Use of Cognitive Aids to Augment Point of Care Hemorrhage Control Skills in Laypersons.

OBJECTIVE: The Stop the Bleed course aims to improve bystander hemorrhage control skills and may be improved with point-of-care aids. We sought to create and examine a variety of cognitive aids to identify an optimal method to augment bystander hemorrhage control skills in an emergency scenario. METHODS: Randomized trial of 346 college students. Effects of a visual or visual-audio aid on hemorrhage control skills were assessed through randomization into groups with and without prior training or familiarization with aids compared with controls. Tourniquet placement, wound packing skills, and participant comfortability were assessed during a simulated active shooter scenario. RESULTS: A total of 325 (94%) participants were included in the final analyses. Participants who had attended training (odds ratio [OR], 12.67; P = 9.3 × 10-11), were provided a visual-audio aid (OR, 1.96; P = 0.04), and were primed on their aid (OR, 2.23; P = 0.01) were superior in tourniquet placement with less errors (P < 0.05). Using an aid did not improve wound packing scores compared with bleeding control training alone (P > 0.05). Aid use improved comfortability and likelihood to intervene emergency hemorrhage scenarios (P < 0.05). CONCLUSIONS: Using cognitive aids can improve bystander hemorrhage control skills with the strongest effects if they were previously trained and used an aid which combined visual and audio feedback that they were previously introduced to during the course training.

What factors influence the cost of orthognathic surgery among patients in the US?

OBJECTIVE: The purpose of our study was to analyze what factors influence the cost of orthognathic surgery performed within the US. STUDY DESIGN: This retrospective cohort study was completed using the Kids' Inpatient Database (KID) from 2000 to 2012 on all patients aged 14 to 20 years who had undergone orthognathic surgery. The predictor variables included patient and hospitalization characteristics. The primary outcome variable was hospital charge ($). Multivariate linear regression was conducted to determine independent predictors for increased/decreased hospital charge. RESULTS: The final sample consisted of 14 191 patients (mean age, 17.4 ± 1.6 years; females, 59.2%). Each additional day in the hospital added $8123 in hospital charges (P < .01). Relative to mandibular osteotomy, maxillary osteotomy (+$5703, P < .01) and bimaxillary osteotomy (+$9419, P < .01) were each associated with increased hospital charges. Genioplasty (+$3499, P < .01), transfusion of packed cells (TPC) (+$11 719, P < .01), continuous invasive mechanical ventilation (CIMV) <96 hours (+$23 502, P < .01), and CIMV ≥96 hours (+$30 901, P < .01) were each associated with significantly increased hospital charges. Obstructive sleep apnea (OSA) added $6560 in hospital charges (P < .01). CONCLUSIONS: Maxillary osteotomy and bimaxillary surgery were each associated with significantly increased charges relative to mandibular osteotomy. Concomitant genioplasty, TPC, CIMV, and OSA each significantly increased the charges. Each additional day to the length of stay significantly increased the charges.

The Impact of a Mobile Phone Application for Retention of Bleeding Control Skills.

BACKGROUND: The American College of Surgeons Bleeding Control Course (B-Con) empowers bystanders with hemorrhage control skills to manage prehospital emergencies, but demonstrates poor skill retention. The point of care use of a free Stop the Bleed mobile phone application on the retention of hemorrhage control skills from the B-Con Course was explored. METHODS: Convenience sample of college students previously trained in B-Con were randomized into mobile application (MA) or control groups. The use of a mobile application during a simulated emergency scenario with tourniquet and situational awareness skills was assessed. Wound packing skill retention without intervention was also assessed. Survey data allowed for comparison of participant perceptions of skills with actual performances. RESULTS: MA (n = 30) was superior to control (n = 32) in correct tourniquet application (62.5% versus 30.0%; P = 0.01) with longer placement times (163 sec versus 95 sec; P < 0.001) and in calling 911 (31.3% versus 3.3%, P = 0.004). Participants maintain inflated perceptions of their skills, but generally feel underprepared for a future bleeding emergency. CONCLUSIONS: Mobile apps improve tourniquet and situational awareness skills and may serve as potential aids to improve bystander hemorrhage control skills in real-time, but require further prospective investigation into its use.