世界卫生组织及伙伴呼吁加强研究以改善患者安全

潮水

摘自世界卫生组织网站：
Call for more research on patient safety
24 SEPTEMBER 2007 | PORTO, PORTUGAL/GENEVA -- WHO and its partners today called for increased research to improve patient safety. They emphasized the need for intensified research at an international conference that opened today in Porto, Portugal. The conference on Patient safety research: shaping the European agenda will examine evidence showing that harm from medical care poses a substantial burden in terms of suffering and death in Europe and around the world.

WHO estimates that tens of millions of patients worldwide endure disabling injuries or death each year, directly attributed to unsafe medical practices and care. In Europe alone, an average of one in every 10 patients admitted to hospital suffers some form of preventable harm. But more research is needed to better understand the full impact of poor patient safety.

The conference, supported by the European Commission, will promote dialogue between researchers, policy-makers and other constituencies in health care in Europe, and build international collaborative research networks. "Research in patient safety offers all WHO Member States a major innovative resource to assist their hospitals in avoiding harm from medical care and ensure that health care reduces patient suffering and does not contribute to it," said Sir Liam Donaldson, Chief Medical Officer for England, who chairs the WHO World Alliance for Patient Safety. "European countries now have the opportunity to translate research findings into tangible actions that can actually save lives."

The conference will build on the work of the WHO World Alliance for Patient Safety and the contribution of the participating scientists and government officials. It will offer opportunities to promote dialogue between researchers, policy-makers and other constituencies involved in health care in Europe. It is jointly organized by the Faculty of Public Health, UK, University College London and the WHO World Alliance for Patient Safety.

Much of the existing research evidence on the burden of harm in health care is from developed countries, although some evidence from developing nations suggests that unsafe care is a major problem there too. Research is needed not only on individual health care areas, but also on the underlying processes and organizational structures that contribute to unsafe care.

Areas where further research is needed include:

Health care-associated infection: Infection caused during health care is estimated to affect some 1.4 million people at any given time. In developed countries the toll is 5% to 10% of patients and in some developing countries, as many as a quarter of patients may be affected. With the sharp rise of antimicrobial resistance in the world, it is key that research now focuses on antimicrobial resistance and the spread of multidrug resistant pathogens.
Adverse drug event: Research estimates show that between 7% and 10% of patients in acute care settings experience an adverse drug event of which some 28-56% are preventable. Hospital admissions due to adverse drug reactions may be more than 10% of the total in some countries. More research is needed in this area, focusing on developing countries, where, it is suggested, rates of adverse drug events are even higher than in the developed world.
Surgery and anaesthesia: These are among the most complex procedures for health systems to deliver and can be among the costliest. Evidence in developed countries indicates that adverse events in the operating room account for at least 50% of all adverse events. In developing countries, surgical care is constrained by poor facilities, lack of trained staff, inadequate technologies and limited supply of drugs and materials. Research is needed to explore the reasons for geographical differences in the incidence of surgical and anaesthesia errors.
Unsafe injection practices: Data show that worldwide up to 40% of injections are given with syringes and needles reused without sterilization and in some countries this proportion is as high as 70%. Unsafe injection practices cause an estimated 1.3 million deaths each year worldwide, a loss of 26 million years of life and an annual burden of US$ 535 million in direct medical costs. Future research should focus on evaluating the impact of injection practices on the burden of diseases transmitted through unsafe injections.
Unsafe blood products: About 5-15% of HIV infections in developing countries are estimated to occur due to unsafe blood transfusions. A WHO study showed that about 60 countries were not able to screen all donated blood for one or more infections including HIV, and other blood-borne infections. Research is urgently needed on the broader aspects of blood safety, including the effectiveness of blood safety strategies and behaviour risk factors among blood donors, particularly in developing countries.
Adverse medical device events: In the United States, more than 1 million such events occur annually. In some developing countries as much as half of medical equipment is unusable or only partly usable. Effective research and surveillance programmes are needed to detect types, frequency and clinical settings of such events.
世界卫生组织及伙伴呼吁加强研究以改善患者安全
2007年9月24日 | 葡萄牙波尔图/日内瓦 -- 今天，在葡萄牙波尔图举行的一次重要国际会议上，世界卫生组织(世卫组织)及其伙伴呼吁加强研究以改善患者安全。这次会议题为“患者安全研究：制定欧洲议程”，将审查证据，证明就欧洲以及全世界的痛苦和死亡而言，医疗伤害造成巨大的负担。
据世卫组织估计，全世界每年有几千万患者直接由于不安全的医疗措施和护理，受到致残性伤害或死亡。仅在欧洲，平均每10名住院患者中就有1名受到某种可预防的伤害。然而，必须进行更多的研究以便更好地了解患者安全状况不良的全部影响。
这次会议得到欧洲委员会的支持，将把研究人员与决策者联系起来，并建立国际合作研究网络。“患者安全方面的研究可以为世卫组织所有会员国提供一种重要的新资源，以协助其各自医院避免医疗伤害并确保卫生保健能减少患者的痛苦，而不是导致痛苦，”英格兰首席医官兼世卫组织世界患者安全联盟主席Liam Donaldson爵士说。“欧洲国家现在有机会将研究结果转化为能切实拯救生命的实际行动。”
这次活动将以世卫组织世界患者安全联盟的工作以及将出席会议的许多科学家和政府官员的贡献为基础。会议由联合王国伦敦大学学院公共卫生系和世卫组织世界患者安全联盟组办，将提供机会促进研究人员、决策者以及参与欧洲卫生保健的其他支持者之间进行对话。
尽管发展中国家有一些证据表明不安全的医护是一个主要问题，但关于卫生保健伤害负担的多数现有研究证据都来自发达国家。不仅要对各卫生保健领域进行研究，而且要对造成不安全医护的基本程序和组织结构进行研究。
需要进一步研究的领域包括：
与卫生保健有关的感染：据估计，这类感染无论何时都会影响大约140万人。在发达国家，受害者占患者的5%-10%，而在一些发展中国家，多达四分之一的患者受到影响。随着世界抗菌素耐药性的激增，现在必须着重研究抗菌素耐药性以及多药物耐药性病原体的传播问题。
药物不良事件的研究估算表明，急救病区患者7%-10%遭受药物不良事件影响，而其中28-56% 是可以预防的。在某些国家，因药物不良反应住院的患者可能占患者总数的10%以上。需要在该领域进行更多研究，并着重于发展中国家，据表明，那里的药物不良事件比率比发达世界还要高。
外科手术和麻醉属于卫生系统要提供的最复杂，可能也是最贵的一些程序。发达国家的证据表明，手术室中的不良事件至少占不良事件总数的50%。在发展中国家，由于设施差、缺乏有训练的人员、技术不足以及药品和材料供应有限，手术治疗受到限制。需要进行研究以探讨手术和麻醉错误发生率方面地域差异的原因。
不安全注射操作方面的数据表明，在全世界，反复使用未经消毒的针管和针头进行注射的比率高达40%，而且在某些国家该比例可高达70%。据估计，不安全的注射操作每年导致全世界130万人死亡，损失2600万生命年，并每年造成5.35亿美元直接医疗费用负担。今后研究应着重于评价注射操作对不安全注射导致的疾病传播负担的影响。
不安全的血液制品。据估计，发展中国家5-15%的艾滋病毒感染源于不安全输血。世卫组织一项研究表明，约有60个国家不能够对捐献的全部血液进行一或多种感染(包括艾滋病毒以及其它血液传播感染)筛查。急需从更广泛的方面研究血液安全问题，包括血液安全战略的效力以及献血者，特别是发展中国家献血者的行为风险因素。
医疗器械不良事件也会伤害患者。在美国，每年发生100多万起这类事件。在一些发展中国家，多达半数的医疗设备不能使用或只能部分使用。需要有效的研究和监测规划以查明这类事件的类型、发生频率和临床环境。


莲雾

卫生保健有关的感染排在第一位，可见各位还须多努力！

桂花香

谢版主的辛勤劳动，学习中。