Fidest – Agenzia giornalistica/press agency

Quotidiano di informazione – Anno 32 n° 55

Posts Tagged ‘World Health Organization’

The Global Burden of Unsafe Medical Care: An Observational Study

Posted by fidest press agency su martedì, 24 settembre 2013

A new study published on 18 September 2013 provides early evidence that adverse events due to medical care represent a major source of morbidity and mortality globally and reinforces the important role quality and safety of care plays in global health. The study, “The Global Burden of Unsafe Medical Care: An Observational Study”, published today at the BMJ Quality & Safety, describes the main results of a first-ever study commissioned by the World Health Organization (WHO) and led by Dr Ashish Jha and David Bates, patient safety scientists of the Harvard School of Public Health and the Brigham & Women’s Hospital respectively.Adapting the methodology developed for the Burden of Disease study series, the researchers estimated disability-adjusted life years (DALYs) lost to measure morbidity and mortality due to specific adverse events. Available data were found for the following set of adverse events: (i) adverse drug events, (ii) catheter-related urinary tract infections, (iii) catheter-related blood stream infections, (iv) nosocomial pneumonia, (v) venous thrombo-embolisms, (vi) falls and (vii) decubitus (pressure) ulcers. The study estimates that there are 421 million hospitalizations in the world annually and approximately 42.7 million adverse events for the seven types described, resulting in 23 million DALYs lost per year. Approximately two-thirds of all adverse events, and the DALYs lost from them, occurred in low and middle income countries. It is clear that this is an early attempt to quantify the burden of unsafe care and more analysis is needed to understand sources of imprecision in these estimates. That said, these data show that the problem of unsafe health care is significantly greater than previously thought globally and that global health policymakers should consider how to make safe patient care an international priority.The number of DALYs lost were more than twice as high in low- and middle- income countries (15.5 million) as they were in high income countries (7.2 million). Compared to other conditions, the combination of these seven types of unsafe care alone ranks as the 20th leading cause of morbidity and mortality for the world’s population. It is unlikely that these are “new” previously undiscovered DALYs, but rather that they are captured within the injuries and deaths attributed to other conditions such as cardiovascular disease.Unsafe medical care may even lead patients to opt out of using the formal healthcare system, raising questions of appropriateness and quality of care in the informal sector. In this sense, unsafe care becomes a potentially significant barrier to access for many of the world’s poor.This study faced significant barriers due to limitations in availability and quality of data sources, hampering the ability to effectively calculate the number of DALYs lost due to unsafe care, particularly within low and middle income countries. While further refinements of the estimates are needed, the data provided in this manuscript represent a significant contribution to the understanding of the burden of unsafe care. They also signal a new direction of scientific enquiry where further methodological developments are necessary to nurture the necessary understanding of this important field.“This landmark study is also an appeal to the donor and scientific communities to further invest and investigate in this important area of work and to creatively develop methodologies to fill the current gaps in data availability and data quality,” says Dr Edward Kelley, Coordinator of the WHO Patient Safety Programme. “Furthermore, it also calls for policy action to strengthen information systems, of which the medical record and related data sources are essential for the needed understanding about the tall of unsafe care”. The estimates provided are conservative, hindering not only the ability to calculate their consequences, but also limiting the ability of clinical leaders and policymakers to track the potential impact of policies designed to increase the safety of healthcare as well as universal health coverage.
Given the magnitude of the effects shown in this manuscript, it is fair to suggest that to improve the health of the world’s citizens, actions are needed to not only improve access to care but also to invest substantial focus on improving the safety of the healthcare systems that people access worldwide. When patients are sick, they should not be further harmed by unsafe care.

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Who Safe Childbirth Checklist Programme

Posted by fidest press agency su venerdì, 18 maggio 2012

A new study from Harvard School of Public Health (HSPH) and the World Health Organization (WHO) finds that a simple checklist-based patient safety programme for childbirth dramatically improved adherence to essential childbirth care practices at a pilot hospital in South India. Of 29 practices measured, 28 were improved after adoption of the checklist and overall adherence to essential practices more than doubled after the checklist was introduced.The study appears in the May 16, 2012 online edition of PLoS ONE at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0035151
There are nearly 300,000 maternal deaths, 3.1 million newborn deaths, and 1.2 million intrapartum-related stillbirths taking place in low-income countries each year, of which the vast majority are preventable. This study offers “hope that use of this simple, low-cost tool can help birth attendants better adhere to universally accepted standards in childbirth care,” as indicated senior author Atul Gawande, Associate Professor in Health Policy and Management at HSPH and lead advisor for WHO Patient Safety’s childbirth and surgery safety checklist-based patient safety programmes.
This prospective before and after intervention study took place over six months at a First Referral Unit (level-II) birth facility located in Karnataka, India. The Safe Childbirth Checklist (SCC) programme led to dramatic improvements in healthcare worker adherence to essential childbirth-related clinical care standards. Healthcare workers provided on average 10 out of 29 (34%) essential clinical care standards at baseline and 25 out of 29 (86%) after introduction of the checklist (p<0.001). For example, rates of breastfeeding within 1 hour after birth increased from 50.4% to 94.6%.
The WHO Safe Childbirth Checklist builds on the success of the WHO Surgical Safety Checklist and targets the major causes of morbidity and mortality in mothers and their newborn babies around the time of delivery. It defines a core set of practical standards to enhance patient safety and includes a behaviour change package to help staff implement the checklist. At the programme’s core is a checklist that helps to ensure adherence to essential childbirth practices known to be associated with improved maternal, foetal, and neonatal health. Each item is a critical action that is commonly missed but proven to reduce complications and deaths.A large Ramdomised Controlled Trial led by researchers from Harvard School of Public Health and funded by the Bill and Melinda Gates Foundation is underway in Uttar Pradesh, India to evaluate the impact of this checklist-based patient safety programme on maternal and newborn health outcomes. Results of the study are expected by 2015.
The Safe Childbirth Checklist programme represents a collaborative effort of the WHO Patient Safety Programme, the Department of Maternal, Newborn, Child and Adolescent Health, and the Department of Reproductive Health and Research and Harvard School of Public Health, in addition to many other experts from around the world. WHO anticipates a draft release of the WHO Safe Childbirth Checklist by the end of the year.

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“The evolving threat of antimicrobial resistance – Options for action”

Posted by fidest press agency su venerdì, 9 marzo 2012

World Health Organization building from the So...

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Geneva – A new book “The evolving threat of antimicrobial resistance – Options for action”, was launched today by the World Health Organization. It showcases examples of actions taken to slow down drug resistance and preserve the ability of medicines to effectively treat many infectious diseases. The steps taken by governments, health facilities and providers and others are examples of what had been recommended in the 2001 WHO Global Strategy for Containment of Antimicrobial Resistance.The book examines the experiences with implementing some of those recommendations ten years on, the lessons learnt along the way and the gaps still remaining. It draws attention to areas where knowledge is lacking and where urgent action is still needed.The aim of the book is to raise awareness about antimicrobial resistance (AMR) and stimulate further efforts to meet the recommendations outlined in the 2001 strategy and the 2011 World Health Day policy package. It does so by examining the current situation, and setting out what has been done and what more could be done around the world, in high-, middle- and low-income countries.While much of what is summarized in this publication is well known to the scientific community, awareness at the political level is essential, but often lacking. A specific objective is therefore to encourage policy decision-makers and the global community to commit to intensified action against AMR.
Over several decades, powerful medicines have been developed to treat diseases such as tuberculosis, malaria, HIV, influenza and many bacterial infections. All the medicines used to treat these infections will eventually become ineffective due to the development of resistance. AMR has evolved to become a worldwide health threat. Of critical importance is the fact that every antibiotic ever developed is at risk. This makes it difficult and more expensive to treat many common infections, causing delays in effective treatment or, in worst cases, an inability to provide effective treatment at all.”In terms of new replacement antibiotics, the pipeline is virtually dry. But much can be done,” says Dr Margaret Chan, Director-General of the World Health Organization. “This includes prescribing antibiotics appropriately and only when needed, following treatment correctly, restricting the use of antibiotics in food production to therapeutic purposes and tackling the problem of substandard and counterfeit medicines.”Drug resistance causes increased and prolonged illness, a greater risk of complications and higher death rates. Infections which are increasingly resistant to antibiotics are causing a heavy disease burden, particularly in developing countries.Some of the examples of a number of successful strategies and measures highlighted in the book include:
• In Thailand, the “Antibiotic Smart Use” programme reduces the prescribing of and demand for antibiotics by both prescribers and patients. It showed an 18%–46% reduction in antibiotic use while 97% of targeted patients recovered or improved regardless of whether they had taken antibiotics.
• A programme in pharmacies in Viet Nam consisting of inspection for prescription-only drugs; education on pharmacy treatment guidelines; and group meetings of pharmacy staff have resulted in a significant reduction in antibiotic dispensing for acute respiratory infections.
• In Norway, the introduction of effective vaccines in farmed salmon and trout together with improved fish health management reduced the annual use of antimicrobials in farmed fish by 98% between 1987 and 2004.
• In 2010, the University of Zambia School of Medicine revised their undergraduate medical curriculum. The topics of AMR and rational use of medicines were prominently inserted. The aim is that graduates enter clinical practice with the right skills and attitudes to be both effective practitioners
and committed stewards of AMR containment.
More information on the book, a link to download it and details on how to order a copy can be found on WHO Patient Safety’s web page: http://www.who.int/patientsafety/en/.

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