Abstracts of the 10th CAPGAN Conference

Background

Tackling Severe Acute Malnutrition (SAM) is critical to achieving child survival targets, such as Millennium Development Goal 4. Most feeding programmes treating SAM report patient outcomes on discharge from the programme. Research on whether children subsequendy remain alive and well is currendy limited, particularly in settings where HIV is prevalent.

Aims

To describe long term outcomes following an episode of SAM

Methods

We followed up on all surviving children discharged from a large urban NRU-based malnutrition programme one year after completion of a probiotic RCT (with no overall effect). HIV patients started cotrimoxazole prophylaxis and were referred for ARVs if meeting WHO (2005) HIV staging criteria.

Results

From July 2006 to March 2007, 1024 patients contributed to 1187 admission episodes for treatment of SAM. 697/1024(68.1%) had oedematous malnutrition, 459/1024(45%) were HIV seronegative, and 445/1024(43%) were seropositive. HIV status was unknown in 120/1024(12%).There were 238/1024(23.2%) inpatient deaths: 42/459(9.2%) among HIV seronegative children, 126/445(28.3%) among seropositives, and 70/120(58.3%) among those not tested. Overall programme nutrition cure (weight-for-height>80% on 2 consecutive outpatient visits) was 471/1024(46.0%): 310/459(67.5%) among seronegatives and 155/445(34.8%) among seropositives.Long-term 1-year-outcomes were identified for 900/1024(87.9%) children. 365/471(77.5%) of children discharged as cured were alive and 37/471 (7.8%)were reported dead. 28/37(75.6%) of these late deaths in the year since discharge were HIV-positive. Total cumulative programme deaths had risen to 428/1024(41.8%):; 77/459(16.7%) among HIV seronegative children; 274/445(61.6%) among known seropositives.

Conclusions

In this study, the majority of children discharged cured from a programme treating SAM were still alive 1 year after discharge. Overall programme mortality was high, however; HIV and failure to achieve cure were major underlying factors. Routine, short-term programme reporting systems would have underestimated this long-term post-SAM mortality. More studies are needed to explore long-term outcomes from other approaches to SAM treatment (notably in Community Management of Acute Malnutrition, CMAM programmes). Future analyses of variables in our programme will also play a role in understanding and addressing factors underlying positive or negative long-term outcomes.

• Malawi Med J. 2009 Sep; 21(3): 123–159.
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• Mortality a Year After Admission with HIV and Severe Acute Malnutrition (SAM) in Malawi: A Cohort Study

2009 Sep; 21(3): 123–159.

Mortality a Year After Admission with HIV and Severe Acute Malnutrition (SAM) in Malawi: A Cohort Study

J Bunn, G Chagaluka, and M Kerac Copyright and License information DisclaimerCopyright notice     

第十四届欧洲卒中会议点评

第十四届欧洲卒中会议（14th European Stroke Conference）于2005年5月25—28日在意大利博洛尼亚市召开。来自欧、美、亚洲和澳洲各国的1500名代表参会，其中我国20余名专家出席了大会。现就该届大会上有关卒中的危险因素、基因遗传、治疗、预后等热点问题概述如下。     

19世纪的德国精神病学

19世纪是德国精神病学的黄金时期。在此期间，德国精神病学不仅在世界范围内占据优势地位，而且基本完成了其自身的职业化过程。因此，了解这一阶段的历史对于认识精神病学的历史和本质具有重要意义。通过论述形而上学观念的变迁、学术的进步以及精神病收容所的兴衰这三个层面的内容论述，将19世纪德国精神病学的面貌完整的展现出来。     

第四届全国生命伦理学学术会议综述

第四届全国生命伦理学学术会议于2010年8月6日至8日在云南昆明召开,100多名来自国内及香港、台湾地区的与会学者对生命伦理学的一些重要问题展开了热烈而富有建设性的探讨.     

2006年第31届美国国际卒中会议纪要

第31届美国国际卒中会议于2006年2月16～18日在美国佛罗里达州基西米市召开,世界各国4000余位专家学者出席了这次盛会,有10余名中国学者参会.现将会议内容扼要介绍如下.     

The 14th College of Medicine Research Dissemination Conference September 25th 2010

Introduction

Severe malarial anaemia requiring blood transfusion is a major cause of in-hospital childhood morbidity and mortality in sub-Saharan Africa. Previous follow-up studies from high malaria transmission areas in southern Malawi and western Kenya have shown that transfused children with severe malarial anaemia are also at high risk of dying after discharge from the hospital. We hypothesize that failure to clear the initial malaria infection due to ineffective antimalarial treatment and the acquisition of new infections after discharge, negate the initial improvements in haemoglobin concentrations that result from the blood transfusion. The study aims to compare the efficacy of a single treatment course with lumefantrine artemether (Coartem®) at discharge to three treatment courses with Coartem® given at discharge, 1 and 2 months (IPTpd) in the post-discharge management of children who have recovered from severe malarial anaemia

Methods

This is a randomised double-blind placebo controlled trial in which children aged between 4–59 months will be randomised to receive IPTpd with Coartem or with placebo. Children are followed up for a period of 6 months with the primary efficacy endpoint being the incidence of recurrent severe anaemia or death.

Results

The study recruitment and follow-up is complete and data is being analysed.

Discussion and Conclusion

This study showing that preventing recurrent severe anaemia and death in this vulnerable group of children would lead to important policy recommendations. At the conference, we shall present important preliminary results

• Malawi Med J. 2010 Sep; 22(3): 82–104.
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• Preliminary Results of Prevalence of Human Birth Defects in Five Referral Hospitals in Malawi

2010 Sep; 22(3): 82–104.

Preliminary Results of Prevalence of Human Birth Defects in Five Referral Hospitals in Malawi

K Bultemeier,¹ A Mwakikunga,² J Mwale,³ K Chimwemwe,⁴ M Chirwa,⁵ and F Mgawedere⁶

K Bultemeier

¹University of Malawi/KCN/Blantyre, MalawiFind articles by K Bultemeier

A Mwakikunga

²University of Malawi/COM/Blantrye, MalawiFind articles by A Mwakikunga

J Mwale

³University of Malawi/College of Health Sciences/Zomba, MalawiFind articles by J Mwale

K Chimwemwe

⁴St. John''s College of Nursing/Mzuzu, MalawiFind articles by K Chimwemwe

M Chirwa

⁵University of Malawi/KCN/Lilongwe, MalawiFind articles by M Chirwa

F Mgawedere

⁶University of Malawi/KCN/Lilongwe, MalawiFind articles by F MgawedereAuthor information Copyright and License information Disclaimer¹University of Malawi/KCN/Blantyre, Malawi²University of Malawi/COM/Blantrye, Malawi³University of Malawi/College of Health Sciences/Zomba, Malawi⁴St. John''s College of Nursing/Mzuzu, Malawi⁵University of Malawi/KCN/Lilongwe, Malawi⁶University of Malawi/KCN/Lilongwe, MalawiCopyright notice     

第十次全国病案管理学术会议纪要

中华医院管理学会第十次全国病案管理学术会议于2001年11月7日-10日在上海市召开。会议主题会“新世纪病案信息管理科室的规范化建设”,会议收到论文255篇,论文水平比过去普遍有所提高,为方便与会代表讨论,会议制定并印发了《病案信息管理科室设置、任务、技术规范》和《病案书写规范》(讨论稿)文件。参加会议的代表240名,来自全国30个省、市、自治区,这是历次会议各省、市、参加会议最全的一次盛会。上海市医院管理学会林发雄会长在会议开幕式上代表上海学会,对大会在上海召开表示欢迎,并预祝会议圆满成功,中华医院管理学会江耘秘书长代表总会对会议的召     

第六届东方脑血管病介入治疗大会纪要

2006年10月26～30日,由第二军医大学长海医院及全军脑血管病诊疗中心主办的第六届东方脑血管病介入治疗大会(Oriental Conference of Interventional Neuroradiology 2006)在上海光大会展中心召开.由该院与韩国神经介入放射学会共同倡议并举办的首届中韩神经介入治疗论坛同期举行.国外近50名专家及国内400余名代表云集上海,希望借助这个交流平台,积极推动中国神经介入放射学的发展.会议学术气氛浓郁,安排紧凑,讨论热烈.现将本次会议的一些主要学术交流情况报道如下.     

The 13th College of Medicine Research Dissemination Conference,October 17th 2009

Introduction

The Health Research Capacity Strengthening Initiative (HRCSI) in Malawi is a DFID and Wellcome Trust-funded programme that started in October 2009. The initiative aims at strengthening research capacity and use of research in decision making and policy formulation. It has life span of five years.

Methods

The HRCSI made first call for applications for fellowships and research grants in February 2009. It received a total of 36 applications by 31st March 2009. All applications were reviewed by 24th August 2009. This paper distils major lessons that have been learned from the review of applications.

Results

The first lesson that has been learned from the processing of applications is that a disproportionate number of applicants do not adhere to the HRCSI guidelines for submission of applications. For example, out of 25 research grant applicants, only 6 adhered to HRCSI budget ceilings. Furthermore, out of 11 fellowship applicants, 4 met all the HRCSI guidelines. In light of this handcap, the guidelines need to be widely publicised and simplified. The second lesson is that research proposals were of very low quality. This assertion find support in the fact that out of 25 research proposals that were received, only seven qualify for funding. There is therefore urgent need to impart proposal writing skills to potential applicants through proposal development workshops. The third lesson is that one-month deadline for submission of proposal was not adequate. Out 25 potential applicants who gave HRCSI feedback on why they did not submit their applications, 20 cited time constraint as the main reason. The allowable time period for submission of applications should therefore be lengthened. The fourth lesson is that potential applicants lack adequate information on HRCSI programme. This is evident from submission of fellowship applications for courses/disciplines that are not targeted by HRCSI and failure of applicants to discriminate different types of research grants. There is therefore need to orient potential applicants with HRCSI guidelines. The fifth lesson is that the research proposals are not multidisciplinary in nature but are biased towards biomedical research. In view of this, among its existing guidelines HRCSI need to include a new guideline that states that preference will be given to multidisciplinary research proposals.

Conclusion

The lessons learned point to the fact the review process of fellowship and research grant applications is cumbersome, complex and time-consuming. In particular, processing of applications require adequate preparations and proper planning. To this end, HRCSI need to learn adequate lessons from the first call before advertising for second call of applications.

• Malawi Med J. 2009 Dec; 21(4): 185–204.
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• Risk Factors and Etiology of Acute Stroke in Malawi, A Country With High Prevalence of HIV

2009 Dec; 21(4): 185–204.

Risk Factors and Etiology of Acute Stroke in Malawi, A Country With High Prevalence of HIV

Terttu Heikinheimo-Connell, Daniel Chimbayo, Johnstone Kumwenda, Sam Kampondeni, and Theresa Allain Copyright and License information DisclaimerCopyright notice