Additionally, we wanted to compare the two drugs in terms of patient preference for treatment, patient and parent satisfaction with treatment, frequency of inhaled albuterol use, adherence to treatment, and safety. This was a 12-week randomized, open-label, crossover study conducted in 42 primary care and asthma/allergy specialty centers in the United States.

"Real-world" effectiveness of daily controller medicine in children with mild persistent asthma.

Background: Unmeasured confounders and selection bias can significantly influence the results of retrospective observational analyses of asthma therapy.

Objective: To evaluate the efficacy of oral montelukast and inhaled fluticasone propionate in a randomized, prospective 12-month "real-world" observational analysis of children with mild persistent asthma.

Methods: Children (n = 104) between 6 and 15 years of age with mild asthma as determined by forced expiratory volume in 1 second, symptoms, and evaluation by an experienced pediatric allergist or pulmonologist, who were not currently receiving controller therapy, were randomly assigned to fluticasone or montelukast on an alternating basis.

The delivery of clinical preventive services: acute care intervention.

Background: . Evidence-based clinical preventive services are underutilized. We explored the major factors associated with delivery of these services in a large physician-owned community-based group practice that provided care for both fee-for-service (FFS) and health maintenance organization (HMO) patient populations.

Where the boys are not: a brief overview of male preventive health.

Excess morbidity and premature mortality in US males is caused, in part, by lack of male participation in preventive health behaviors. Unlike women, who routinely access the health care system for periodic reproductive exams, men between the ages of 15 and 50 rarely seek preventive care services. A chart survey of a sample of female reproductive exams was undertaken to investigate the types of health care services these exams provide.

Chlamydia pneumoniae as a respiratory pathogen.

Chlamydia pneumoniae is a recently recognized human respiratory pathogen with a unique biphasic life cycle characterized by an obligate intracellular (replicative) and an extracellular (infectious) form of the organism. C. pneumoniae is widely distributed and, via the respiratory route, infects the majority of the world's population.

The relationship between prescribed and delivered doses of inhaled corticosteroids in adult asthmatics.

A model was developed to estimate the impact of adherence and inhalation technique over time on delivered doses of inhaled corticosteroids (ICS) for asthmatics using metered-dose inhalers (MDIs) and dry powder inhalers (DPIs). Factors affecting inhalation technique include ongoing training, inhalation device, spacer use (with MDIs), and natural ability. Model parameters were derived from a literature review or were estimated from clinical experience.

A comparison of asthma-related expenditures for patients started on montelukast versus fluticasone propionate as monotherapy.

Background: The prevalence of asthma is increasing, and this chronic condition imposes a substantial economic burden worldwide. It is not known whether newer therapies, such as leukotriene receptor antagonists (LTRAs), can ease this burden.

Objective: This analysis examined the association between choice of first-line asthma control therapy and health care resource utilization and expenditures in patients with mild asthma.

A comparison of a five-day regimen of cefdinir with a seven-day regimen of loracarbef for the treatment of acute exacerbations of chronic bronchitis.

To compare the efficacy and safety of five-day cefdinir treatment with seven-day loracarbef treatment in patients with acute exacerbations of chronic bronchitis, 586 patients were enrolled in a multicentre, randomised, double-blind trial. Patients received either five days of treatment with cefdinir (n = 291) at 300 mg twice daily or seven days of treatment with loracarbef (n = 295) at 400 mg twice daily. Microbiological assessments were done on sputum specimens obtained at admission and at the two post-therapy visits, if available.

Physical diagnosis of the multiple-ligament-injured knee.

Knee dislocations and related knee trauma represent dramatic orthopedic injuries. The severity and spectrum of injury may not be immediately evident to the clinician. A high index of suspicion for associated neurovascular involvement must be maintained throughout the initial care of the patient.