[Closed-circuit television systems : Current importance and tips on adaptation and prescription]. / Bildschirmlesegeräte : Aktueller Stellenwert und Hinweise zu Anpassung und Verordnung.

Closed-circuit television systems (CCTVs) have become an indispensable tool in rehabilitating low vision patients. Compared to optical visual aids, apart from providing maximum magnification these devices have the additional advantage of improved contrast sensitivity and an enlarged field of view. They are often the only visual aid enabling patients to regain reading ability. Our data reflect a decrease in the number of prescriptions caused by improved counseling of low-vision patients. Any prescription of reading aids must be preceded by comprehensive testing and counseling. More recent developments, such as electronic magnifiers are becoming increasingly more important but they are no substitute for CCTV.

[Dice test--a simple method for assessment of visual acuity in infants with visual deficits]. / Würfel-Test--eine einfache Methode zur Visusbestimmung bei Sehbehinderung im Kleinkindalter.

PURPOSE: Determination of visual acuity in low vision infants or patients with additional cerebral retardation is difficult. In our low vision department we used dice of different sizes and colors as well as other defined objects to determine visual acuity (VA). In this study we compared the results of the dice test with conventional tests for measurement of visual acuity. METHODS: A total of 88 children with different causes of visual impairment e.g. albinism, retinal scars, retinopathy of prematurity (ROP), achromatopsia and optic atrophy etc., were included in this longitudinal study. Median follow-up time was 8.7 years (range 2.9-18.9 years). The first reliable examination was performed between the ages of 4 and 24 months (median 11 months). We estimated VA depending on the edge length of the dice, which were recognized at a distance of 30 cm, while 4 mm complied with VA 20/200. Best corrected binocular visual acuity was compared between the dice test, measurement with the Lea symbols and with numbers or Landolt rings. RESULTS: Estimation of visual acuity using the dice test was possible at the end of the first year of life (median 11 months, range 4-27 months). Although observation is limited to visual acuity results in the low vision range between light reaction and 20/120 there was nearly complete agreement between all three VA measurements. Visual acuity ranged from light perception to 20/20 with a median of 20/100. In 39 patients visual acuity was 20/200 or less at the end of the observation period. Visual acuity estimation overestimated visual acuity only in 5 out of the 88 patients, while in all of the patients with later acuity measurements better than 20/200, our best value of 20/200 was achieved. CONCLUSIONS: Using simple visual objects, such as dice with different colors and size down to an edge length of 4 mm, it is possible to estimate visual acuity in low vision infants within the first year of life. This option is also very helpful in patients who are not able to perform other visual acuity measurements or to give reliable answers using preferential looking, such as severely handicapped patients. In contrast to preferential looking with this dice test there is not only judgment of the reaction by the observer but also activity of the patient who grips the dice he can really see. This allows better counseling of families with low vision infants concerning current and later visual functions.

Inefficacy of simulator-based training on anaesthesiologists' non-technical skills.

BACKGROUND: Analysis of critical incidents in anaesthesia practice emphasizes the important role of non-technical skills (NTS) in improving patient safety. Therefore, debriefing with regard to NTS has been added to medical management (MM) simulator training to improve acute crisis competencies of anaesthesiologists. The purpose of this study was to compare the NTS and MM performance of two groups of anaesthesiologists in a simulated anaesthesia crisis after undergoing different types of training. METHODS: Forty-two anaesthesiologists were randomly assigned to two different training groups, with each group participating in two simulation training sessions. One group's (NTS+MMG) training included extensive debriefing of NTS (resource management, planning, leadership and communication) and MM, while the other group (MMG) received a simpler debriefing that focused solely on MM. The quality and quantity of NTS and quality of MM performance were rated by reviewing the videotapes of the scenarios. RESULTS: NTS+MMG did not prove superior to MMG with regard to behavioural and MM markers. The quality of NTS performances correlated significantly (P<0.01) with the quantity of NTS demonstration, and also correlated significantly with the MM actions (P<0.01) in both groups. CONCLUSION: A single session of training including debriefing of NTS and MM did not improve the NTS performances of anaesthesiologists when compared with anaesthesiologists who only received MM training. This might indicate that a more frequent or individual training is needed to improve participants' NTS performance.

Simulation as an additional tool for investigating the performance of standard operating procedures in anaesthesia.

BACKGROUND: In medicine, the use of standard operating procedures (SOPs) is often evaluated using questionnaires (QUES). However, QUES can have limitations with regard to method, thus leading to errors. Simulation (SIM) offers another opportunity for evaluation. We hypothesized that medical errors in the evaluation of SOPs using QUES could be detected by SIM, and that SIM is better qualified to demonstrate applied medicine. METHODS: We investigated the use of SOPs in anaesthesia, rapid sequence induction (RSI), by means of a QUES (n=42) or SIM (n=42) among 84 anaesthesiologists. Seven measures for preventing aspiration during induction of anaesthesia were examined and evaluated according to a predetermined points system. RESULTS: The average number of times that precautionary measures to prevent aspiration were mentioned in the QUES [4.8 (0.9)] or performed during SIM [5.0 (1.1)] did not differ between the two groups. Pre-oxygenation was the most frequently described or performed measure (95% vs 93%). However, other measures, such as avoidance of positive pressure ventilation (45% vs 85%), differed significantly between the two groups. CONCLUSIONS: QUES and SIM are powerful instruments for evaluating the implementation of SOPs such as RSI. SIM demonstrates automated behaviours and thus more clearly represents behaviours used in clinical practice than is possible to demonstrate using QUES. Using a combination of these two instruments, method errors resulting from the individual instruments can be reduced.

[Influence of cutoff filters on reading behavior in age-related macular degeneration]. / Einfluss von Kantenfiltern auf die Lesefähigkeit bei altersabhängiger Makuladegeneration.

BACKGROUND: Cutoff filters may improve contrast sensitivity in different retinal dystrophies and therefore lead to improved visual function. We investigated whether cutoff filters result in improved reading ability in age-related macular degeneration (AMD). METHODS: Reading performance was examined in 22 patients with AMD aged 63-91 years (visual acuity 0.1-0.5) using the Radner reading charts. These charts were presented in random order either with or without cutoff filters (Zeiss CF 540 and CF 580) monocularly to the better eye using a defined luminance of the test charts of 105 cd/m(2). RESULTS: Using the CF 540 cutoff filter, there was no significant change in visual acuity while there was a tendency to decrease. Calculating the LogRAD score, which takes reading errors into account, three patients improved by one line, while nine deteriorated, six of them by one line or more. There was no significant improvement using the CF 580 compared to either the CF 540 or to normal reading glasses. CONCLUSIONS: Overall, we found no measurable improvement using the CF 540 cutoff filter. The cutoff filter CF 580, tested for additional comparison, did not show any advantage.

The novel missense mutation methionine 442 threonine in the thyroid hormone receptor beta causes thyroid hormone resistance: a case report.

We report a family with thyroid hormone resistance caused by a novel mutation M442T in the thyroid hormone receptor beta (TRbeta) gene. The 59-year-old propositus and one of his two daughters had typical clinical signs of reduced responsiveness of tissues to thyroid hormones. Thus, elevated free T (3) and T (4) plasma concentrations in coexistance with a diffuse nodular goiter, nonsuppressed TSH, and atrial fibrillation with tachycardia were present in the propositus. His affected daughter also had increased levels of free T (3) and T (4) with slightly elevated TSH concentrations. Both affected members harboured a heterozygous M442T TRbeta mutation. The unaffected child had no mutation in the TRbeta gene and no clinical manifestations.

Concurrent genital and rectal prolapse: two pathologies--one joint operation.

This study is a prospective assessment of a joint operation to repair concomitant genital and rectal prolapse, including 10 women treated for concomitant genital and rectal prolapse from 1991 to 1995. Joel-Cohen vaginal hysterectomy was used to correct the genital prolapse, followed by the Altemeier procedure (transperineal rectosigmoidectomy) to correct the rectal prolapse. The post-operative course was uneventful in all cases and there were no recurrences of prolapse in the three year follow up period. Improvement of sphincteric tone was shown in all cases by transrectal manometry, and bladder and rectal continence was maintained. The combined surgical procedure for concurrent genital and rectal prolapse is easy to perform and safe and efficient in terms of recurrence and continence. It is hoped this report will increase multidisciplinary awareness of an effective solution for a potentially debilitating problem.

[A rare pelvic tumor].

Splenosis consists of the autotransplantation of splenic tissue following splenic trauma. Unlike hypersplenism, to which it is not related, it does not usually result in any clinical manifestation. It is usually discovered incidentally during operation years after splenic trauma. A benign tumor is found which may or may not be histologically identical with normal splenic tissue, and may or may not be functional. We present a 52-year-old man with a pelvic mass thought to be malignant. Work-up, including CT scan, 99m Tc colloid scintigraphy and 99m Tc-labeled heat-denaturated erythrocyte scintigraphy revealed pelvic splenosis. This case highlights the fact that a pelvic tumor after emergency splenectomy may represent splenosis.