Increase bleeding control knowledge and self-efficacy among middle school students and determine efficacy of health care student-led Stop the Bleed (STB) training.

An interprofessional group of health care students led STB trainings at 6 Texas middle schools. Trainings included a presentation plus hands-on skills training and were evaluated using pre- and post-training surveys focused on bleeding control knowledge, self-efficacy, and willingness to assist in emergencies. Paired pre- and post-training survey responses were compared using McNemar’s test for knowledge-based questions and paired t tests for Likert scale responses.

Health care students (N = 103) trained 805 middle school students, aged 10-16 years, of which 447 (55.5%) completed pre- and post-surveys. There was significant improvement in all 7 knowledge-based questions from pre- to post-training. There were significant improvements in comfort using tourniquets (median [interquartile range]: 3 [2-4] vs. 4 [3-5]; P < 0.0001), confidence applying direct pressure (3 [2-4] vs. 4 [3-5]; P < 0.0001), and likeliness to assist someone bleeding (4 [3-5] vs. 4 [4-5]; P = 0.0096). Eighty-four percent of students found this training “useful.”

While previous studies have demonstrated STB training efficacy, this is among the first to provide evidence that health care student-led STB training significantly increased bleeding control knowledge and self-efficacy among middle school students.

To describe the use of next-generation sequencing (NGS) and to determine whether NGS leads to changes in antimicrobial management.

This retrospective cohort study included patients aged ≥18 years admitted to a single tertiary-care center in Houston, Texas, with an NGS test performed between January 1, 2017, and December 31, 2018.

In total, 167 NGS tests were performed. Most patients were of non-Hispanic ethnicity (n = 129), white (n = 106), and male (n = 116), with a mean age of 52 years (SD, 16). Moreover, 61 patients were immunocompromised: solid-organ transplant (n = 30), patients with human immunodeficiency virus (n = 14), and rheumatology patients on immunosuppressive therapy (n = 12).

Of the 167 NGS tests performed, 118 (71%) were positive. Test results associated with a change in antimicrobial management were found in 120 (72%) of 167 cases, with an average of 0.32 (SD, 1.57) fewer antimicrobials after the test. The largest change in antimicrobial management was in glycopeptide use (36 discontinuations) followed by antimycobacterial drug use (27 additions among 8 patients). Also, 49 patients had negative NGS results, but only 36 patients had their antibiotics discontinued.

Plasma NGS testing is associated with a change in antimicrobial management in most cases. We observed a decrease in glycopeptide use after NGS results, which highlights physicians’ comfort in withdrawing methicillin-resistant Staphylococcus aureus (MRSA) coverage. In addition, antimycobacterial coverage increased, corresponding with early mycobacterial detection by NGS. Further studies are needed to determine effective ways to use NGS testing as an antimicrobial stewardship tool.