Sabbatical Experience World Health Organization J Conly MD Professor of Medicine, Microbiology, Immunology & Infectious Diseases University of Calgary Infection Control and Prevention in Health Care Department of Global Alert and Response (GAR)
Objectives To know different ways infectious disease and microbiology practitioners can contribute to international health both locally and abroad To list local contacts and links for gaining access to international health opportunities To know what training opportunities exist in Canada for international health training
Contacts Primary contact Dr Carmem Lucia Pessoa-Silva Medical Director for Innovations and Translational Interventions, Department of Global Alert and Response, Health Security and Environment Cluster, World Health Organization (WHO),Geneva Infection Prevention and Control in Health Care Contact was facilitated through Shirley Paton, former Head of the Nosocomial and Occupational Infections Section, Centre for Infectious Diseases Prevention and Control, PHAC
General Objectives at WHO To understand the activities, role, organization and response of the WHO for emerging infectious diseases To develop clinical management guidelines for new emerging infectious diseases, infection control preparedness, and international outbreak management To collaborate on projects related to the development of evidence based policies and practices in infection control, especially as it relates to developing countries
Activities at WHO Activities related to emerging infectious diseases Reviewer and independent adjudicator for Active and passive surveillance of yellow fever vaccine 17D or 17DD-associated serious adverse events: Systematic review Member of Writing Team and Reviewer for World Health Day April 7 2011 Antimicrobial resistance: no action today, no cure tomorrow Six Point Policy Package Invited member of WHO Technical Consultative Group for the Global Infection Prevention and Control Network (GIPC Network)
Activities at WHO Development of guidelines for new emerging infectious diseases, and infection control preparedness Developed document on Use of UV Germicidal irradiation (UVGI) for Disinfection of Air to Reduce or Prevent the Transmission of Epidemic and Pandemic Prone Acute Respiratory Diseases in Health Care Evidence Based Review Developed document on Use of A Prolonged Duration of Precautions: Evidence Based Review Panel member for the Expert Consultation for Development of a standard Guideline on clinical Management of Influenza WHO Global Influenza Program Panel member for the World HAI Forum, Annecy, France for the session Making Global Resistance a Reality
Activities at WHO Collaboration on projects related to the development of evidence based policies and practices related to infection control, especially as it relates to developing countries Technical Report completed Field Testing of WHO Interim Guidelines "Infection Prevention and Control of Epidemic and Pandemic- Prone Acute Respiratory Diseases in Health Care" Lead author for WHO Global Infection Prevention and Control (IPC) Network Meeting ARD Systematic Reviews Physical Interventions to Prevent Respiratory Tract Infections (RTIs) Aerosol Generating Procedures and Risk of Acute RTIs Formally joined the Cochrane Collaboration
Revision of Infection Prevention and Control of Epidemic- and Pandemic-Prone Respiratory Diseases in Health Care Infection Control and Prevention in Health Care Department of Global Alert and Response (GAR)
WHO Infection Control Guidelines on Acute Infectious Respiratory Diseases Publication Pending for Spring 2012 http://www.who.int/csr/resources/publications/csrpublications/en/index7.html
Scope Acute febrile infectious respiratory syndrome Focus on epidemic- and pandemic-prone respiratory infections Acute respiratory disease of potential concern International Health Regulation (2005) SARS New influenza subtype New organisms
WHO Recommended Steps in Guideline Development WHO recommended steps in guideline development Action taken/planned Define the specific issues to be addressed by the guidelines Definition of guideline WHO steering group Definition of guideline development group Undertake a systematic search for evidence Review the evidence available Draft evidence-based recommendations Define strength of recommendations In progress Draft guidelines In progress WHO Internal review & External peer review Interim version of the guidelines Aug-Sep 2011 Consultation with external panel Oct 2011 Amendment, technical editing and layout Nov 2011 Feb 2012 Clearance & Publication March April 2012
Specific Items Major recommendations n=10 Discussed at meeting June 8 2011 Comments from meeting incorporated Additional specific recommendations (less contentious) Transport of specimens, family/visitors, specimen collection, occupational health Engineering and environmental controls specific to placement and corridors Care of the deceased
What is a WHO guideline? "Guidelines are recommendations intended to assist providers and recipients of health care and other stakeholders to make informed decisions. Recommendations may relate to clinical interventions, public health activities, or government policies. WHO 2003, 2007 Source: Regina Kulier, Guidelines Review Committee Secretariat, WHO-HQ
Review of guidelines by the WHO Guideline Review Committee Membership- HQ, Regional Offices, External Experts Meet monthly Review the guideline at initial stage of development and final documents Review done by 2 members of the Committee Decisions are made by consensus If individuals on the GRC are conflicted in relation to a specific guideline they leave the room All GRC recommendations are documented in minutes that are available on the intranet site Source: Regina Kulier
Planning for guideline development Identify target audience Existing scientific evidence that can guide the recommendations Involving external organizations Available budget / timeline Prioritization of topics Controversy Urgent need Feasibility of implementation Formulation of key questions (PICO) : Source : Regina Kulier, Guidelines Review Committee Secretariat, WHO-HQ
Guideline Development WHO Guideline Steering Group (WHO staff) Guideline Development Group (15-20 ) Actively involved in the guideline development External Review Group To consult on scope, choice of questions, review of draft Source: Regina Kulier, Guidelines Review Committee Secretariat, WHO-HQ
Composition: Guideline Development Group Content experts for specialties involved Methodologists Representatives of potential stakeholders Patients, consumers Regional, gender representation Source: Regina Kulier, Guidelines Review Committee Secretariat, WHO-HQ
Guideline Development Group Purpose: Develop and agree on the recommendations Develop a plan and assist with the implementation Source: Regina Kulier, Guidelines Review Committee Secretariat, WHO-HQ
WHO Guidelines Production Process 1 Beginning A WHO department decides to produce a guideline 2 3 4 5 Initial review by GRC Initial approval for development The guideline is produced by the WHO department (i.e. from a few months to 2-3 years time frame) Final approval by GRC End Relevant approvals are obtained (ADG or DGO) ADVICE AND SUPPORT from GRC Secretariat from GRC members from WHO Collaborating Centres from GRC through WHO lists of technical experts from external experts on guideline production Source: Regina Kulier, Guidelines Review Committee Secretariat, WHO-HQ
1 Guideline Development Development of the scope of the document Process 2 3 4 5 6 7 8 9 Setting up Guideline Development Group and External Review Group Management of Conflicts of Interest Formulation of the questions (PICOT) and choice of the relevant outcomes Evidence retrieval, assessment and synthesis (systematic review(s) GRADE - evidence profile Formulation of the recommendations (GRADE) Including explicit consideration of: Benefits and harms Values and preferences Resource use Dissemination, implementation (adaptation) Evaluation of impact Plan for updating Initial guideline approval After completion of 1 and 2 With draft of 4 With plan for 3, 5-9 Final guideline approval after completion of 6 with plan for 7-9 Source: Regina Kulier, Guidelines Review Committee Secretariat, WHO-HQ
Declaration of conflicts of interest DOIs are required from: All experts participating in WHO meetings Experts under contract or working under voluntary basis Includes: Personal/family financial interest Academic interest Public statements or other activities relevant to the meeting/guideline Source: Regina Kulier, Guidelines Review Committee Secretariat, WHO-HQ
Support for Guideline Developers Interaction with the GRC Secretariat throughout guideline development process GRC members Methodologists WHO Handbook for Guideline Development Training workshops Source: Regina Kulier, Guidelines Review Committee Secretariat, WHO-HQ
Summary of Opportunities at WHO Sabbatical WHO Internships Duration 6 weeks 3 mos (rarely 6 mos), usually summer All costs of travel and accommodation are the responsibility of the intern or the sponsoring institution Second degree or higher Must be > 20 yrs age First degree held in area of interest to WHO Applicable to Post Fellowship, Post MSc or PhD
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