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Purpose: To document contact lens prescribing patterns in the United States between 2002 and 2014., Methods: A survey of contact lens prescribing trends was conducted each year between 2002 and 2014, inclusive. Randomly selected contact lens practitioners were asked to provide information relating to 10 consecutive contact lens fits between January and March each year., Results: Over the 13-year survey period, 1650 survey forms were received from US practitioners representing details of 7702 contact lens fits. The mean (±SD) age of lens wearers was 33.6 (±15.2) years, of whom 65.2% were female. Rigid lens new fits decreased from 13.0% in 2002 to 9.4% in 2014. Across this period, silicone hydrogels have replaced mid water contact lens hydrogels as the soft lens material of choice. Toric lenses represented about 25 to 30% of all soft lens fits. Multifocal soft lenses are generally preferred to monovision. Daily disposable lens fits have recently increased, and in 2014, they represented 27.1% of all soft lens fits. Most lenses are prescribed on 1 to 2 weekly or monthly lens replacement regimen. Extended wear remains a minority lens wearing modality. The vast majority of those wearing reusable lenses use multipurpose lens care solutions. Lenses are mostly worn 7 d/wk., Conclusions: This survey has revealed prescribing trends and preferences in the United States over the past 13 years.

Background: For most items used in operating rooms, it is unclear whether reusable items are environmentally and financially advantageous in comparison with single-use variants. We examined the life cycles of reusable and single-use central venous catheter kits used to aid the insertion of single-use, central venous catheters in operating rooms. We did not examine the actual disposable catheter sets themselves. We assessed the entire financial and environmental costs for the kits, including the influence of the energy source used for sterilization., Methods: For the reusable central venous catheter kit, we performed a "time-in-motion" study to determine the labor costs and measured the energy and water consumption for cleaning and sterilization at Western Health, Melbourne, Australia. For the majority of the inputs for the single-use kit, we relied upon industry and inventory-sourced databases. We modeled the life cycles of the reusable and single-use central venous catheter kits with Monte Carlo analysis., Results: Inclusive of labor, the reusable central venous catheter insertion kits cost $6.35 Australian ($A) (95% confidence interval [CI], $A5.89 to $A6.86), and the single-use kits cost $A8.65. For the reusable kit, CO(2) emissions were 1211 g (95% CI, 1099 to 1323 g) and for the single-use kit 407 g (95% CI, 379 to 442 g). Water use was 27.7 L (95% CI, 27.0 to 28.6 l) for the reusable kit and 2.5 L (95% CI, 2.1 to 2.9 l) for the single-use kit. For the reusable kit, sterilization had the greatest environmental cost, and for the single-use kit, the manufacture of plastic and metal components had the largest environmental costs. Different sources of electricity to make the reusable kits patient-ready again affected the CO(2) emissions: electricity from hospital gas cogeneration resulted in 436 g CO(2) (95% CI, 410 to 473 g CO(2)), from the United States electricity grid 764 g CO(2) (95% CI, 509 to 1174 g CO(2)), and from the European electricity grid 572 g (95% CI, 470 to 713 g CO(2))., Conclusions: Inclusive of labor, the reusable central venous catheter insertion kits were less expensive than were the single-use kits. For our hospital, which uses brown coal-sourced electricity, the environmental costs of the reusable kit were considerably greater than those of the single-use kit. Efforts to reduce the environmental footprint of reusable items should be directed towards decreasing the water and energy consumed in cleaning and sterilization. The source of hospital electricity significantly alters the relative environmental effects of reusable items.

Purpose: To determine the types of contact lenses prescribed for infants (aged 0 to 5 years), children (6 to 12 years), and teenagers (13 to 17 years) around the world., Methods: Up to 1000 survey forms were sent to contact lens fitters in each of 38 countries between January and March every year for 5 consecutive years (2005 to 2009). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form., Results: Data were received relating to 105,734 fits [137 infants, 1,672 children, 12,117 teenagers, and 91,808 adults (age ≥ 18 years)]. The proportion of minors (<18 year old) fitted varied considerably between nations, ranging from 25% in Iceland to 1% in China. Compared with other age groups, infants tend to be prescribed a higher proportion of rigid, soft toric, and extended wear lenses, predominantly as refits for full-time wear, and fewer daily disposable lenses. Children are fitted with the highest proportion of daily disposable lenses and have the highest rate of fits for part-time wear. Teenagers have a similar lens fitting profile to adults, with the main distinguishing characteristic being a higher proportion of new fits. Orthokeratology fits represented 28% of all contact lenses prescribed to minors., Conclusions: Patterns of contact lens prescribing to infants and children are distinctly different to those of teenagers and adults in a number of respects. Clinicians can use the data presented here to compare their own patterns of contact lens prescribing to minors.

Purpose: To assess eye care practitioners (ECPs) recommendations for replacement frequency (RF) of silicone hydrogel (SH) and daily disposable (DD) lenses in Canada and the U.S. and to compare noncompliance (NC) with manufacturer recommended RF by the ECP and patient, and the reasons given for NC., Methods: Invitations to participate were sent by e-mail to ECPs in Canada and the U.S. Twenty patient surveys were sent to 420 ECPs, and 2232 eligible surveys were received from 216 ECPs (26% Canada, 74% U.S.). Questions related to patient demographics, lens type, wearing patterns, ECP instructions for RF, and actual patient RF. ECPs provided lens information and their recommendation for RF after the surveys were completed and sealed in envelopes. Responses were anonymous., Results: DD accounted for 18% (Canada) vs. 16% (U.S.) of wearers (p > 0.05); 35% (Canada) vs. 45% (U.S.) wore 2-week replacement SH (2WR; p = 0.011); and 47% (Canada) vs. 39% (U.S.) wore 1-month replacement SH (1MR) lenses (p = 0.025). Thirty-four percent (Canada) vs. 18% (U.S.) of ECPs recommended longer RFs than the manufacturer recommended RF for 2WR lens wearers (p < 0.001); 6% (Canada) vs. 4% (U.S.) for DD wearers; and 2% (Canada) vs. 1% (U.S.) for 1MR lens wearers. NC rates for actual RFs reported by patients were not different between countries (p > 0.05) and were lowest for DD (13% Canada, 12% U.S.), followed by 1MR (33% Canada, 28% U.S.). The highest NC rates were with 2WR (50% Canada, 52% U.S.). The most frequent reason for NC with 2WR and 1MR was "forgetting which day to replace lenses" (54% Canada, 53% U.S.) and in DD wearers "to save money" (56% Canada, 29% U.S., p < 0.001)., Conclusions: 1MR lenses are more frequently prescribed in Canada. ECPs in Canada were NC with 2WR lenses more frequently than U.S. ECPs, but patient NC rates were the same in both countries for all lens types. ECP and patient NC rates were highest for 2WR lens wearers.

Objective: The objectives of this study were to assess current recommendations for replacement frequency (RF) of silicone hydrogel (SH) and daily disposable (DD) lenses, to determine compliance with these recommendations, and to investigate the reasons given for noncompliance., Methods: A package containing 20 patient surveys was sent to 309 eye care practitioners (ECPs) in the United States who had agreed to participate in the study. One thousand eight hundred fifty-nine completed surveys were received from 158 ECPs and 1,654 surveys were eligible for analysis. Questions related to patient demographics, lens type, lens wearing patterns, the ECP instructions for RF, and the actual patient reported RF. ECPs were asked to provide lens information and their recommendation for RF after the surveys had been completed and sealed in envelopes. All responses were anonymous., Results: Sixty-six percent of patients were women and their mean age was 34 +/- 12 years. Eighty-eight percent of lenses were worn for daily wear, 12.8 +/- 3.2 hours a day, 6.2 +/- 1.5 days a week. Lens type distribution was 16% DD, 45% 2 week (2W) SH, and 39% 1 month (1M) SH. ECP recommendations for RF varied according to the lens type; 1% of 1M (95% CI 0.2-1.7), 4% of DD (95% CI 2.1-7.2), and 18% of 2W (95% CI 15.1-20.7) patients were given instructions that did not conform to the manufacturers' recommended RF (MRRF). When considering only those patients who were given the correct instructions for RF, 38% were not compliant with the MRRF; noncompliance rates varied according to the lens type and were 12% for DD (95% CI 8.6-17.2), 28% for 1M (95% CI 24.9-32.1), and 52% for 2W (95% CI 47.8-55.8). The most frequent reasons for over wearing lenses were "forgetting which day to replace lenses" (51%) and "to save money" (26%). Fifty-three percent believed that a reminder system would aid compliance; the most popular methods being a cell phone reminder or text message (29%) and a nominated day each week or month (26%). Discussions between the ECPs and the patients were more extensive for patients who were compliant with the MRRF., Conclusions: ECPs recommended RFs more frequently with DD and 1M SH lenses than with 2W SH lenses, consistent with manufacturers' recommendations. Patients were less compliant with RF than ECPs for all lens types investigated. Patients were most compliant with RF when wearing DD lenses and least compliant when wearing 2W SH lenses. Better communication facilitated greater compliance with RF. More than half of those not replacing lenses, when recommended, reported that this was because they forgot which day to replace their lenses.

Objectives: To determine the proportion of prescribed soft lenses rounded to the nearest half diopter and any variations from country to country and between lens types., Methods: Marketing data were obtained for soft lenses supplied during a 1-year period for lenses representing each of the following categories: mid-water hydrogel (MWH), silicone hydrogel, daily disposable, and toric silicone hydrogel (TSH). The data were analyzed for several countries/regions. Spherical lenses were analyzed in the range 1.00 to 5.75 D for plus and minus powers, and toric lenses in the range 0.50 to 5.75 D. This ensured a similar number of lenses in full or half diopter powers were compared with quarter and three-quarter diopter powers, and that there was no enforced rounding due to nonavailability of powers. By comparing the proportion of lenses from the 2 power groups, the proportion of lenses rounded to the nearest half diopter was estimated. It was assumed that half the difference between the totals of the 2 power groups represented those lenses dispensed to the nearest half diopter and, therefore, dispensed inaccurately; this was termed the "rounding rate" (RR)., Results: The power distribution curve for the sphere powers spiked in half diopter steps, illustrated a bias toward prescribing full and half diopter powers. With all lenses, the RR varied widely between countries. For the MWH, this ranged from 1.7% (Canada) to 11.6% (Iberia). The RRs were 2 to 3 times higher for plus than minus power lenses, however, this also varied by country. Overall, the RRs were lower for the silicone hydrogel and daily disposable contact lenses compared with the MWH, in particular for France and Iberia. The TSH results showed the greatest consistency between countries, with RRs ranging from 3.9% (Germany) to 9.5% (Rest of Europe). Most countries showed similar or lower RRs for TSH compared with MWH although, for some countries (e.g., United Kingdom, Nordic), these were higher. There was less difference in RRs for TSH lenses between plus and minus spheres., Conclusion: A surprising proportion of soft lenses are prescribed to the nearest half diopter, although this varies according to lens type. There are also considerable variations between countries, presumably due to differences in training, fitting practices, and supply routes. These findings suggest that there is widespread room for improvement in the prescribing accuracy of soft contact lenses.

There is little evidence to suggest the appropriate frequency for changing suction canisters and tubing in the gastroenterology setting. This survey was initiated to determine whether there was a community standard for this issue. A diverse geographic response from attendees at the 2006 Society of Gastroenterology Nurses and Associates revealed that there is no current "standard of practice." Findings were diverse and are reported on the basis of the size of the facility, type of facility, number of endoscopic procedure rooms, and number of endoscopic procedures per month. The majority of respondents (91%) used disposable suction devices. The authors recommend the need for well-designed, systematic studies to determine the appropriate frequency for changing suction canisters and tubing in the endoscopic setting.

Purpose: To explore whether there was a significant relationship between difficulty paying for ostomy supplies and overall quality of life among a sample of ostomates receiving care from the Veterans Health Administration (VHA)., Methods: The data were collected as part of the Veterans Affairs (VA) Ostomy Health-Related Quality of Life Study, in which 511 respondents (239 cases, 272 controls) completed a survey instrument that included the modified City of Hope Quality of Life (mCOH-QOL) Ostomy questionnaire, SF-36V, and sociodemographic items. Responses from the 239 cases (ie, patients with intestinal stomas) were used in this analysis. The modified City of Hope Quality of Life Ostomy questionnaire item, "How good is your overall quality of life?," was the dependent variable for this analysis. The primary independent variable was the response (yes/no) to the item, "If you pay for any of the (ostomy) costs, is it difficult for you?" A hierarchical regression model was used to examine whether difficulty paying was significantly related to overall quality of life after adjusting for age, income, race/ethnicity, and physical health., Results: After accounting for the proportion of variance explained by age, income, race/ethnicity, and physical health, the additional proportion of variance explained by difficulty paying was statistically significant. Individuals reporting difficulty paying had a roughly 1 point lower (ie, beta-coefficient = -1.052; SE = 0.481) overall quality of life score on the 11-point scale., Conclusions: We found a significant association between difficulty paying for ostomy supplies and overall quality of life. Although the cross-sectional study design does not allow causal inference, the results suggest a relationship that merits further examination.

In June 1998, a questionnaire was mailed to approximately 2,900 healthcare professionals to assess current instrument reprocessing and infection control practices and determine whether they have changed during the past decade. Surveys were returned from 146 respondents whose facilities performed gastrointestinal endoscopy. Most respondents were registered nurses and almost all worked in healthcare facilities located in the United States. More than 75% of the respondents reported that infection control practices in endoscopy have improved during the past 10 years. Most respondents used glutaraldehyde to reprocess flexible endoscopes. Immersing endoscopes for 20 minutes at room temperature was commonly practiced. Almost 75% of respondents used an automated device to reprocess flexible endoscopes. Most respondents terminally rinsed the endoscope's channels with 70% alcohol followed by forced-air drying. Few respondents outsourced instruments to a commercial reprocessing company and almost 50% reused disposable items. While some practices in endoscope reprocessing have changed during the past several years, others have not. In general, infection controls appear to have improved during the past decade, with the possible exception of a trend to reuse single-use items.

To determine trends in a number of hemodialysis associated diseases and practices, the Centers for Disease Control and Prevention, in collaboration with the Health Care Financing Administration, performed a mail survey of 2,304 chronic hemodialysis centers in the United States in 1993. By the end of 1993, at least three doses of hepatitis B vaccine were administered to 29% of patients and 76% of staff at responding centers. Hepatitis B surface antigen was present at low frequency in patients (incidence = 0.1%, prevalence = 1.2%) and staff members (incidence = 0.2%, prevalence = 0.3%). The 1993 incidence of hepatitis B virus infection among patients was higher at centers that accepted hepatitis B surface antigen positive patients but did not use a separate room and dialysis machine for treatment of these patients, government and profit (versus nonprofit) centers, and centers in four End Stage Renal Disease Networks. The prevalence of antibody to hepatitis C virus was 9.7% among patients and 1.6% among staff members. Pyrogenic reactions in the absence of septicemia were reported by 21% of centers and associated with use of high flux dialysis. Human immunodeficiency virus infection was known to be present in 1.5% of patients; 34% of centers reported providing hemodialysis to one or more human immunodeficiency virus infected patients.

To determine trends in several hemodialysis associated diseases and practices, the Centers for Disease Control (CDC), in collaboration with the Health Care Financing Administration (HCFA), performed a mail survey of chronic hemodialysis centers in the United States in 1990. Of 1,995 centers surveyed, 1,882 (94%) representing 140,608 patients and 36,907 staff members responded. As in recent years, the 1990 survey found that certain hemodialysis practices are increasing in frequency, including treatment of water with reverse osmosis and deionizer units; use of bicarbonate dialysate and high-flux dialysis; and reuse of disposable dialyzers (in 1990, 70% of centers reused dialyzers). Hepatitis B surface antigen (HBsAg) was present at low frequency in patients (incidence, 0.2%; prevalence, 1.2%) and staff (incidence, 0.04%; prevalence, 0.3%). Antibody to hepatitis B surface antigen was present in 20% of patients and 58% of staff, and was significantly related to levels of hepatitis B vaccine coverage. Pyrogenic reactions in the absence of septicemia were reported by 20% of centers and were associated with use of high-flux dialyzer membranes and reuse of dialyzers (particularly in centers where the maximum number of reuses was 40 or more). Septicemia among hemodialysis patients was reported by 49% of centers. Twenty-six percent of centers reported providing hemodialysis for patients infected with human immunodeficiency virus (HIV), and 1.1% of dialyzed patients had known HIV infection.