Health news
14/01/2009 Checklist helps reduce surgical complications, deaths
Surgical adverse events reduced by one third in trials in eight countries
14 January 2009 -- Hospitals in eight cities around the globe have successfully demonstrated that the use of a simple surgical checklist, developed by WHO, during major operations can lower the incidence of surgery-related deaths and complications by one third.
The studies were undertaken in hospitals in each of the six WHO regions. Analysis shows that the rate of major complications following surgery fell from 11% in the baseline period to 7% after introduction of the checklist, a reduction of one third. Inpatient deaths following major operations fell by more than 40% (from 1.5% to 0.8%).
"The concept of using a brief but comprehensive checklist is surprisingly new to us in surgery. Not everyone on the operating teams were happy to try it. But the results were unprecedented. And the teams became strong supporters," said Dr Atul Gawande, main author of the study and team leader for the development of the WHO surgical safety checklist.
Data was collected from 7688 patients - 3733 before and 3955 after the checklist was introduced.
The study was carried out in hospitals in both high and lower income settings-in Ifakara (Tanzania), Manila (Philippines), New Delhi (India), Amman (Jordan), Seattle (United States of America), Toronto (Canada), London (United Kingdom) and Auckland (New Zealand). The reductions in complications proved to be of equal magnitude in high and lower income sites in the study.
Implications for other medical fields
"These findings have implications beyond surgery, suggesting that checklists could increase the safety and reliability of care in numerous medical fields," Dr Gawande said. "The checklists must be short, extremely simple, and carefully tested in the real world. But in specialties ranging from cardiac care to paediatric care, they could become as essential in daily medicine as the stethoscope."
The safe surgery checklist, which was launched by WHO as a recommended guideline for safe practice last year, has since gained global recognition by operating theatre staff, including surgeons and anaesthetists.
It requires only a few minutes to complete at three critical points during operative care - before anaesthesia is administered, before skin incision and before the patient leaves the operating room. It is intended to ensure the safe delivery of anaesthesia, appropriate prophylaxis against infection, effective teamwork by the operating room staff and other essential practices in perioperative care.
"The immediate response to the checklist has been remarkable, and the studies undertaken in the pilot hospitals are significant. They will make a major contribution towards our goal of having 2500 hospitals around the world using the safe surgery checklist by the end of this year," said Sir Liam Donaldson, Chair of the WHO World Alliance for Patient Safety and Chief Medical Officer for England.
The results of the study are published on the web site of the New England Journal of Medicine. The material will appear in the the journal's printed issue on 29 January 2009.
For more information please contact:
Dan Epstein
WHO News Team Leader
WHO, Geneva
Telephone: +41 22 791 1492
Mobile: +41 79 475 5534
E-mail: epsteinda@who.int
Vivienne Allan
Patient Safety Programme
WHO, Geneva
Mobile: +41 79 615 5065
E-mail: allanvi@who.int
10/12/2008 Preventable injuries kill 2000 children every day
10 December 2008 | Geneva/Hanoi/New York
More than 2000 children die every day as a result of unintentional or accidental injuries. Every year tens of millions more worldwide are taken to hospitals with injuries that often leave them with lifelong disabilities, according to a new report by WHO and UNICEF.
The World report on child injury prevention provides the first comprehensive global assessment of unintentional childhood injuries and prescribes measures to prevent them. It concludes that if proven prevention measures were adopted everywhere at least 1000 children's lives could be saved every day.
"Child injuries are an important public health and development issue. In addition to the 830 000 deaths every year, millions of children suffer non-fatal injuries that often require long-term hospitalization and rehabilitation," said WHO Director-General Dr Margaret Chan. "The costs of such treatment can throw an entire family into poverty. Children in poorer families and communities are at increased risk of injury because they are less likely to benefit from prevention programmes and high quality health services."
"This report is the result of a collaboration of more than 180 experts from all regions of the world," said UNICEF Executive Director Ann M. Veneman. "It shows that unintentional injuries are the leading cause of childhood death after the age of nine years and that 95% of these child injuries occur in developing countries. More must be done to prevent such harm to children."
Africa has the highest rate overall for unintentional injury deaths. The report finds the rate is 10 times higher in Africa than in high-income countries in Europe and the Western Pacific such as Australia, the Netherlands, New Zealand, Sweden and the United Kingdom, which have the lowest rates of child injury.
However, the report finds that although many high-income countries have been able to reduce their child injury deaths by up to 50% over the past 30 years, the issue remains a problem for them, with unintentional injuries accounting for 40% of all child deaths in such countries.
The report finds that the top five causes of injury deaths are:
Road crashes: They kill 260 000 children a year and injure about 10 million. They are the leading cause of death among 10-19 year olds and a leading cause of child disability.
Drowning: It kills more than 175 000 children a year. Every year, up to 3 million children survive a drowning incident. Due to brain damage in some survivors, non-fatal drowning has the highest average lifetime health and economic impact of any injury type.
Burns: Fire-related burns kill nearly 96 000 children a year and the death rate is 11 times higher in low- and middle-income countries than in high-income countries.
Falls: Nearly 47 000 children fall to their deaths every year, but hundreds of thousands more sustain less serious injuries from a fall.
Poisoning: More than 45 000 children die each year from unintended poisoning.
"Improvements can be made in all countries," said Dr Etienne Krug, Director of WHO's Department of Violence and Injury Prevention and Disability. "When a child is left disfigured by a burn, paralysed by a fall, brain damaged by a near drowning or emotionally traumatized by any such serious incident, the effects can reverberate through the child's life. Each such tragedy is unnecessary. We have enough evidence about what works. A known set of prevention programmes should be implemented in all countries."
The report outlines the impact that proven prevention measures can have. These measures include:
laws on child-appropriate seatbelts and helmets;
hot tap water temperature regulations;
child-resistant closures on medicine bottles, lighters and household product containers; separate traffic lanes for motorcycles or bicycles;
draining unnecessary water from baths and buckets;
redesigning nursery furniture, toys and playground equipment;
strengthening emergency medical care and rehabilitation services.
It also identifies approaches that either should be avoided or are not backed by sufficient evidence to recommend them. For example, it concludes
that blister packaging for tablets may not be child resistant;
that airbags in the front seat of a car could be harmful to children under 13 years;
that butter, sugar, oil and other traditional remedies should not be used on burns;
that public education campaigns on their own don't reduce rates of drowning.
For more information please contact:
Laura Sminkey
WHO, Geneva
Telephone: +41 22 791 4547
Mobile: +41 79 249 3520
E-mail: sminkeyl@who.int
Najwa Mekki
UNICEF, New York
Telephone: +1 212 326 7162
E-mail: nmekki@unicef.org
n/a Essential medicines out of reach for most people
Lack of medicines in public sector forcing patients to pay high prices, finds new study
1 December 2008 | GENEVA -- An alarming lack of availability of essential medicines in the public sector drives patients to pay higher prices in the private sector or go without, according to a WHO study reported in today's online edition of The Lancet. The results confirm that governments must do more to improve access to essential medicines as part of their efforts to make national health systems more efficient and equitable.
The study analysed data from surveys in 36 countries from all WHO geographical regions and World Bank income groups. Results show an average public-sector availability of only 38% across surveys. This forces patients to buy medicines from the private sector where treatments are more expensive and frequently unaffordable. In Africa, for example, the lowest-paid government worker needs to spend two days' salary each month to purchase diabetes treatment using the lowest-priced generic medicine. When the originator brand is used, costs escalate to over eight days' wages.
"You should not have to choose between buying medication for an ailing parent or buying food for your children," said Carissa Etienne, WHO Assistant Director-General of Health Systems and Services. "It is not fair or necessary. That is why we are calling again for comprehensive primary health care, so that health systems in every country put the real health needs of people and communities first, and families are not impoverished or bankrupted because of health care payments."
On the pricing side, the study revealed that "cuts" taken by wholesalers, distributors and retailers plus government taxes and duties are driving prices beyond affordability in many countries. In some countries, add-on costs can double the public-sector price of medicine, while in the private sector, wholesale mark-ups ranged from 2% to 380%, and retail mark-ups ranged from 10% to 552%.
"Essentially, multi-layered supply chain costs add up to one thing for patients, no access to essential medicines," said Dr Richard Laing of the Essential Medicines and Pharmaceutical Policies department at WHO. "When you pull apart the layers of additional charges, the potential solutions for governments to make life-saving medicines more available and accessible are clear - improve financing and distribution efficiency, promote the use of generic products and control supply chain costs by limiting mark-ups and removing duties and taxes."
The study further asserts that these actions should all be part of national medicine policies that are measured and evaluated against predetermined benchmarks at least every two years, with routine monitoring and reporting more frequently.
The results cover 15 medicines included in at least 80% of surveys, as well as four specific medicines used to treat asthma, diabetes, hypertension and acute infections. The figures are adjusted to account for differences in buying power of local currencies and then compared to international reference prices, allowing for cross-country comparison.
The work is part of an ongoing joint effort between WHO and Health Action International (HAI) to highlight and improve availability and affordability of essential medicines, especially in low- and middle-income countries.
For more information please contact:
Elizabeth Finney
Communications Officer
Essential Medicines and Pharmaceutical Policies
WHO, Geneva
Telephone: +41 22 791 18 66
E-mail: finneye@who.int
26/11/2008 Universal voluntary testing, immediate treatment can reduce HIV cases
New findings, based on mathematical model, published for discussion and further research
26 November 2008 | GENEVA -- Universal and annual voluntary testing followed by immediate antiretroviral therapy treatment (irrespective of clinical stage or CD4 count) can reduce new HIV cases by 95% within 10 years, according to new findings based on a mathematical model developed by a group of HIV specialists in WHO. The findings were published in The Lancet1 today to stimulate discussion, debate and further research.
Authors of the study also report that the universal voluntary testing followed by immediate ART could have additional public health benefits, including reducing the incidence of tuberculosis and the transmission of HIV from mother to child. Additionally, the model suggests that there could be a significant reduction of HIV-related morbidity and mortality in resource-limited countries with generalized HIV epidemics.
The current WHO policy on treatment involves voluntary testing and clinical and/or immunological evaluation (e.g. CD4 count) to determine eligibility for treatment with antiretrovirals.
The authors emphasize the theoretical nature of the exercise based on data and raise a number of concerns regarding feasibility, including the protection of individual rights, drug resistance, toxicity and financing challenges.
The paper does not signal a change in WHO guidance. WHO-recommended preventive interventions need to be maintained and expanded. This includes male circumcision, partner reduction, correct and consistent use of condoms, and interventions targeting most-at-risk populations, also known as "combination prevention."
WHO will convene a meeting early next year bringing together ethicists, funders, human rights advocates, clinicians, prevention experts and AIDS programme managers to discuss this and other issues related to the wider use of antiretroviral therapy for HIV prevention.
For more information please contact:
Dick Thompson
News Team Leader
WHO, Geneva
Telephone: +41 22 791 1492
Mobile: +41 79 475 5534
E-mail: thompsond@who.int
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