Background Insurance-related outcomes disparities are well-known, but associations between distinct insurance types and trauma outcomes remain unclear. Prior studies have generally merged various insurance types into broad groups. The purpose of this study is to determine the association of specific insurance types with mortality after blunt injury. Materials and Methods Cases of blunt injury among adults aged 18-64 years with an Injury Severity Score (ISS)>9 were identified using the 2007-2009 National Trauma Data Bank. Crude mortality was calculated for ten insurance types. Multivariable logistic regression was employed to determine difference in odds of death between insurance types, controlling for ISS, Glasgow Coma Scale motor, mechanism of injury, sex, race and hypotension. Clustering was used to account for possible inter-facility variations. Results 312,312 cases met inclusion criteria. Crude mortality ranged from 3.2-6.0% by insurance type. Private Insurance, Blue Cross Blue Shield, Workers Compensation, and Medicaid yielded the lowest relative odds of death, while Not Billed and Self Pay yielded the highest. Compared to Private Insurance, odds of death were higher for No Fault (OR 1.25, p=0.022), Not Billed (OR 1.77, p<0.001), and Self Pay (OR 1.78, p<0.001). Odds of death were higher for Medicare (OR 1.52, p<0.001) and Other Government (OR 1.35, p=0.049), while odds of death were lower for Medicaid (OR 0.89, p=0.015). Conclusions Significant differences in mortality after blunt injury were seen between insurance types, even among those commonly grouped in other studies. Policymakers may use this information to implement programs to monitor and reduce insurance-related disparities.
Background Dyad learning has been shown to be an effective tool for teaching procedural skills, but little is known about how dyad learning may impact the stress, anxiety, and cognitive load that a student experiences when learning in this manner. In this pilot study, we investigate the relationship between dyad training on stress, anxiety, cognitive load, and performance in a simulated bradycardia scenario. Methods Forty-one fourth-year medical school trainees were randomized as dyads (n = 24) or individuals (n = 17) for an education session on day 1. Reassessment occurred on day 4 and was completed as individuals for all trainees. Primary outcomes were cognitive load (Paas scale), stress (Cognitive Appraisal Ratio), and anxiety levels (abbreviated State-Trait Anxiety Inventory). Secondary outcomes were time-based performance metrics. Results On day 1 we observed significant differences for change in anxiety and stress measured before and after the training scenario between groups. Individuals compared to dyads had larger mean increases in anxiety, (19.6 versus 7.6 on 80-point scale, p = 0.02) and stress ratio (1.8 versus 0.9, p = 0.045). On the day 4 post-intervention assessment, no significant differences were observed between groups. Secondary outcomes were significant for shorter time to diagnosis of bradycardia (p = 0.01) and time to initiation of pacing (p = 0.04) in the dyad group on day 1. On day 4, only time to recognizing the indication for pacing was significantly shorter for individual training (hazard ratio [HR] = 2.26, p = 0.02). Conclusions Dyad training results in lower stress and anxiety levels with similar performance compared to individual training.
Although ambulatory surgery offers patients convenience and reduced costs, same-day cancellation of ambulatory surgery negatively affects patient experiences and operational efficiency. We conducted a retrospective analysis to determine the frequency and reasons for same-day cancellations in an outpatient surgery center at a large academic tertiary referral center. Of 41 389 ambulatory surgical procedures performed, same-day cancellations occurred at a rate of 0.5% and were usually unforeseeable in nature. Focusing on foreseeable cancellations offers opportunities for enhanced patient satisfaction, improved quality of care, and systems-based practice improvements to mitigate cancellations related to areas such as scheduling or patient noncompliance.
Introduction: The transition into clinical anesthesiology is a challenging period that requires swift acquisition of clinical knowledge and procedural skills. Senior residents are in a prime position to help their junior colleagues into the operating room environment due to their ability to relate from personal experience. We created a workshop for enhancing peer apprenticeship during this transition. Methods: The workshop consisted of PowerPoint didactics interspersed with small-group practice sessions. Surveys were administered pre-, post-, 1-week post-, and 1-month postworkshop. The primary outcome was pre-post improvement in the proportion of residents prepared to be a trainer. Secondary outcomes included pre-to 1-week postworkshop improvement, pre-postworkshop change in knowledge of learning theory concepts, and pre-postworkshop change in first-year clinical anesthesiology perceptions of trainers. Results: Of residents, 12 of 43 (28%) eligible to be resident trainers attended the workshop. The proportion of residents who felt prepared increased from 75% preworkshop to 100% postworkshop and remained at 93% at 1 week. Knowledge of cognitive load and microskills improved from 0% preworkshop to 83% postworkshop but dropped to 0% at 1 month. Comfort using microskills improved from 0% preworkshop to 83% postworkshop. Discussion: Early anesthesiology training demands rapid acquisition of novel cognitive and procedural skills. Senior anesthesiology residents are in a prime position to train junior residents, yet many are uncomfortable with this role. We developed a workshop to transition residents into a peer trainer role and significantly increased their confidence to be a trainer. Other programs may benefit from implementing similar training.
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