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It is important to proactively identify and address psychological difficulties in patients and their families prior to transplant. Following transplantation, a multidisciplinary approach to targeting rehabilitation and decreasing negative effects of the transplant may assist with improving the QOL for patients and their families.

BackgroundThe overuse of antibiotics in newborns leads to increased mortality and morbidities. Implementation of a successful antibiotic stewardship programme (ASP) is necessary to decrease inappropriate use of antibiotics and its adverse effects.ProblemOur neonatal intensive care unit (NICU) is a tertiary referral centre of north India, consisting of all outborn babies mostly with sepsis caused by high rate of multidrug-resistant organisms (MDROs). So antibiotics are not only life-saving but also used excessively with a high antibiotic usage rate (AUR) of 574 per 1000 patient days.MethodA quality improvement (QI) study was conducted using the Plan–Do–Study–Act (PDSA) approach to reduce AUR by at least 20% from January 2019 to December 2020. Various strategies were made : such as making a unit protocol, education and awareness of NICU nurses and doctors, making check points for both starting and early stoppage of antibiotics, making specific protocol to start vancomycin, and reviewing yearly antibiotic policy as per antibiogram.ResultsThe total AUR, AUR (culture negative) and AUR (vancomycin) was reduced by 32%, 20% and 29%, respectively, (p<0.01). The proportion of newborns who never received antibiotics increased from 22% to 37% (p<0.045) and the proportion of culture-negative/screen-negative newborns where antibiotics were stopped within 48 hours increased from 16% to 54% (p<0.001). The compliance with the unit protocol in starting and upgrading antibiotic was 75% and 82%, respectively. In early 2020, there was a sudden upsurge in AUR due to central line-related bloodstream infection breakout. However, we were able to control it, and all the PDSA cycles were reinforced. Finally, we could reattain our goals, and also able to sustain it until next 1 year. There was no significant difference in overall necrotising enterocolitis and mortality rates.ConclusionIn a centre such as ours, where sepsis is a leading cause of neonatal deaths, restricting antibiotic use is a huge challenge. However, we have demonstrated implementation of an efficient ASP with the help of a dedicated team and effective PDSA cycles. Also, we have emphasised the importance of sustainability in success of any QI study.

A decision analytic approach for evaluating new aviation safety products and technologies is developed and demonstrated to consolidate five existing program assessment metrics to develop a unified metric that simultaneously considers the relative importance and contribution of each. This allows for a meaningful and objective evaluation and comparison of the National Aeronautics and Space Administration (NASA) Aviation Safety Program (AvSP) advanced aeronautical products and technologies. The resulting decision model is referred to as the Composite Program Assessment Score (CPAS). The CPAS includes the five existing metrics; technical development risk, implementation risk, fatal accident rate reduction, safety benefits and cost, and safety risk reduction, which are each defined and quantified by different sources. The CPAS involves the scaling and combination of these individual metrics. In this paper, two alternative combinatorial modeling approaches to calculate the CPAS are presented. The weighted sum model and an additive value theory model are compared and contrasted. The resulting CPAS metrics allow an overall comparison of all 48 of the NASA AvSP products and technologies. Currently CPAS is based on preliminary weight measures from subject matter experts to reflect the relative importance of each metric. Actual case studies of both linear and non-linear value functions are demonstrated.

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