scholarly journals Variations in processes for guideline adaptation: a qualitative study of World Health Organization staff experiences in implementing guidelines

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Zhicheng Wang ◽  
Quinn Grundy ◽  
Lisa Parker ◽  
Lisa Bero
Keyword(s):  
Public Health ◽  
Clinical Practice ◽  
Qualitative Study ◽  
Local Development ◽  
World Health ◽  
Recent Experience ◽  
Who Guidelines ◽  
Guideline Adaptation ◽  
The World ◽  
Adaptation Processes

Abstract Background The World Health Organisation (WHO) publishes a large number of clinical practice and public health guidelines to promote evidence-based practice across the world. Due to the variety of health system capacities and contextual issues in different regions and countries, adapting the recommendations in the guidelines to the local situation is vital for the success of their implementation. We aim to understand the range of experiences with guideline adaptation from the perspectives of those working in WHO regional and country offices. Our findings will inform development of guidance on how to improve adaptability of WHO guidelines. Methods A grounded theory-informed, qualitative study was carried out between March 2018 and December 2018. Seventeen semi-structured interviews were conducted with participants who included WHO guideline developers and staff in the headquarters, regional and country offices recruited from a sample of published WHO guidelines. Participants were eligible for recruitment if they had recent experience in clinical practice or public health guideline implementation. Deidentified transcripts of these interview were analysed through three cycles of coding. Results We categorised the adaptation processes described by the participants into two dominant models along a spectrum of guideline adaptation processes. First, the Copy or Customise Model is a pragmatic approach of either copying or customising WHO guidelines to suit local needs. This is done by local health authorities and/or clinicians directly through consultations with WHO staff. Selections and adjustments of guideline recommendations are made according to what the implementers deemed important, feasible and applicable through the consensus discussions. Second, the Capacity Building Model focuses on WHO building local capacity in evidence synthesis methods and adaptation frameworks to support local development of a national guideline informed by international guidelines. Conclusions In comparing and contrasting these two models of guideline adaptation, we outline the different kinds of support from WHO that may be necessary to improve the effectiveness and efficiency of the respective models. We also suggest clarifications in the descriptions of the process of guideline adaptation in WHO and academic literature, to help guideline adaptors and implementers decide on the appropriate course of action according to their specific circumstances. Ethics This project was conducted with ethics approval from The University of Sydney (Project number: 2017/723) and WHO (Protocol ID: 00001).

scholarly journals Building a Digital Tool for the Adoption of the World Health Organization’s Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology (Preprint)

2019 ◽  
Author(s):  
Samira M Haddad ◽  
Renato T Souza ◽  
Jose Guilherme Cecatti ◽  
Maria Barreix ◽  
Tigist Tamrat ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Clinical Practice ◽  
Decision Support ◽  
Antenatal Care ◽  
Digital Systems ◽  
World Health ◽  
Evidence Based ◽  
Data Dictionary ◽  
The World

BACKGROUND One of the key mandates of the World Health Organization (WHO) is to develop guidelines, defined as “a document containing recommendations for clinical practice or public health policy.” Guidelines represent the global standard for information sources shaping clinical practice and public health policies. Despite the rigorous development process and the value of guidelines for setting standards, implementing such standards within local contexts and at the point of care is a well-documented challenge. Digital technologies enable agile information management and may facilitate the adaptation of guidelines to diverse settings of health services delivery. OBJECTIVE The objective of this paper is to detail the systematic and iterative process involved in transforming the WHO Antenatal Care (ANC) guidelines into a digital decision-support and patient-record application for routine use in primary health care settings, known as the WHO digital ANC module. METHODS The WHO convened a team of clinical and digital health experts to develop the WHO digital ANC module as a tool to assist health care professionals in the implementation of WHO evidence-based recommendations for pregnant women. The WHO digital ANC module’s creation included the following steps: defining a minimum viable product (MVP), developing clinical workflows and algorithms, algorithm testing, developing a data dictionary, and the creation of a user interface or application development. The overall process of development took approximately 1 year to reach a stable prototype and to finalize the underlying content requirements of the data dictionary and decision support algorithms. RESULTS The first output is a reference software reflecting the generic WHO ANC guideline content, known as the WHO digital ANC module. Within it, all actionable ANC recommendations have related data fields and algorithms to confirm whether the associated task was performed. WHO recommendations that are not carried out by the health care worker are saved as pending tasks on a woman’s health record, and those that are adequately fulfilled trigger messages with positive reinforcement. The second output consists of the structured documentation of the different components which contributed to the development of the WHO digital ANC module, such as the data dictionary and clinical decision support workflows. CONCLUSIONS This is a novel approach to facilitate the adoption and adaptation of recommendations through digital systems at the health service delivery level. It is expected that the WHO digital ANC module will support the implementation of evidence-based practices and provide information for monitoring and surveillance; however, further evidence is needed to understand how the WHO digital ANC module impacts the implementation of WHO recommendations. Further, the module’s implementation will inform the WHO’s ongoing efforts to create a pathway to adaptive and integrated (Smart) Guidelines in Digital Systems to improve health system quality, coverage, and accountability.

scholarly journals Building a Digital Tool for the Adoption of the World Health Organization’s Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology

10.2196/16355 ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. e16355
Author(s):  
Samira M Haddad ◽  
Renato T Souza ◽  
Jose Guilherme Cecatti ◽  
Maria Barreix ◽  
Tigest Tamrat ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Clinical Practice ◽  
Decision Support ◽  
Antenatal Care ◽  
Digital Systems ◽  
World Health ◽  
Evidence Based ◽  
Data Dictionary ◽  
The World

Background One of the key mandates of the World Health Organization (WHO) is to develop guidelines, defined as “a document containing recommendations for clinical practice or public health policy.” Guidelines represent the global standard for information sources shaping clinical practice and public health policies. Despite the rigorous development process and the value of guidelines for setting standards, implementing such standards within local contexts and at the point of care is a well-documented challenge. Digital technologies enable agile information management and may facilitate the adaptation of guidelines to diverse settings of health services delivery. Objective The objective of this paper is to detail the systematic and iterative process involved in transforming the WHO Antenatal Care (ANC) guidelines into a digital decision-support and patient-record application for routine use in primary health care settings, known as the WHO digital ANC module. Methods The WHO convened a team of clinical and digital health experts to develop the WHO digital ANC module as a tool to assist health care professionals in the implementation of WHO evidence-based recommendations for pregnant women. The WHO digital ANC module’s creation included the following steps: defining a minimum viable product (MVP), developing clinical workflows and algorithms, algorithm testing, developing a data dictionary, and the creation of a user interface or application development. The overall process of development took approximately 1 year to reach a stable prototype and to finalize the underlying content requirements of the data dictionary and decision support algorithms. Results The first output is a reference software reflecting the generic WHO ANC guideline content, known as the WHO digital ANC module. Within it, all actionable ANC recommendations have related data fields and algorithms to confirm whether the associated task was performed. WHO recommendations that are not carried out by the health care worker are saved as pending tasks on a woman’s health record, and those that are adequately fulfilled trigger messages with positive reinforcement. The second output consists of the structured documentation of the different components which contributed to the development of the WHO digital ANC module, such as the data dictionary and clinical decision support workflows. Conclusions This is a novel approach to facilitate the adoption and adaptation of recommendations through digital systems at the health service delivery level. It is expected that the WHO digital ANC module will support the implementation of evidence-based practices and provide information for monitoring and surveillance; however, further evidence is needed to understand how the WHO digital ANC module impacts the implementation of WHO recommendations. Further, the module’s implementation will inform the WHO’s ongoing efforts to create a pathway to adaptive and integrated (Smart) Guidelines in Digital Systems to improve health system quality, coverage, and accountability.

scholarly journals SITUAÇÃO ATUAL DA QUALIDADE DO AR DAS PRINCIPAIS CIDADES DA AMÉRICA LATINA

2016 ◽  
Vol 38 ◽  
pp. 523
Author(s):  
Liana Giselle Murcia ◽  
Edison Ortiz ◽  
Jorge Martins ◽  
Marcos Morais ◽  
Leda Ardiles ◽  
...  
Keyword(s):  
Public Health ◽  
Latin America ◽  
Particulate Matter ◽  
World Health ◽  
Government Agencies ◽  
Who Guidelines ◽  
The Public ◽  
The World ◽  
America Latina ◽  
Health Organization

In this paper was done the compilation of Particulate Matter (PM) concentrations for the largest cities in Latin America, with over 1 million inhabitants in order to investigate the air quality situation in this region. For this study were obtained data from 28 cities of 13 countries from the World Health Organization reports (WHO), government agencies and monitoring stations. The results shows that, in most cities, the levels established by WHO guidelines, both PM10 and PM2.5, are exceeded, providing conditions that threaten the public health of citizens.

scholarly journals Evaluation of the first pharmacy-led weight management programme in Greece

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i45-i46
Author(s):  
A Peletidi ◽  
R Kayyali
Keyword(s):  
Public Health ◽  
Health Services ◽  
Potential Role ◽  
Annual Report ◽  
World Health ◽  
Public Health Services ◽  
Cvd Risk ◽  
The World ◽  
Health Organization

Abstract Introduction Obesity is one of the main cardiovascular disease (CVD) risk factors.(1) In primary care, pharmacists are in a unique position to offer weight management (WM) interventions. Greece is the European country with the highest number of pharmacies (84.06 pharmacies per 100,000 citizens).(2) The UK was chosen as a reference country, because of the structured public health services offered, the local knowledge and because it was considered to be the closest country to Greece geographically, unlike Australia and Canada, where there is also evidence confirming the potential role of pharmacists in WM. Aim To design and evaluate a 10-week WM programme offered by trained pharmacists in Patras. Methods This WM programme was a step ahead of other interventions worldwide as apart from the usual measuring parameters (weight, body mass index, waist circumference, blood pressure (BP)) it also offered an AUDIT-C and Mediterranean diet score tests. Results In total,117 individuals participated. Of those, 97.4% (n=114), achieved the programme’s aim, losing at least 5% of their initial weight. The mean % of total weight loss (10th week) was 8.97% (SD2.65), and the t-test showed statistically significant results (P<0.001; 95% CI [8.48, 9.45]). The programme also helped participants to reduce their waist-to-height ratio, an early indicator of the CVD risk in both male (P=0.004) and female (P<0.001) participants. Additionally, it improved participants’ BP, AUDIT-C score and physical activity levels significantly (P<0.001). Conclusion The research is the first systematic effort in Greece to initiate and explore the potential role of pharmacists in public health. The successful results of this WM programme constitute a first step towards the structured incorporation of pharmacists in public’s health promotion. It proposed a model for effectively delivering public health services in Greece. This study adds to the evidence in relation to pharmacists’ CVD role in public health with outcomes that superseded other pharmacy-led WM programmes. It also provides the first evidence that Greek pharmacists have the potential to play an important role within primary healthcare and that after training they are able to provide public health services for both the public’s benefit and their clinical role enhancement. This primary evidence should support the Panhellenic Pharmaceutical Association, to “fight” for their rights for an active role in primary care. In terms of limitations, it must be noted that the participants’ collected data were recorded by pharmacists, and the analysis therefore depended on the accuracy of the recorded data, in particular on the measurements or calculations obtained. Although the sample size was achieved, it can be argued that it is small for the generalisation of findings across Greece. Therefore, the WM programme should be offered in other Greek cities to identify if similar results can be replicated, so as to consolidate the contribution of pharmacists in promoting public health. Additionally, the study was limited as it did not include a control group. Despite the limitations, our findings provide a model for a pharmacy-led public health programme revolving around WM that can be used as a model for services in the future. References 1. Mendis S, Puska P, Norrving B, World Health Organization., World Heart Federation., World Stroke Organization. Global atlas on cardiovascular disease prevention and control [Internet]. Geneva: World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization; 2011 [cited 2018 Jun 26]. 155 p. Available from: http://www.who.int/cardiovascular_diseases/publications/atlas_cvd/en/ 2. Pharmaceutical Group of the European Union. Pharmacy with you throughout life:PGEU Annual Report [Internet]. 2015. Available from: https://www.pgeu.eu/en/library/530:annual-report-2015.html

A Framework Convention on Alcohol Control: Getting Concrete about Its Contents

2020 ◽  
pp. 1-11
Author(s):  
Robin ROOM ◽  
Jenny CISNEROS ÖRNBERG
Keyword(s):  
Public Health ◽  
World Health ◽  
Alcohol Industry ◽  
Alcohol Control ◽  
The World ◽  
Draft Convention ◽  
History Of ◽  
Supplementary Material ◽  
Health Organization ◽  
Narcotic Drugs

This article proposes and discusses the text of a Framework Convention on Alcohol Control, which would serve public health and welfare interests. The history of alcohol’s omission from current drug treaties is briefly discussed. The paper spells out what should be covered in the treaty, using text adapted primarily from the Framework Convention on Tobacco Control, but for the control of trade from the 1961 narcotic drugs treaty. While the draft provides for the treaty to be negotiated under the auspices of the World Health Organization, other auspices are possible. Excluding alcohol industry interests from the negotiation of the treaty is noted as an important precondition. The articles in the draft treaty and their purposes are briefly described, and the divergences from the tobacco treaty are described and justified. The text of the draft treaty is provided as Supplementary Material. Specification of concrete provisions in a draft convention points the way towards more effective global actions and agreements on alcohol control, whatever form they take.

scholarly journals Systematic review of clinical practice guidelines for adults with fractures: identification of best evidence for rehabilitation to develop the WHO’s Package of Interventions for Rehabilitation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Francesca Gimigliano ◽  
◽  
Sara Liguori ◽  
Antimo Moretti ◽  
Giuseppe Toro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Hip Fracture ◽  
Distal Radius ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Adult Population ◽  
World Health ◽  
The World

Abstract Background The identification of existing rehabilitation interventions and related evidence represents a crucial step along the development of the World Health Organization’s (WHO) Package of Interventions for Rehabilitation (PIR). The methods for such identification have been developed by the WHO Rehabilitation Programme and Cochrane Rehabilitation under the guidance of the WHO’s Guideline Review Committee secretariat. The aim of this paper is to report on the results of the systematic search for clinical practice guidelines (CPGs) relevant to the rehabilitation of adults with fractures and to present the current state of evidence available from the identified CPGs. Methods This paper is part of the Best Evidence for Rehabilitation (be4rehab) series, developed according to the methodology presented in the World Health Organization’s (WHO) Package of Interventions for Rehabilitation (PIR) introductory paper. It is a systematic review of existing CPGs on fractures in adult population published from 2009 to 2019. Results We identified 23 relevant CPGs after title and abstract screening. According to inclusion/exclusion criteria, we selected 13 CPGs. After checking for quality, publication time, multiprofessionality, and comprehensiveness, we finally included five CPGs dealing with rehabilitative management of fractures in adult population, two CPGs addressing treatment of distal radius fracture and three the treatment of femoral/hip fracture. Conclusion The selected CPGs on management of distal radius and femoral/hip fracture include few recommendations regarding rehabilitation, with overall low to very low quality of evidence and weak/conditional strength of recommendation. Moreover, several gaps in specific rehabilitative topics occur. Further high-quality trials are required to upgrade the quality of the available evidence. Level of evidence Level 1.

(Mis)Information on Digital Platforms: Lessons from Twitter and Sina Weibo in the COVID-19 Pandemic (Preprint)

2021 ◽  
Author(s):  
Sarah Kreps
Keyword(s):  
Public Health ◽  
World Health Organization ◽  
Public Discourse ◽  
The United States ◽  
World Health ◽  
Sina Weibo ◽  
Digital Platforms ◽  
The World ◽  
Health Organization ◽  
Relative Prevalence

BACKGROUND Misinformation about COVID-19 has presented challenges to public health authorities during pandemics. Understanding the prevalence and type of misinformation across contexts offers a way to understand the discourse around COVID-19 while informing potential countermeasures. OBJECTIVE The aim of the study was to study COVID-19 content on two prominent microblogging platform, Twitter, based in the United States, and Sina Weibo, based in China, and compare the content and relative prevalence of misinformation to better understand public discourse of public health issues across social media and cultural contexts. METHODS A total of 3,579,575 posts were scraped from both Weibo and Twitter, focusing on content from January 30th, 2020, when the World Health Organization (WHO) declared COVID-19 a “Public Health Emergency of International Concern” and February 6th, 2020. A 1% random sample of tweets that contained both the English keywords “coronavirus” and “covid-19” and the equivalent Chinese characters was extracted and analyzed based on changes in the frequencies of keywords and hashtags. Misinformation on each platform was compared by manually coding and comparing posts using the World Health Organization fact-check page to adjudicate accuracy of content. RESULTS Both platforms posted about the outbreak and transmission but posts on Sina Weibo were less likely to reference controversial topics such as the World Health Organization and death and more likely to cite themes of resisting, fighting, and cheering against the coronavirus. Misinformation constituted 1.1% of Twitter content and 0.3% of Weibo content. CONCLUSIONS Quantitative and qualitative analysis of content on both platforms points to cross-platform differences in public discourse surrounding the pandemic and informs potential countermeasures for online misinformation.

Agile stockpiles an insurance for drug supply

2020 ◽  
pp. 4-17
Author(s):  
Eddy Gilissen ◽  
◽  
Chris Mulligan ◽  
Simon Tottman ◽  
Per Troein ◽  
...  
Keyword(s):  
Public Health ◽  
Public Service ◽  
Healthcare Systems ◽  
Essential Medicines ◽  
World Health ◽  
Catastrophic Event ◽  
Health Organizations ◽  
Safety Stock ◽  
The World ◽  
Additional Burden

Healthcare systems across the world are looking at ways of maintaining the continuity of supply of medicines to patients in times of crisis.Whilst this is not a new phenomenon, the additional burden placed on the supply chain during COVID-19 has meant it has come more into the spotlight. The need to use a stockpile can be caused by an interruption to supply, a rapid and unexpected peak in demand, or when both an interruption to supply and a peak in demand occur simultaneously. The objectives of a stockpile will guide the portfolio breadth and depth to be held. Stockpile objectives are broadly driven either by government requirements to protect public health or by organisations seeking toachieve commercial gain. These drivers are not mutually exclusive as in the case of holding safety stock and Public Service Obligation stock. An Emergency Stockpile is Public Health driven and held in order to supply essential medicines during a signifcant or catastrophic event. Emergency stockpiles can be split into three categories — preparation for imminent event, disease specifc response and general contingency stockpiles. Governments and authorities determine which products and volumes should be held in an emergency stockpile which may be guided by the World Health Organizations (WHO) l ist of essential medicines.

OBESITY IN SARS-COV-2 INFECTION: LITERATURE REVIEW

2021 ◽  
pp. 19-23
Author(s):  
Donizete Tavares Da Silva ◽  
Priscila De Sousa Barros Lima ◽  
Renato Sampaio Mello Neto ◽  
Gustavo Magalhães Valente ◽  
Débora Dias Cabral ◽  
...  
Keyword(s):  
Public Health ◽  
Acute Respiratory Distress Syndrome ◽  
Gastrointestinal Tract ◽  
Severe Acute Respiratory Syndrome ◽  
Distress Syndrome ◽  
Circulatory System ◽  
World Health ◽  
Global Public Health ◽  
The World ◽  
Health Organization

In March 2020, the World Health Organization (1) declared COVID-19 as a pandemic and a threat to global public health (2). The virus mainly affects the lungs and can cause acute respiratory distress syndrome (ARDS). In addition, coronavirus 2 severe acute respiratory syndrome (SARSCOV2) also has devastating effects on other important organs, including the circulatory system, brain, gastrointestinal tract, kidneys and liver

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