Optometric office design for maximizing efficiency

In order to design an efficient optometric examination room, we made nineteen visits to practicing optometrist\u27s offices and a thorough review of all pertinent literature. These efforts culminated in our optimally efficient examination room. To test our hypothesis that our examination room was more efficient than others, a carefully controlled time and motion study was conducted. Ten timed examinations were run on a mockup of our design and ten timed examinations were run on a standard or unimproved room. All ten examiners were third or fourth year interns at the PUCO clinic. The authors served as subjects for all of the examinations. All examinations were complete-21 point procedures including biomicroscopy and non-contact tonometry. The optimal room design included: a set of switches on a chairside console for controlling various pieces of equipment and lights, a project-a-chart mounted above the patient\u27s head within easy arms reach of the examiner, and a separate 14A-B light permanently pointed at the ceiling. The average examination time in the unimproved room was 59. 16 minutes as opposed to 52. 9 minutes in the more efficient room. The 6. 26 minutes, or almost 11% time savings was shown to be statistically sighificant. It is felt that any optometric practitioner could save about 11% of his examination time if he instituted these improvements into the examination room

Safety and short term outcomes of a new truly minimally-invasive mesh-less and dissection-less anchoring system for pelvic organ prolapse apical repair

Objective To evaluate the safety and short term outcomes of a new, truly minimally-invasive, mesh-less and dissection-less anchoring system for pelvic floor apical repair. Methods A prospective study was conducted using the NeuGuide™ device system for pelvic floor apical repair. The primary effectiveness outcome was centro-apical pelvic floor prolapse by POP-Q after six months. The primary safety outcome was intra-operative, immediate (first 48 h) post-operative complications and adverse effects after six months. A standardized questionnaire (UDI-6) to assess quality of life at entry and during follow-up visits was used. Patients’ six months-follow-up and evaluation are reported. Results The mean age of the study population (n=10) was 63.8±12.0 years. All patients had a previous prolapse surgery. Five had a previous hysterectomy and two had stress urinary incontinence symptoms. During surgery six patients had a concurrent colporrhaphy. There was no injury to the bladder, rectum, pudendal nerves, or major pelvic vessels and no febrile morbidity was recorded. At six months, no cases of centro-apical recurrence were noted. Patients were satisfied with the procedure and had favorable quality of life scores. Using the UDI-6 questionnaire an improvement, in all domains was seen. Moreover, although the sample size was small, the improvement in urge and overflow incontinence related domains were demonstrated to be statistically significant. Conclusions This new NeuGuide™ device allows rapid and safe introduction of a suspending suture through the sacrospinous ligament and makes sacrospinous ligament fixation easy to perform, while avoiding dissection and mesh complications

The addition of a sagittal image fusion improves the prostate cancer detection in a sensor-based MRI /ultrasound fusion guided targeted biopsy

Background To explore the diagnostic benefit of an additional image fusion of the sagittal plane in addition to the standard axial image fusion, using a sensor-based MRI/US fusion platform. Methods During July 2013 and September 2015, 251 patients with at least one suspicious lesion on mpMRI (rated by PI- RADS) were included into the analysis. All patients underwent MRI/US targeted biopsy (TB) in combination with a 10 core systematic prostate biopsy (SB). All biopsies were performed on a sensor-based fusion system. Group A included 162 men who received TB by an axial MRI/US image fusion. Group B comprised 89 men in whom the TB was performed with an additional sagittal image fusion. Results The median age in group A was 67 years (IQR 61–72) and in group B 68 years (IQR 60–71). The median PSA level in group A was 8.10 ng/ml (IQR 6.05–14) and in group B 8.59 ng/ml (IQR 5.65–12.32). In group A the proportion of patients with a suspicious digital rectal examination (DRE) (14 vs. 29%, p = 0.007) and the proportion of primary biopsies (33 vs 46%, p = 0.046) were significantly lower. The rate of PI-RADS 3 lesions were overrepresented in group A compared to group B (19 vs. 9%; p = 0.044). Classified according to PI-RADS 3, 4 and 5, the detection rates of TB were 42, 48, 75% in group A and 25, 74, 90% in group B. The rate of PCa with a Gleason score ≥7 missed by TB was 33% (18 cases) in group A and 9% (5 cases) in group B; p-value 0.072. An explorative multivariate binary logistic regression analysis revealed that PI-RADS, a suspicious DRE and performing an additional sagittal image fusion were significant predictors for PCa detection in TB. 9 PCa were only detected by TB with sagittal fusion (sTB) and sTB identified 10 additional clinically significant PCa (Gleason ≥7). Conclusion Performing an additional sagittal image fusion besides the standard axial fusion appears to improve the accuracy of the sensor-based MRI/US fusion platform

Goethe e l'antico

Il tema Goethe e l’antico, contrariamente alle aspettative, non è un campo di ricerca molto frequentato dalla germanistica internazionale. Il presente volume, che raccoglie – in gran parte – i contributi tenuti al convegno internazionale svoltosi a Roma nel novembre del 1998, vuole rappresentare un cambio di paradigma nell’approccio al problema, in quanto prende in considerazione l’assieme del conforto di Goethe con l’antico, tanto nei suoi aspetti di teoria dell’arte, quanto nei suoi aspetti poetologici. Prima del 1770 il testo letterario acquisiva la sua autorità dalla tradizione antecedente che costituiva un rapporto con il passato come una catena senza soluzione di continuità. A partire da Goethe il testo non fonda più la sua autorità nei suoi riferimenti ad Omero o a Orazio, ma nella capacità combinatoria dell'autore che è in grado di riformulare i motivi poetici in modo da ricollocarli nel suo tempo e nel contempo di ridefinirne il significato anche rispetto all'antico. Goethe ha preso dall’antico temi, immagini, motivi perchè credeva che essi potessero esprimere letterariamente una serie di situazioni archetipiche in grado di essere recepite in ogni caso. Ma ha anche avuto l’intuizione geniale, e di una sconcertante modernità, di rappresentare tali immagini e tali motivi con un linguaggio adeguato alla capacità recettiva dei sui contemporanei e di costruirli in un contesto artistico adeguato alla comunicazione della sua epoca