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Mathuram Santosham - One of the best experts on this subject based on the ideXlab platform.

  • zinc Therapy for diarrhoea increased the use of Oral Rehydration Therapy and reduced the use of antibiotics in bangladeshi children
    Journal of Health Population and Nutrition, 2004
    Co-Authors: Abdullah H Baqui, Robert E Black, Shams El Arifeen, Mohammad Yunus, K Zaman, Nazma Begum, Amira A Roess, Mathuram Santosham
    Abstract:

    Excessive use of antibiotics for diarrhoea is a major contributing factor towards increasing rates of antimicrobial resistance in developing countries. Zinc Therapy for diarrhoea has been shown to be bene-ficial in controlled efficacy trials, and it is of interest to determine if availability of zinc syrup for treatment of diarrhoea would satisfy the demand for a ’medicine’ for diarrhoea, thus reducing the use of antibiotics, without competing with the use of Oral Rehydration Therapy (ORT). This community-based controlled trial was conducted from November 1998 to October 2000, and all children aged 3-59 months in the study area were included. In this trial, the availability of zinc supplements, along with ORT and appropriate education programmes, was associated with significantly higher use of ORT and lower use of antibiotics. Key words: Zinc; Zinc Therapy; Diarrhoea; Diarrhoea, Infantile; Oral Rehydration Therapy; Antibiotics; Bangladesh

  • zinc Therapy for diarrhoea increased the use of Oral Rehydration Therapy and reduced the use of antibiotics in bangladeshi children
    Journal of Health Population and Nutrition, 2004
    Co-Authors: Abdullah H Baqui, Robert E Black, Shams El Arifeen, Mohammad Yunus, K Zaman, Nazma Begum, Amira A Roess, Mathuram Santosham
    Abstract:

    Excessive use of antibiotics for diarrhoea is a major contributing factor towards increasing rates of antimicrobial resistance in developing countries. Zinc Therapy for diarrhoea has been shown to be beneficial in controlled efficacy trials, and it is of interest to determine if availability of zinc syrup for treatment of diarrhoea would satisfy the demand for a 'medicine' for diarrhoea, thus reducing the use of antibiotics, without competing with the use of Oral Rehydration Therapy (ORT). This community-based controlled trial was conducted from November 1998 to October 2000, and all children aged 3-59 months in the study area were included. In this trial, the availability of zinc supplements, along with ORT and appropriate education programmes, was associated with significantly higher use of ORT and lower use of antibiotics.

  • Oral Rehydration Therapy for diarrhea an example of reverse transfer of technology
    Pediatrics, 1997
    Co-Authors: Mathuram Santosham, Edward Maurice Keenan, Jim Tulloch, Denis Broun, Roger I. Glass
    Abstract:

    On November 13 and 14, 1996, a scientific symposium on Oral Rehydration Therapy (ORT) was held at the Johns Hopkins University School of Hygiene and Public Health in Baltimore, MD. The purpose of the meeting was to review the current treatment practices for the treatment of this disease in the United States. The group noted that diarrhea resulted in 300 to 400 deaths per year among children, ∼200 000 hospitalizations, 1.5 million outpatient visits, and costs >$1 billion in direct medical costs. ORT is well established Therapy for the treatment and prevention of dehydration due to diarrhea. The principles of ORT treatment include early adequate Rehydration Therapy using an appropriate Oral Rehydration solution (ORS), replacement of ongoing fluid losses from vomiting and diarrhea with ORS, and frequent feeding of appropriate foods as soon as dehydration is corrected. The effective use of ORT has saved millions of lives around the world. However, in the United States, ORT is grossly underused. Contrary to the recommendations of the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), health care providers overuse intravenous hydration, prolong Rehydration, delay reintroduction of feeding, and inappropriately withhold ORT, especially with children who are vomiting. The expert panel noted that the majority of deaths, hospitalization, and visits to emergency departments could be prevented by the appropriate use of ORT. They generated guidelines for the treatment and prevention of dehydration secondary to diarrhea. These measures, together with training providers, could substantially reduce diarrhea mortality and decrease hospitalizations of children by 100 000 per year in the next 5 years.

  • Oral Rehydration Therapy for diarrhea an example of reverse transfer of technology
    Pediatrics, 1997
    Co-Authors: Mathuram Santosham, Edward Maurice Keenan, Jim Tulloch, Denis Broun, Roger I. Glass
    Abstract:

    On November 13 and 14, 1996, a scientific symposium on Oral Rehydration Therapy (ORT) was held at the Johns Hopkins University School of Hygiene and Public Health in Baltimore, MD. The purpose of the meeting was to review the current treatment practices for the treatment of this disease in the United States. The group noted that diarrhea resulted in 300 to 400 deaths per year among children, approximately 200 000 hospitalizations, 1.5 million outpatient visits, and costs >$1 billion in direct medical costs. ORT is well established Therapy for the treatment and prevention of dehydration due to diarrhea. The principles of ORT treatment include early adequate Rehydration Therapy using an appropriate Oral Rehydration solution (ORS), replacement of ongoing fluid losses from vomiting and diarrhea with ORS, and frequent feeding of appropriate foods as soon as dehydration is corrected. The effective use of ORT has saved millions of lives around the world. However, in the United States, ORT is grossly underused. Contrary to the recommendations of the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), health care providers overuse intravenous hydration, prolong Rehydration, delay reintroduction of feeding, and inappropriately withhold ORT, especially with children who are vomiting. The expert panel noted that the majority of deaths, hospitalization, and visits to emergency departments could be prevented by the appropriate use of ORT. They generated guidelines for the treatment and prevention of dehydration secondary to diarrhea. These measures, together with training providers, could substantially reduce diarrhea mortality and decrease hospitalizations of children by 100 000 per year in the next 5 years.

  • barriers to use of Oral Rehydration Therapy
    Pediatrics, 1994
    Co-Authors: Evelyn Cohen Reis, Julius G Goepp, Scott Katz, Mathuram Santosham
    Abstract:

    Not all physicians comply with American Academy of Pediatrics guidelines for the use of Oral Rehydration Therapy (ORT) to treat acute diarrhea and dehydration in children under five years old. The authors therefore surveyed 104 general pediatricians attending a national continuing medical education conference on their ORT-related knowledge attitude and practices to identify potential barriers to the use of ORT. 66% of the doctors were in private practice and 76% completed their training after 1980. Although 83% reported ORT to be important in their management of dehydration 30% reported withholding ORT in children with vomiting or moderate dehydration 50% fail to advise prompt refeeding and only 3% advise use of a spoon or syringe. The degree of importance of ORT in physicians practice was negatively associated with reported lack of convenience of ORT administration in the practice setting support staff preference for intravenous versus ORT need for additional training of support staff to implement ORT and likelihood of reimbursement for intravenous versus ORT. The degree of importance of ORT was not however associated with physician ORT knowledge. The authors conclude that efforts to improve use of ORT should be expanded beyond physician education and focus upon barriers such as support staff limitations and financial constraints.

J D Snyder - One of the best experts on this subject based on the ideXlab platform.

  • is rice based Oral Rehydration Therapy effective in young infants
    Archives of Disease in Childhood, 1994
    Co-Authors: A Islam, Abdul Majid Molla, M A Ahmed, A Yameen, R Thara, Ayesha Molla, Z Issani, Kristy Hendricks, J D Snyder
    Abstract:

    Rice based Oral Rehydration Therapy (ORT) solutions have been shown to be superior to glucose Oral Rehydration salts (World Health Organisation (WHO) ORS) in reducing stool volume and duration of diarrhoea in children and adults. Rice based ORT has been used only sparingly in young infants, however, because of theoretical concerns about digestibility. A randomised controlled trial of rice based ORT (50 g rice and electrolytes identical to WHO ORS) and WHO ORS was carried out in 52 male infants less than 6 months old with moderately severe acute diarrhoea to evaluate efficacy and digestibility. Nineteen (70%) of 27 children who received rice based ORT and 18 (72%) of 25 children who received WHO ORS were treated successfully. The mean (SD) diarrhoeal stool output for the first 24 hours of treatment was significantly lower in the infants receiving the rice based ORT than in those receiving WHO ORS (101.0 (60.5) v 137.1 (74.6) g/kg). The stool output was also significantly less in the rice based ORT group in the second 24 hours. Infants in the rice based ORT group drank significantly less Rehydration solution than infants in the WHO ORS group (mean (SD) 165.4 (77.4) v 217.9 (86.1) during the first 24 hours of treatment. There was no difference in the duration of diarrhoea between the groups. The volume of breast and formula feeding was similar in the two groups. No difference was seen in the frequency of finding reducing substances or acid pH in the stools of either group of children. The results suggest that rice based ORT is as effective as WHO ORS in infants with moderately severe diarrhoea and that rice based ORT is as well tolerated as WHO ORS in infants.

William B Greenough - One of the best experts on this subject based on the ideXlab platform.

Charles D. Ericsson - One of the best experts on this subject based on the ideXlab platform.

  • Oral Rehydration Therapy plus loperamide versus loperamide alone in the treatment of traveler s diarrhea
    Clinical Infectious Diseases, 1999
    Co-Authors: Juan Pablo Caeiro, Herbert L. Dupont, Helmut Albrecht, Charles D. Ericsson
    Abstract:

    Eighty United States students in Mexico received either loperamide (an initial dose of 4 mg, followed by 2 mg after passage of each unformed stool, up to 8 mg/d; 40 patients) or loperamide (at the same dosage schedule) plus an Oral Rehydration Therapy (ORT) preparation (500 mL initially, followed by 250 mL after each subsequently passed unformed stool, up to 1,000 mL per 24 hours; 40 patients). The ORT preparation was a modification of the World Health Organization-recommended solution, adjusted to a sodium concentration of 60 mEq/L. All treatments were given for 48 hours. The study demonstrated equivalent clinical responses with regard to diminishment of diarrhea or subjective findings such as abdominal pain/cramps, headache, dry mouth, dizziness, or thirst. Stool number (by form) and specific gravity of urine postenrollment were similar in the groups. Administration of loperamide plus ORT for the management of traveler's diarrhea, in cases in which subjects were encouraged to drink ad libitum, offered no benefit over administration of loperamide alone.

  • Oral Rehydration Therapy Plus Loperamide Versus Loperamide Alone in the Treatment of Traveler's Diarrhea
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 1999
    Co-Authors: Juan Pablo Caeiro, Herbert L. Dupont, Helmut Albrecht, Charles D. Ericsson
    Abstract:

    Eighty United States students in Mexico received either loperamide (an initial dose of 4 mg, followed by 2 mg after passage of each unformed stool, up to 8 mg/d; 40 patients) or loperamide (at the same dosage schedule) plus an Oral Rehydration Therapy (ORT) preparation (500 mL initially, followed by 250 mL after each subsequently passed unformed stool, up to 1,000 mL per 24 hours; 40 patients). The ORT preparation was a modification of the World Health Organization-recommended solution, adjusted to a sodium concentration of 60 mEq/L. All treatments were given for 48 hours. The study demonstrated equivalent clinical responses with regard to diminishment of diarrhea or subjective findings such as abdominal pain/cramps, headache, dry mouth, dizziness, or thirst. Stool number (by form) and specific gravity of urine postenrollment were similar in the groups. Administration of loperamide plus ORT for the management of traveler's diarrhea, in cases in which subjects were encouraged to drink ad libitum, offered no benefit over administration of loperamide alone.

Hideki Taniguchi - One of the best experts on this subject based on the ideXlab platform.

  • modified eras protocol using preoperative Oral Rehydration Therapy outcomes and issues
    Journal of Anesthesia, 2014
    Co-Authors: Hideki Taniguchi, Toshio Sasaki, Hisae Fujita, Rieko Kawasaki, Osami Takano, Hiroko Kobayashi, Minako Goloubev, Tomomi Ishikawa, T Ogata
    Abstract:

    In recent years, the use of postoperative recovery management protocols such as the “enhanced recovery after surgery (ERAS®) protocol” [1] and “fast track program” [2] is steadily spreading to clinical institutions across the country. These protocols involve evidence-based interventions to enhance patient recovery after surgery, which can be realized by a multidisciplinary team approach performed during perioperative periods. As the outcomes of the protocols, shorter hospitalization, reduced perioperative complications, and medical cost reduction are anticipated, and consistent outcomes are actually obtained [3]. At the same time, since these protocols have their origins in Europe and America, there are some aspects which are not consistent with Japanese medical culture and situation. These are (1) patients are very reluctant to accept shorter hospitalization (though length of hospital stay following operative procedures is taken as one of the endpoints in the protocol), (2) patient education and counseling are still not sufficient to adequately perform early postoperative mobilization and Oral intake in patients, and more nurses and staff are required for such education and consulting services. At our hospital, we practice a “modified ERAS® protocol;” an enhanced recovery after surgery protocol modified to match medical practices and situations in this country [4]. In particular, preoperative fluid management using “preoperative Oral Rehydration Therapy (PO-ORT)” is one of the important features, and we herein report the safety and efficacy of the “modified ERAS® protocol”, including its outcomes and issues [4, 5].

  • safety and efficacy of Oral Rehydration Therapy until 2 h before surgery a multicenter randomized controlled trial
    Journal of Anesthesia, 2012
    Co-Authors: Kenji Itou, Hideki Taniguchi, Tatsuya Fukuyama, Yusuke Sasabuchi, Hiroyuki Yasuda, Norihito Suzuki, Hajime Hinenoya, Masamitsu Sanui, Hideki Miyao, Mamoru Takeuchi
    Abstract:

    Purpose In many countries, patients are generally allowed to have clear fluids until 2–3 h before surgery. In Japan, long preoperative fasting is still common practice. To shorten the preoperative fasting period in Japan, we tested the safety and efficacy of Oral Rehydration Therapy until 2 h before surgery.

  • Safety and efficacy of Oral Rehydration Therapy until 2 h before surgery: a multicenter randomized controlled trial
    Journal of Anesthesia, 2012
    Co-Authors: Kenji Itou, Hideki Taniguchi, Tatsuya Fukuyama, Yusuke Sasabuchi, Hiroyuki Yasuda, Norihito Suzuki, Hajime Hinenoya, Masamitsu Sanui, Chol Kim, Hideki Miyao
    Abstract:

    Purpose In many countries, patients are generally allowed to have clear fluids until 2–3 h before surgery. In Japan, long preoperative fasting is still common practice. To shorten the preoperative fasting period in Japan, we tested the safety and efficacy of Oral Rehydration Therapy until 2 h before surgery. Methods Three hundred low-risk patients scheduled for morning surgery in six university-affiliated hospitals were randomly assigned to an Oral Rehydration solution (ORS) group or to a fasting group. Patients in the ORS group consumed up to 1,000 ml of ORS containing balanced glucose and electrolytes: 500 ml between 2100 the night before surgery and the time they woke up the next morning and 500 ml during the morning of surgery until 2 h before surgery. Patients in the fasting group started fasting at 2100 the night before surgery. Primary endpoints were gastric fluid volume and pH immediately after anesthesia induction. Several physiological measures of hydration and electrolytes including the fractional excretion of sodium (FENa) and the fractional excretion of urea nitrogen (FEUN) were also evaluated. Results Mean (SD) gastric fluid volume immediately after anesthesia induction was 15.1 (14.0) ml in the ORS group and 17.5 (23.2) ml in the fasting group ( P  = 0.30). The mean difference between the ORS group and fasting group was −2.5 ml. The 95% confidence interval ranged from −7.1 to +2.2 ml and did not include the noninferior limit of +8 ml. Mean (SD) gastric fluid pH was 2.1 (1.9) in the ORS group and 2.2 (2.0) in the fasting group ( P  = 0.59). In the ORS group, mean FENa and FEUN immediately after anesthesia induction were both significantly greater than those in the fasting group ( P  

  • Oral Rehydration Therapy for preoperative fluid and electrolyte management
    International Journal of Medical Sciences, 2011
    Co-Authors: Hideki Taniguchi, Toshio Sasaki, Hisae Fujita
    Abstract:

    Aim: Preoperative fluid and electrolyte management is usually performed by intravenous Therapy. We investigated the safety and effectiveness of Oral Rehydration Therapy (ORT) for preoperative fluid and electrolyte management of surgical patients. Methods: The study consisted of two studies, designed as a prospective observational study. In a pilot study, 20 surgical patients consumed 1000 mL of an Oral Rehydration solution (ORS) until 2 h before induction of general anesthesia. Parameters such as serum electrolyte concentrations, fractional excretion of sodium (FENa) as an index of renal blood flow, volume of esophageal-pharyngeal fluid and gastric fluid (EPGF), and patient satisfaction with ORT were assessed. In a follow-up study to assess the safety of ORT, 1078 surgical patients, who consumed ORS until 2 h before induction of general anesthesia, were assessed. Results: In the pilot study, water, electrolytes, and carbohydrate were effectively and safely supplied by ORT. The FENa value was increased at 2 h following ORT. The volume of EPGF collected following the induction of anesthesia was 5.3±5.6 mL. In the follow-up study, a small amount of vomiting occurred in one patient, and no aspiration occurred in the patients. Conclusion: These results suggest that ORT is a safe and effective Therapy for the preoperative fluid and electrolyte management of selected surgical patients.

  • preoperative fluid and electrolyte management with Oral Rehydration Therapy
    Journal of Anesthesia, 2009
    Co-Authors: Hideki Taniguchi, Toshio Sasaki, Hisae Fujita, Mina Takamori, Rieko Kawasaki, Yukinori Momiyama, Osami Takano, Toshinari Shibata, Takahisa Goto
    Abstract:

    We hypothesized that Oral Rehydration Therapy using an Oral Rehydration solution may be effective for preoperative fluid and electrolyte management in surgical patients before the induction of general anesthesia, and we investigated the safety and effectiveness of Oral Rehydration Therapy as compared with intravenous Therapy. Fifty female patients who underwent breast surgery were randomly allocated to two groups. Before entry to the operation room and the induction of general anesthesia, 25 patients drank 1000 ml of an Oral Rehydration solution (“Oral group”) and 25 patients were infused with 1000 ml of an intravenous electrolyte solution (“intravenous group”). Parameters such as electrolyte concentrations in serum and urine, urine volume, vital signs, vomiting and aspiration, volumes of esophageal-pharyngeal fluid and gastric fluid (EPGF), and patient satisfaction with the Therapy (as surveyed by a questionnaire) were assessed. After treatment, the serum sodium concentration and the hematocrit value, which both declined within the normal limits, were significantly higher in the Oral group than in the intravenous group (sodium, 140.8 ± 2.9 mEq·l−1 in the Oral group and 138.7 ± 1.9 mEq·l−1 in the intravenous group; P = 0.005; hematocrit, 39.03 ± 4.16% in the Oral group and 36.15 ± 3.41% in the intravenous group; P = 0.01). No significant difference was observed in serum glucose values. Urine volume was significantly larger in the Oral group (864.9 ± 211.5 ml) than in the intravenous group (561.5 ± 216.0 ml; P < 0.001). The fractional excretion of sodium (FENa), as an index of renal blood flow, was increased in both groups following treatment (0.8 ± 0.5 in the Oral group and 0.8 ± 0.3 in the intravenous group). Patient satisfaction with the Therapy favored the Oral Rehydration Therapy, as judged by factors such as “feeling of hunger”, “occurrence of dry mouth”, and “less restriction in physical activity”. The volume of EPGF collected following the induction of anesthesia was significantly smaller in the Oral group than in the intravenous group (6.03 ± 9.14 ml in the Oral group and 21.76 ± 30.56 ml in the intravenous group; P < 0.001). No adverse events or adverse reactions were observed in either group. The results suggest that the Oral Rehydration Therapy with an Oral Rehydration solution before surgery is superior to the current preoperative intravenous Therapy for the provision of water, electrolytes, and carbohydrates, and this Therapy should be considered as an alternative to the intravenous Therapy for preoperative fluid and electrolyte management in selected surgical patients in whom there is no reason to suspect delayed gastric emptying.