Diagnostic Yield of head Computed Tomography in Patients with Syncope: Sex Differences.

BACKGROUND: Syncope is responsible for approximately 1-3% of all emergency department (ED) visits and up to 6% of all hospital admissions in the United States. Although often of no long-term consequence, syncope can be the first presentation of a range of serious conditions such as strokes, tumors, or subarachnoid hemorrhages. Head computed tomography (CT) scanning is therefore commonly ordered in the ED for patients presenting with syncope to rule out any of these conditions, which may present without other associated physical or neurological findings on initial examination. However, the diagnostic yield of head CTs in patients presenting with syncope is unclear. OBJECTIVES: To determine the diagnostic yield of head CT in the ED in patients with syncope. METHODS: We conducted an observational analytical retrospective cross-sectional study on 360 patients diagnosed with syncope who underwent a head CT to determine the diagnostic yield of syncope to determine whether head CT is necessary for every patient presenting with syncope to the ED. RESULTS: The total of new CT findings was 11.4%. Percentages varied between men (12.8%) and women (9.7%), P = 0.353. There were no significant differences between sexes regarding the findings in head CT, yet the incidence increased, especially among elderly males. CONCLUSIONS: Age had a more significant impact on diagnostic yield of syncope than head CT. The use of a head CT scan as a routine diagnosis tool in patients with syncope is unjustifiable unless there is an indication based on medical history or physical examination.

The influence of early virtual reality intervention on pain, anxiety, and function following primary total knee arthroplasty.

BACKGROUND: Total knee arthroplasty (TKA) is one of the most popular surgeries in the orthopedic field. One of the reasons for a failed TKA is pain and difficulty to return to normal function. A pain control method that is becoming more and more popular is the use of virtual reality (VR). We aimed to examine VR intervention in the immediate post-operative physiotherapy following TKA. METHODS: This prospective randomized-controlled study recruited a total of 55 patients undergoing primary TKA in a single institute, operated by three surgeons. They were assigned either study group or control group. Both groups were treated with conventional physiotherapy and CPM equipment (Continuous passive motion device), the study group received additional VR modality. Both groups completed a series of questionnaires prior and after the intervention: State-Trait Anxiety Inventory (STAI) questionnaire (used to diagnose anxiety), Visual analog scale (VAS) for pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) (knee function score). RESULTS: The average age was 70 years-old with equal distribution of male and female. Both groups showed a decrease in pain and anxiety following the intervention (p value < 0.05) but there was no difference between the groups (p value > 0.05 for all parameters). The was no difference in the WOMAC scores in the six-month post-operative examination between groups (p-value = 0.653). CONCLUSIONS: Virtual reality intervention in the immediate post-operative period following total knee arthroplasty decrease pain and anxiety but did not influence the pain, anxiety, and long-term function results more than conventional physiotherapy.