Use of standardized discharge instruction templates and rapid feedback to staff improved the readability of instructions. Next steps include adaptation and spread to other patient populations.

Glutaraldehyde cross-linked porcine aortic valves, referred to as bioprosthetic heart valves (BHVs), are often used in heart valve replacements. Glutaraldehyde does not stabilize glycosaminoglycans (GAGs) and they are lost during preparation, in vivo implantation, cyclic fatigue, and storage. We report that binding of neomycin, a hyaluronidase inhibitor, to the tissues with carbodiimide cross-linking improves GAG retention without reducing collagen and elastin stability. It also led to improved biomechanical properties. Neomycin carbodiimide cross-linking did not significantly reduce calcification in a rat subdermal implantation model when they were stored in formaldehyde after cross-linking. Removal of formaldehyde storage significantly reduced calcification.

Objectives To validate the pediatric Patient Reported Outcomes Measurement Information System short forms (PROMIS®-SFs) in childhood-onset systemic lupus erythematosus (cSLE) in a clinical setting. Methods At three study visits, cSLE patients completed the PROMIS-SFs (Anger, Anxiety, Depressive Symptoms, Fatigue, Physical Function-Mobility, Physical Function-Upper Extremity, Pain Interference, Peer Relationships) using the PROMIS Assessment Center, and health-related quality of life (HRQoL) legacy measures (Pediatric Quality of Life Inventory™, Childhood Health Assessment Questionnaire, Simple Measure of Impact of Lupus Erythematosus in Youngsters [SMILEY], visual analog scales [VAS] of pain and well-being). Physicians rated cSLE activity on a VAS, and completed the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Physicians rated change of cSLE activity (GRC-MD1: better/same/worse) and change of patient overall health (GRC-MD2: better/same/worse) between study visits with a global rating scale of change. Questionnaire scores were compared in support of validity and responsiveness to change (external standards: GRC-MD1, GRC-MD2). Results In this population-based cohort (n=100) with a mean age of 15.8 (range: 10–20) years, the PROMIS-SFs were completed in less than five minutes in a clinical setting. The PROMIS-SF scores correlated at least moderately (Pearson’s r ≥0.5) with those of legacy HRQoL, except for the SMILEY. Measures of cSLE activity did not correlate with the PROMIS-SFs. Responsiveness to change of the PROMIS-SFs was supported by path, mixed model, and correlation analyses. Conclusions To assess HRQoL in cSLE, the PROMIS-SFs demonstrated feasibility, internal consistency, construct validity, and responsiveness to change in a clinical setting.

Objective To examine incidence of acute kidney injury (AKI), antenatal and postnatal predictors, and impact of AKI on outcomes in infants with congenital diaphragmatic hernia (CDH). Study design Single center retrospective study of 90 CDH infants from 2009–2017. Baseline characteristics, CDH severity, possible AKI predictors, and clinical outcomes were compared between infants with and without AKI. Result In total, 38% of infants developed AKI, 44% stage 1, 29% stage 2, 27% stage 3. Lower antenatal lung volumes and liver herniation were associated with AKI. Extracorporeal life support (ECLS), diuretics, abdominal closure surgery, hypotension, and elevated plasma free hemoglobin were associated with AKI. Overall survival was 79%, 47% with AKI, and 35% with AKI on ECLS. AKI is associated with increased mechanical ventilation duration and length of stay. Conclusion AKI is common among CDH infants and associated with adverse outcomes. Standardized care bundles addressing AKI risk factors may reduce AKI incidence and severity.