ABSTRACT
BACKGROUND: Although guidelines suggest that the best strategy for evaluating syncope is clinical history and physical examination, the inappropriate utilization of diagnostic imaging is common. METHODS: A single center retrospective analysis conducted in adult patients admitted for evaluation and management of syncope for a period of 12 months. Charts were reviewed to abstract demographic data, admitting and discharge diagnosis, diagnostic investigatory tests including imaging modalities (echocardiogram, carotid ultrasound, and cranial computed tomography (CT)) ordered, subspecialty consultation requested, treatment rendered and hospital length of stay (LOS). RESULTS: A total of 109 patients were admitted for syncope, mean age was 68.74 ± 21.04 years and 39.44% were men. Echocardiogram, carotid ultrasound, and cranial CT were ordered in 69.72%, 33.02%, and 76.14% respectively. The mean hospital LOS was 2.6 days. Patients with no imaging test, one imaging test, two imaging tests, and three imaging tests ordered have an average hospital LOS of 2.22 days, 2.44 days, 2.58 days, and 3.07 days respectively. The number of imaging test and its relation to the admitting (Chi-square (chi-sq) P = 0.4165, nominal logistic regression (LR) P = 0.939) and discharge (chi-sq P = 0.1507, nominal LR P = 0.782) diagnosis as well as the LOS in relation to the number of imaging test ordered (analysis of variance (ANOVA) P = 0.368, Kruskal Wallis (KW) P = 0.352) were not statistically significant although there was a trend of prolonged hospital LOS the more imaging diagnostic test had been ordered. Syncope was the admitting and discharge diagnosis in 89.9% and 91.74% respectively. CONCLUSIONS: Choosing the appropriate diagnostic tests as dictated by the patient's clinical manifestation and utilizing less expensive test would be appropriate and cost-effective approach in appraising patients with syncope.
ABSTRACT
OBJECTIVE: Robotic training (RT) using the da Vinci skills simulator and conventional training (CT) using a laparoscopic "training box" are both used to augment operative skills in minimally invasive surgery. The current study tests the hypothesis that skill acquisition is more rapid using RT than using CT among naive learners. DESIGN AND PARTICIPANTS: A total of 40 subjects without laparoscopic or robotic surgical experience were enrolled and randomized to begin with either RT or CT. Then, 2 specific RT tasks were reproduced for CT and repeated 5 times each with RT and CT. Time and quality indicators were measured quantitatively. A crossover technique was used to control for in-study experience bias. RESULTS: The tasks "pick and place jacks" (PP) and "thread the rings" (TR) were achieved faster with RT than with CT despite crossover (p < 0.0001). An RT-favoring difference was observed in speed for both tasks when changing modality. Percentage improvement with increasing trials was similar for RT and CT: RT completion time averaged 39 seconds and 211 seconds (PP and TR, respectively), compared with 65 seconds and 362 seconds when using CT (p < 0.0001); final improvement averaged 26% and 46% for RT (PP and TR, respectively) vs 31% and 47% for CT (p was 0.76 for PP and 0.20 for TR). Within the PP task, RT times averaged 41 seconds without previous CT experience vs 35 seconds with previous CT experience (p = 0.20); CT times averaged 61 seconds without and 69 seconds with previous RT experience (p = 0.48). Comparable times for the TR task were 212 seconds vs 216 seconds (p = 0.66) and 388 seconds vs 334 seconds (p = 0.17). Both instrument collisions and excessive force occurred more commonly for RT than for CT within the TR task (p < 0.0001). CONCLUSIONS: Speeds were faster overall with RT than with CT, but the percentage of speed improvement with trials was similar, suggesting similar learning curves, with minimal transfer effect appreciated.
