Implementation of a Regional Oxygen Saturation Thought Algorithm and Association with Clinical Outcomes in Pediatric Patients Following Cardiac Surgery.

Near infrared spectroscopy is routinely used in the noninvasive monitoring of cerebral and somatic regional oxygen saturation (rSO2) in pediatric patients following surgery for congenital heart disease. We sought to evaluate the association of a bedside rSO2 thought algorithm with clinical outcomes in a cohort of pediatric patients following cardiac surgery. This was a single-center retrospective cohort study of patients admitted following cardiac surgery over a 42-month period. The intervention was the implementation of an rSO2 thought algorithm, the primary goal of which was to supply bedside providers with a thought aide to help identify, and guide response to, changes in rSO2 in post-operative cardiac surgical patients. Surgical cases were stratified into two 18-month periods of observation, pre- and post-intervention allowing for a 6-month washout period during implementation of the thought algorithm. Clinical outcomes were compared between pre- and post-intervention periods. There were 434 surgical cases during the period of study. We observed a 27% relative risk reduction in our standardized mortality rate (0.61 to 0.48, p = 0.01) between the pre- and post-intervention periods. We did not observe differences in other post-operative clinical outcomes such as ventilator free days or post-operative ICU length of stay. Providing frontline clinical staff with education and tools, such as a bedside rSO2 thought algorithm, may aide in the earlier detection of imbalance between oxygen delivery and consumption and may contribute to improved patient outcomes.

Completeness of Written Discharge Guidance for English- and Spanish-Speaking Patient Families.

OBJECTIVES: Written discharge guidance for hospitalized pediatric patients should include language-appropriate key elements to ensure positive discharge outcomes. Our objective in this study was to determine the completeness of written pediatric discharge guidance and to test the hypothesis that Spanish-speaking families with limited English proficiency (LEP) receive less complete written discharge guidance than English-speaking families. METHODS: We conducted a retrospective review of written discharge guidance provided to 100 English- and 100 Spanish-speaking families at an urban nonfreestanding children's hospital to assess the inclusion of key elements: follow-up plan, contingency plan, telephone contact, discharge medications, discharge diagnosis, and hospital course. We compared the completeness of discharge guidance (number of elements provided among number of applicable elements) between English- versus Spanish-speaking families. RESULTS: When evaluating discharge guidance for the presence of key elements in any language, there was no significant difference between English- and Spanish-speaking families. However, the mean completeness of language-appropriate discharge guidance for English- and Spanish-speaking families was 87.8% (95% confidence interval [CI] 84.4%-91.1%) and 16.0% (95% CI 11.5%-20.4%), respectively. The ordinal logistic regression examining the association between the number of key element deficits and English- (reference group) versus Spanish-speaking families demonstrated an adjusted odds ratio of 339.8 (95% CI 112.4-1027.5). CONCLUSIONS: Few Spanish-speaking families with LEP receive written discharge guidance in their preferred language. Complete, language-appropriate discharge guidance was identified as an area for improvement efforts to work toward improving care provided to families with LEP.

Characterization of a non-ribosomal peptide synthetase-associated diiron arylamine N-oxygenase from Pseudomonas syringae pv. phaseolicola.

The regiospecific oxidation of aromatic amines to aryl nitro compounds is critical to the synthesis of several natural products having pharmacological importance. The arylamine N-oxygenase (AAO) from Streptomyces thioluteus (AurF) selectively oxidizes p-aminobenzoic acid to p-nitrobenzoic acid and has been the subject of investigation for its unique chemistry and substrate preferences. Little, however, is known about the biochemistry and substrate specificities of AurF homologues, which are often associated with non-ribosomal peptide synthetases or polyketide synthases and have substrate binding pockets with substantially different amino acid compositions based on sequence alignments. An AAO homolog from Pseudomonas syringae pv. phaseolicola was expressed and purified to further explore the substrate specificity and biosynthetic utility of this enzyme class. PsAAO was most active on substituted o-aminophenols at pH 9 in buffer solutions containing 40% methanol. o-Aminophenols allow both the Pseudomonas and Streptomyces AAOs to act on para-substituted arylamines having methoxy, methyl, and nitro groups, which was previously unseen. A Hammett plot of k(cat,app) vs. σ has a ρ = -1.5, indicating substrate reactivity is dependent on the electron donating effects of substituents. The mechanistic data are consistent with an amine lone pair attacking an activated oxygen atom after formation of the hydroperoxy Fe(III/III) intermediate.