Implementing an Evidence-Based Practice Change for Alcohol Withdrawal in an Acute Care Hospital

Practice Problem: Alcohol Use Disorders (AUD) affects a significant portion of the population in the United States. When AUD is either unrecognized or inadequately treated in the acute care setting it can lead to medical complications, increased length or stay (LOS), increased healthcare expense, and increased patient mortality. PICOT: In a population of adult patients admitted to an acute care hospital progressive care unit (P), how does applying an initial evidence-based screening tool to detect risk for moderate to severe alcohol withdrawal, the PAWSS (I), compare to no standard screening or assessment for potential alcohol withdrawal symptoms (C) affect the occurrence of patient deterioration for acute alcohol withdrawal symptoms (O) within an eight week timeframe (T)? Intervention: The PAWSS tool was utilized to screen all patients admitted to the progressive care unit. Patients identified at moderate to severe risk by a score of ≥4 were treated according to the standard facility practice with included CIWA-Ar monitoring and medication management with benzodiazepine medication. Outcome: The project was able to demonstrate a significant decrease in the mean LOS for those patients identified at risk and treated for AWS, with an average decrease of 50 hours in length of stay for those patients treated during the project implementation. Conclusion: Early recognition of patients at risk for AWS is an important component of effective management and treatment. Further study is needed into best practices for treatment of patients at risk, and internal compliance measures within the organization.

Measurement of Flow Fluctuation in the Flow Standard Facility Based on Singular Value Decomposition

In order to accurately evaluate the flow stability of the flow standard facility, the flow fluctuation in the standard facility needs to be accurately measured. However, the flow fluctuation signal is always superimposed with the fluctuation signal of the measuring flowmeter or measurement system (mainly noise), which leads to inaccurate measurement of the flow fluctuation and even an unreliable evaluation result of the flow stability. In addition, when there are multiple fluctuation sources, flow fluctuations with different frequencies are superimposed together, which is extremely unfavorable for evaluating the impact of flow fluctuation with different single frequencies. In this paper, a new measuring method was proposed to obtain the fluctuation signal and the flow fluctuation based on singular value decomposition (SVD). Simulation experiments on the fluctuation signal (single frequency and multiple frequencies) under different levels of noise were conducted, and simulation results showed that the proposed method could accurately obtain the fluctuation signal and the flow fluctuation, even under high noise. Finally, an experimental platform was set-up based on a water flow standard facility and a flow fluctuation generator, and experiments on the output signal of a venturi flowmeter were carried out. The experiment results showed that the proposed method could effectively obtain the fluctuation signal and accurately measure the flow fluctuation.

Importance of Standards in Biomedical Device and Its Role in Strengthening the Healthcare Sector

Biomedical Metrology group of CSIR-NPL (Council of Scientific and Industrial Research—National Physical Laboratory), India is contributing significantly for establishing National Biomedical equipment standardswhich are traceable to primary standards to cater the quality control regulation in Health sector. This initiative has great impact on the health policy and Nation's economy as well. The laboratory has recently established biomedical equipment standard facility and disseminated the services to Industries, stake holders, hospitals and accredited laboratories. Although, the laboratory is successfully providing biomedical equipment calibration services for last 2 years, the sensitization of the information on the recently established metrological capabilities is required, which has great implications in implementation of India's New medical Device rule 2017 effectively. The present paper describes the summary on the significant achievements and role of National Physical Laboratory in supporting the Indian medical device regulations.

Comparative Analysis: Cost of Two Community ARTDelivery ModelsIn the Urban Settings In Zambia

In the quest to improve and address the bottle necks of ART services to the affected population, Zambia has implemented three models of delivering this service which are; Standard of Care, Door to Door and Adherence Clubs. The aim of this study was to identify and cost the provision of ART services using the three models. A quantitative retrospective cross-sectional study was done to compare the cost of delivering two models, adherence clubs and door to door in relation to the standard facility-based model. The 2018 costing data for ART was collected retrospectively in the Kanyama and Chipata Health Urban Centers in Lusaka, Zambia. A checklist and a data costing tool was developed to help identify and cost all the costs items attached to the provision of ART services in the two Health Centers. The study shows that the total cost of delivering ART services to 11,225 patients at Chipata Health center was 53,087,649.54 ZMW ($ 4,994,134.48) translating into 21,802.49 ($2,051.03) per patient. Furthermore, providing the same services at Kanyama to 12,293 clients costed 35,823,354.87 ZMW ($ 3,370,023.98) and cost per patient was 24989.65 ZMW ($2,350.86).The study concluded that it was more expensive to deliver ART through health facility model than community-based models. The major costs of ART services using three models of care were ARV drugs followed capital and personnel costs. In order to reduce barriers and costs ART services must be brought close to people as much as possible.