Utah Valley Regional Medical Center

To perform three studies needed to design the "U-BET" trial (Umbilical cord Blood for Extremely-low-gestational-age Transfusions). (1) Survey-based self-assessment of Intermountain Health obstetricians regarding drawing umbilical cord blood. (2) Determine the percentage of the potentially donating neonates who have type O blood (to be utilized in U-BET). (3) Quantify cord blood drawn using American Red Cross collection kits. (1) 72% of respondents declared experience drawing cord blood; 62% with the placenta in utero. (2) Of the past 100,000 women delivering, 48% were type O, and 66% of neonates born to them were type O. (3) The volume of cord blood obtained at 10 births ranged from 20 to 86 mL after the placenta was delivered vs. 14 to157 mL when in utero. The U-BET trial will consent type O women and use Red Cross kits to draw term umbilical cord blood while the placenta is still in utero.

Utah Valley Family Medicine Residency, Provo, UT The corresponding author is Sarah Daly; [email protected]. The authors declare no conflicts of interest.

Utah Valley Family Medicine Residency, Provo, UT The Corresponding Faculty Author on the manuscript is: Sarah Daly; [email protected]. The authors declare no conflicts of interest.

Schools of business seek to prepare students for the workplace with employer-valued skills such as communication, teamwork, and application of knowledge. As such, a common practice for business and management educators is to involve students in collaborative team-based assignments and community projects. To facilitate the development of teamwork skills, faculty members may have students create a team charter, which involves student teams identifying goals, roles, and norms. However, empirical evidence of the value of team charters is limited. This study examined student perceptions of team charters to determine if they played a role in effective teamwork or if other variables accounted for team success. The study entailed an analysis of a mid-semester team evaluation survey and an end-of-semester team charter survey. Findings indicated that overall, the inclusion of the development and application of student charters in student group projects leads to several important benefits and learning outcomes. However, the perceived usefulness of charters varies among students by level of experience and year in school.

Predictors for successful aerosolized surfactant treatment are not well defined. To identify predictors for successful treatment in the AERO-02 trial and the AERO-03 expanded access program. Neonates receiving nasal continuous positive airway pressure (NCPAP) at the time of first aerosolized calfactant administration were included in this analysis. Associations between demographic and clinical predictors to need for intubation were examined using univariate testing and multivariate logistic regression analyses. Three hundred and eighty infants were included in the study. Overall, 24% required rescue by intubation. Multivariate modeling revealed that the predictors of successful treatment were a gestational age ≥31 weeks, a respiratory severity score (RSS) of <1.9, and <2 previous aerosol treatments. Gestational age, number of aerosols, and RSS are predictive of successful treatment. These criteria will help select patients most likely to benefit from aerosolized surfactant.

Utah Valley Family Medicine Residency, Provo, UT The corresponding author is Sarah Daly DO; [email protected]. The authors declare no conflicts of interest.

Rationale: Care of emergency department (ED) patients with pneumonia can be challenging. Clinical decision support may decrease unnecessary variation and improve care. Objectives: To report patient outcomes and processes of care after deployment of electronic pneumonia clinical decision support (ePNa): a comprehensive, open loop, real-time clinical decision support embedded within the electronic health record. Methods: We conducted a pragmatic, stepped-wedge, cluster-controlled trial with deployment at 2-month intervals in 16 community hospitals. ePNa extracts real-time and historical data to guide diagnosis, risk stratification, microbiological studies, site of care, and antibiotic therapy. We included all adult ED patients with pneumonia over the course of 3 years identified by International Classification of Diseases, 10th Revision discharge coding confirmed by chest imaging. Measurements and Main Results: The median age of the 6,848 patients was 67 years (interquartile range, 50-79), and 48% were female; 64.8% were hospital admitted. Unadjusted mortality was 8.6% before and 4.8% after deployment. A mixed effects logistic regression model adjusting for severity of illness with hospital cluster as the random effect showed an adjusted odds ratio of 0.62 (0.49-0.79; P < 0.001) for 30-day all-cause mortality after deployment. Lower mortality was consistent across hospital clusters. ePNa-concordant antibiotic prescribing increased from 83.5% to 90.2% (P < 0.001). The mean time from ED admission to first antibiotic was 159.4 (156.9-161.9) minutes at baseline and 150.9 (144.1-157.8) minutes after deployment (P < 0.001). Outpatient disposition from the ED increased from 29.2% to 46.9%, whereas 7-day secondary hospital admission was unchanged (5.2% vs. 6.1%). ePNa was used by ED clinicians in 67% of eligible patients. Conclusions: ePNa deployment was associated with improved processes of care and lower mortality. Clinical trial registered with www.clinicaltrials.gov (NCT03358342).