World Health Organization disability assessment schedule 2.0: An international systematic review

Purpose: This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument.

Method: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on “whodas” using the ProQuest, PubMed, and Google Scholar electronic databases.

Results: We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).

Conclusions: The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them.

• Implications for Rehabilitation

• WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability.

• The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry.

• WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations.

• A critical issue for rehabilitation is that a single “minimal clinically important .difference” score for the WHODAS 2.0 has not yet been established.

     

Implementing the World Health Organization surgical safety checklist: a model for future perioperative initiatives

In the fall of 2008, perioperative leaders at Brigham and Women’s Hospital, Boston, Massachusetts, conducted a two-week trial of the World Health Organization Surgical Safety Checklist in the main OR. The checklist was incorporated by using a Plan-Do-Study-Act cycle. In 2009, we began a 14-week rollout of the surgical safety checklist to all our ORs. Critical factors that led to the success of this implementation included gaining executive leadership endorsement; recruiting volunteers from each discipline to lead the project; using quality methodologies to ensure a thoughtful, organizing implementation; providing frequent feedback and data; and confirming standardized use of the checklist by creating a policy.     

A comparison of renal-related adverse drug reactions between rofecoxib and celecoxib, based on the World Health Organization/Uppsala Monitoring Centre safety database

BACKGROUND: Two isoforms of cyclooxygenase (COX) have been identified, both of them inhibited by traditional nonsteroidal anti-inflammatory drugs (NSAIDs). Inhibition of COX-2 has been associated with the therapeutic effects of NSAIDs, whereas inhibition of COX-1 is believed to be the cause of the adverse gastrointestinal effects associated with NSAID therapy. When administered at therapeutic doses, new COX-2-specific inhibitors inhibit only the COX-2 isoform. OBJECTIVE: This study sought to compare renal safety signals between the COX-2-specific inhibitors rofecoxib and celecoxib, based on spontaneous reports of adverse drug reactions (ADRs) in the World Health Organization/Uppsala Monitoring Centre (WHO/UMC) safety database through the end of the second quarter 2000. METHODS: Disproportionality in the association between a particular drug and renal-related ADR was evaluated using a bayesian confidence propagation neural network method in which a statistical parameter, the information component (IC) value, was calculated for each drug-ADR combination. In this method, an IC value significantly greater than 0 implies that the association of a drug-ADR pair is stronger than background; the higher the IC value, the more the combination stands out from the background. The ratio of actual to expected numbers of ADRs was also used to assess disproportionality. RESULTS: As with traditional NSAIDs, both COX-2-specific inhibitors were associated with renal-related ADRs. However, the adverse renal impact of rofecoxib was significantly greater than that of celecoxib. IC values were significantly different for the following comparisons: water retention (1.97 rofecoxib vs 1.18 celecoxib; P < 0.01); abnormal renal function (2.38 vs 0.70; P < 0.01); renal failure (2.22 vs 1.09; P < 0.01); cardiac failure (2.39 vs 0.48; P < 0.01); and hypertension (2.15 vs 1.33; P < 0.01). In an additional analysis, celecoxib was shown to have a similar renal safety profile to that of diclofenac and ibuprofen. CONCLUSIONS: Based on spontaneous ADR reports in the WHO/UMC safety database at the end of the second quarter 2000, this analysis indicates that rofecoxib has significantly greater renal toxicity than celecoxib or traditional NSAIDs. This negative renal impact may have the potential to increase the risk for serious cardiac and/or cerebrovascular events.     

基于世界卫生组织康复胜任力架构的康复工作者绩效评价研究

目的 探索基于世界卫生组织康复胜任力架构(RCF)的康复工作者绩效评价理论与方法。方法 采用RCF理论架构和方法,从实践、专业精神、学习与发展、管理与领导力、研究5个维度,融合核心价值观和信念、胜任力和行为、活动和任务、知识和技能,对康复工作者岗位胜任力进行分析,构建康复工作者绩效评价方法和路径。结果 基于RCF确认了康复工作者岗位胜任要求,形成多维度、多层次、规范的康复工作者绩效评价指标框架。以物理治疗师为例,将RCF与物理治疗师岗位标准相结合,建立了物理治疗师绩效评价指标体系,其中涵盖5个一级指标,26个二级指标。结论 基于RCF的康复工作者绩效评价能够科学、规范、全面地评价康复工作者绩效表现。以胜任力为中心,多维度、多层次评价康复工作者绩效表现,使绩效评价更加科学、全面,同时使康复工作者了解在不同熟练程度应完成的工作,明确不同熟练程度间胜任力水平的差距,促进康复工作者不断提高自身水平,进而提升康复服务质量。     

基于康复胜任力架构的本科层次特殊教育专业设置研究

目的 基于世界卫生组织康复胜任力架构(RCF),构建以胜任力为本位并且满足残疾学生教育康复需求特点的本科层次特殊教育专业,提升特殊教育专业建设的水平,适应基于胜任力教育发展的要求。方法 运用RCF的理论与方法,参照《特殊教育教师专业标准(试行)》《特殊教育专业认证标准》和《特殊教育专业师范生教师职业能力标准》,分析学校教育情境中特殊教育教师的胜任力要求。结果 构建了基于RCF的特殊教育教师胜任力架构,提出了基于RCF的特殊教育专业设置原则和基于RCF的特殊教育专业建设的原则,根据学校教育环境的特点,建立了适用于本科层次特殊教育专业的胜任力模式。结论 RCF作为一个服务全民健康的全球康复胜任力架构,其理论与方法对于构建特殊教育专业基于胜任力的教育体系具有重要的意义。基于RCF构建了本科层次特殊教育专业的原则、方法、教育目标以及方法体系,促进实施国家《特殊教育教师专业标准(试行)》、《特殊教育专业认证标准》和《特殊教育专业师范生教师职业能力标准》。     

Calcitonin gene-related peptide-targeting drugs and Raynaud’s phenomenon: a real-world potential safety signal from the WHO pharmacovigilance database

BackgroundMigraine is responsible for significant disability and societal burden. Recently, drugs targeting the calcitonin gene-related peptide (CGRP) pathway raised new hopes. CGRP, a potent vasodilator, plays a key role in the pathogenesis of migraine attacks. The deficiency of CGRP is involved in Raynaud’s phenomenon, which consists of abnormal vasoconstriction of the digits. We aimed to assess the potential association of Raynaud’s phenomenon with CGRP-targeting drugs, analyzing real-world data from the World Health Organization (VigiBase®).MethodsWe queried all reports of Raynaud’s phenomenon involving a CGRP-targeting drug. We sought disproportionate reporting of Raynaud’s phenomenon with these drugs. For this purpose, we relied on the calculation of the Information Component (IC). A positive lower end of the 95% confidence interval (CI) of the IC defines a statistically significant association. As migraine patients are prone to Raynaud’s phenomenon, we also calculated the IC of Raynaud’s phenomenon with CGRP-targeting drugs compared to 5HT1_B/D agonists (triptans), and beta-blockers used in the treatment of migraine.ResultsOverall, 99 reports of Raynaud’s phenomenon involving CGRP-targeting drugs have been yielded in VigiBase®. The most reported CGRP-targeting drug was erenumab, with 56 reports (56.6%). The median time to onset was 84 days. No fatality was notified, but one patient suffered from gangrene and extremity necrosis. As a whole, CGRP-targeting drugs were significantly associated with Raynaud’s phenomenon, with an IC of 3.3 (95%CI: 3.0–3.5). There was a disproportionate reporting of Raynaud’s phenomenon with CGRP-targeting drugs compared to triptans (IC 0.4; 95%CI: 0.1–0.6) and to beta-blockers (IC 0.5; 95%CI: 0.2–0.7) as well.ConclusionsThere is a significant disproportionality signal of Raynaud’s phenomenon with CGRP-targeting. This signal stands out when CGRP-targeting drugs are compared to other drugs used in patients with migraine. This study is limited by missing data in pharmacovigilance reports. CGRP-targeting drugs may be subject to Weber effect and reporting bias. Nonetheless, CGRP blockade might be the last straw that disrupts the physiological balance of vascular response in patients at-risk of Raynaud’s phenomenon. Pending further data regarding vascular safety of CGRP-targeting drugs, caution is warranted in these patients.     

基于世界卫生组织康复胜任力架构的康复心理学专业人才胜任力研究

目的 应用世界卫生组织康复胜任力架构(RCF),构建康复心理学专业人才的胜任力架构,开发康复心理学方向研究生的课程体系。方法 运用RCF及其情景化指南,结合《国际功能、残疾和健康分类》的生物-心理-社会功能和残疾理论,对接康复的学科发展和康复职业能力要求,研究康复心理学专业人才的胜任力及其培养模式。结果 构建了基于RCF的康复心理学专业人才胜任力架构;采用基于胜任力的教育(CBE)模式对接康复职业能力与岗位职责标准,明确培养目标;基于RCF与CBE模式设计康复心理学专业人才培养课程体系,有助于培养适应团队工作模式的应用型人才。结论 基于RCF的康复心理学专业人才胜任力研究整合了教育系统的学科发展与职业能力的社会需求,为推动康复心理学专业人才的培养提供了思路与方法。     

World Health Organization surveys to monitor HIV drug resistance prevention and associated factors in sentinel antiretroviral treatment sites

The World Health Organization (WHO) estimates that >2 million people will have started antiretroviral therapy (ART) by the end of 2006. As the development of some HIV drug resistance (HIVDR) is inevitable in populations taking ART, the emergence of HIVDR must be balanced against the benefits of providing ART, including improved health outcomes and decreased HIV/AIDS-associated morbidity and mortality. ART programmes should operate to minimize the emergence of HIVDR in populations receiving therapy and HIVDR itself must be monitored to ensure ongoing regimen efficacy. ART regimens in resource-limited settings are usually selected at the national level following a public health approach: generally only one first-line regimen with alternate regimen(s) incorporating within-class drug substitutions are available in the public sector. The WHO has developed a population-based HIVDR assessment and prevention strategy, which includes standardized HIVDR monitoring surveys in populations receiving first-line ART at sentinel sites. The WHO surveys monitor HIVDR prevention in sentinel sites by utilizing a standardized, minimum-resource prospective survey methodology to assess the success of adult and paediatric ART sites in preventing HIVDR emergence during the first year of ART. The surveys also identify associated factors that can be addressed at the level of the ART site or programme. WHO HIVDR monitoring surveys are designed to be integrated easily into a country's ongoing, routine HIV-related evaluation activities. Performed regularly at representative sites, the data generated will inform evidence-based decision making regarding national and global ART regimen selection and minimize the emergence of HIVDR at a population level.     

Proposed 5-step World Health Organization analgesic and side effect ladder

The WHO analgesic ladder has, up to now, been the “gold standard” for pain management. The ladder focuses on the presence or absence of pain relief but, at present, does not take into account the intolerable side effects of opioids. We believe that debilitating side effects are an equally valid reason for changing analgesia, particularly in light of new evidence supporting 'opioid switching'. Opioid switching involves changing a patient's strong opioid to an alternative strong opioid with the aim of improving analgesic response and/or reducing adverse side effects.We propose adding two additional steps to the WHO analgesic ladder to build an alternative five step ladder. The proposed fourth step involves 'opioid switching' and includes both pain and side effects as criteria for switching analgesics. The evidence for Step IV uses an algorithm derived from analysis of intervention patterns based on our recent trial data to identify the point at which a change in management is indicated. In our prospective study we identified four main factors which predict the need to switch. Three out of the four factors are opioid-induced side effects. Thus, once a strong opioid has been commenced (Step 3) and a patient has had an adequate trial of titration on their first-line strong opioid, the need for opioid switching (Step 4) is identified in the clinical setting once side effect scores fall within a critical range, triggering a change of treatment.If switching opioids fails, we propose that the fifth and final step of the WHO analgesic ladder should involve anaesthetic intervention.