Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 5 uppsatser.

M.MED- Family Medicine / Background Oral rehydration therapy (ORT) has been used for many decades, and its usefulness in the management of dehydration caused by diarrhoea is well established. On the other hand, childhood mortality from diarrhoea, is reportedly high in most developing countries. Improved case management of children with diarrhoea, adequate maternal and caregiver’s knowledge on correct preparation, administration and use of oral rehydration solution, are seen as important interventions that could assist in addressing the problem. Aim and Objectives The aim of the study was to assess knowledge and skills of mothers and caregivers in the preparation and use of Salt Sugar Solution (SSS) at Mofolo Community Health Centre (CHC), Soweto. The study objectives were as follows: 1. To determine the proportion of caregivers that had ever-been-taught how to prepare SSS. 2. To assess knowledge of mothers and caregivers’ on the correct use of SSS, including signs of dehydration and danger signs in the Integrated Management of Childhood Illness (IMCI). 3. To determine the proportion of caregivers who demonstrate correct preparation of SSS. Method The study was conducted in the well-baby and general clinic of Mofolo Community Health Centre in Soweto where 407 mothers and caregivers were conveniently sampled, interviewed and asked to practically demonstrate how they prepare SSS. The proportion of mothers and caregivers who were: a) ever-taught; b) knew how to correctly prepare SSS; had the new road to health card and knew signs of dehydration were determined. The chi-square test was used to determine the association between demographic characteristics and the main outcome measure, (correct preparation of SSS). Logistic regression analysis was used to determine the strengths of associations of different variables in relation to the outcome variable (correct preparation of SSS). Results Only 21% of mothers and caregivers could correctly prepare SSS. Less than half (45.7%) had the new road to health card containing correct preparation instructions. Only 7.6% of the 45.7% with the new road to health card, demonstrated how to correctly prepare SSS. A small proportion (2%) of participants said they were never taught how to prepare SSS, while, 55.6% had been taught by healthcare workers. In the category of household income, the largest group, 25.3% of participants had an income between South African Rands (R) 1000 and 2999. Male participants were only 4.9%. About 79% of participants knew at least one sign of dehydration. The chisquare test was used to determine the main outcome measure, which was correct preparation of SSS and demographic factors. Factors associated with correct preparation of SSS were; a) number of teaching sessions received, p-value = 0.0001; b) teaching done by healthcare worker, p-value = 0.0001; c) perceived knowledge of mothers or caregiver on how to correctly prepare SSS, p-value = 0.015; and d) number of children in the household, p-value = 0.011. Conclusion Overall, 79% of mothers and caregivers did not correctly prepare SSS, despite 97% of participants agreeing to having been taught how to prepare SSS. Over half (55.6%) of mothers and caregivers were taught by healthcare worker, however, incorrect SSS use in over half (57.8%) of mothers and caregivers as well as inability to recognize at least one sign of dehydration gave credence to general poor knowledge and use of SSS which is a threat to management of diarrhoeal diseases and overall child mortality and morbidity. / MT2017

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 6 uppsatser.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the award of a degree of Master of Medicine in Family Medicine / BACKGROUND: Diarrhea is an important health problem and has remained a threat to the lives of children under 5 years old especially in developing regions of the world. Presently, it is estimated that about 1.5 million of these children die every year from diarrhea that would have been prevented by giving oral rehydration therapy (ORT). The value of ORT in treating diarrhea has remained unquestionable but emerging evidence still points to unsatisfactory uptake. This study assessed the knowledge, attitudes and practices of mothers/caregivers regarding oral rehydration therapy at Johan Heyns community health center, Vanderbijlpark. OBJECTIVE: To assess the knowledge, attitudes and practices of mothers/caregivers regarding oral rehydration therapy at Johan Heyns community health center. METHODS: This study was a descriptive cross sectional study involving mothers/caregivers’ attended to by the primary health care (PHC) nurses at the Integrated management of childhood illnesses (IMCI) clinic of a large community health center in Sedibeng district. Respondents were systematically recruited until a sample size of 377 was reached. A face to face questionnaire was used to collect data on demography, knowledge, attitudes, practices and response to diarrhea from the participants. The data collected was analyzed by the use of descriptive statistics, chi-square test and Fisher’s exact test. The main outcome measures were the level of ORT knowledge of mothers/caregivers, attitudes, practices and response to diarrhea. RESULTS: Most of the caregivers were mothers (88.3%) who had completed matric (72.5%) and were unemployed (60.6%). The mean age was 30 years. About 53.3% of the caregivers gave ORT as an initial response to diarrhea, 30.2% took their child to the clinic/hospital, while 4% gave orthodox or traditional medicine. The majority of the caregivers (89.4%) had heard of ORT. The main source of ORT information was clinic/hospital (89.6%). Most of the caregivers (81.7%) said ORT stops diarrhea while 18.3% said it stops dehydration. Many of the caregivers (66%) had used ORT. The caregivers’ORT knowledge was significantly associated with attitude and (P= 0.0000). A small proportion of the caregivers (29%) had problems preparing ORT at home. Most of the caregivers’ children (75.5%) did not like the taste of ORT. The ORT attitude of caregivers was significantly associated with knowledge and practice (P=0.0000; P=0.0127). Less than half (33.7%, n=127) of the entire study sample (n=377) and about half (50%, n=127) of the caregivers who claimed that they could prepare ORT (67.4%, n=254) was able to prepare a correct recipe. Over half (54.2%) of the caregivers stopped giving ORT or did not know what to do when vomiting starts. A large number of the caregivers (72.7%) continued feeding their child at the onset of diarrhea. Many of the caregivers (82.8%) used only ORT at the onset of diarrhea while few (17.2%) added some unconventional remedies. There was no association between ORT practice and ORT knowledge (P=0.4797). CONCLUSION: This study shows a significant association between ORT knowledge and attitude, and also between ORT attitude and practice. There was no correlation between ORT knowledge and practice, therefore ORT knowledge did not satisfactorily translate to the practice. Majority of the caregivers could not prepare ORT correctly and either stopped giving ORT or did not know what to do when vomiting starts. The reported use of unconventional remedies like raw egg and custard by some caregivers to treat diarrhea at home is disturbing. It is obvious that much work still needs to be done to improve home treatment of diarrhea using ORT; a good starting point is to initiate new strategies aimed at improving caregivers’ education on the different aspects of ORT.

A utilização de colóides é indicada em várias situações, mas nem sempre aplicável na clínica de eqüinos. O objetivo desse trabalho foi avaliar o uso de solução concentrada de albumina eqüina (diluída a 5%) durante fluidoterapia em eqüinos com desidratação leve a moderada, comparando-a com fluidoterapia apenas com solução fisiológica. Foram utilizados dois grupos de cinco eqüinos adultos, sem alterações clínicas. Cada animal passou pelo protocolo dos dois grupos experimentais (fluidoterapia apenas com solução fisiológica; fluidoterapia com solução de albumina eqüina e solução fisiológica). A desidratação foi induzida com duas aplicações de furosemida e jejum. Durante o experimento foram realizadas várias avaliações: pesagem; exame físico geral; hematócrito; osmolalidade plasmática; gasometria; proteína total; albumina; Na; K; débito cardíaco; pressão arterial; uréia e creatinina, e cálculo da pressão oncótica e volume plasmático. Com a aplicação da solução de albumina houve diferença em relação ao outro grupo, embora nem sempre demonstrada estatisticamente, na avaliação do turgor de pele, hematócrito, proteína total, albumina, Na plasmático, pressão arterial, débito cardíaco, pressão oncótica e volume plasmático. Concluiu-se que: a aplicação apenas de pequeno volume de solução de albumina é capaz de causar efeitos comparáveis aos da infusão sob pressão de metade do volume de solução fisiológica calculado para reidratar o mesmo animal; ao final da fluidoterapia, a solução de albumina leva a maior valor de pressão arterial e de albumina sérica e menor de proteína total, mesmo sem diferença estatística, do que apenas a aplicação de solução fisiológica; ao final da fluidoterapia, com o uso de solução de albumina o turgor de pele dos animais ainda indica presença de desidratação, ao contrário dos que recebem apenas solução fisiológica onde o mesmo indica boa hidratação em todos os animais; a solução concentrada de albumina eqüina é passível de ser usada em fluidoterapia nesta espécie, com facilidade de preparação e aplicação e não demonstrando efeitos deletérios. / The colloids utilization is indicated in several situations, but not always applicable in equine practice. The objective of this study was to evaluate the use of the equine concentrated albumin solution (diluted to 5%) during fluid therapy in horses with slight to moderate dehydration, making a comparison with fluid therapy only with physiologic saline solution. Two groups of five adult horses, without clinical alterations, were used. Each animal was submitted to the protocol of each experimental group (fluid therapy only with physiologic saline solution; fluid therapy with equine albumin solution and physiologic saline solution). The dehydration was induced with two administrations of furosemide and fasting. During the experimental period, several evaluations were made: weighing; gasometry; total protein; albumin; Na; K; cardiac output; arterial pressure; urea and creatinin, and calculation of the oncotic pressure and plasmatic volume. With the administration of albumin solution, there was difference, although not always statistically demonstrated in the evaluation of the skin turgor, packed cell volume, total protein and albumin, plasmatic Na, arterial pressure, cardiac output, oncotic pressure and plasmatic volume. It was concluded that: the administration of only a small volume of albumin solution is capable of causing effects comparable to the infusion under pressure of half of the calculated volume of physiologic saline solution necessary to rehydrated the animal; at the end of the fluid therapy, the albumin solution leads to higher values of arterial pressure and serum albumin and lower values of total protein, although without statistical difference, than the single administration of physiologic saline solution; at the end of the fluid therapy, with the use of the albumin solution, the skin turgor still indicates the presence of dehydration, the opposite that occurs with the animals when receiving only physiologic saline solution, where the test indicates good hydration in all the horses; the equine concentrated albumin solution is utilizable in fluid therapy in this species, with easy preparation and administration and with no demonstration of deleterial effects.

Made available in DSpace on 2014-06-11T19:29:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-18Bitstream added on 2014-06-13T20:19:22Z : No. of bitstreams: 1 gurgel_sjt_me_botfm.pdf: 577604 bytes, checksum: a0f3cdc5beda60fb135d7a4466cc25ac (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Pacientes cirúrgicos com reserva orgânica limitada são considerados de alto risco e possuem uma taxa de mortalidade maior do que a esperada, necessitando, portanto, de um protocolo de controle hemodinâmico peroperatório mais rigoroso, no sentido de impedir situações de hipoperfusão tissular. O objetivo desta dissertação é rever de maneira sistemática, os estudos clínicos aleatórios controlados que utilizaram algum tipo de protocolo de otimização hemodinâmica da perfusão tissular em pacientes cirúrgicos com alto risco para complicações no pós-operatório. Foi realizada uma busca computadorizada nas bases de dados da MEDLINE, EMBASE, LILACS, COCHRANE, utilizando o cruzamento de termos médicos, e recuperado estudos clínicos aleatórios controlados, de pacientes cirúrgicos submetidos de maneira controlada, a algum tipo de protocolo de otimização hemodinâmica peroperatória com objetivo de reduzir taxa de mortalidade, número de disfunções orgânicas e dias de internação hospitalar, sendo realizada uma metanálise dos resultados obtidos. Foram recuperados 31 estudos clínico, cuja metanálise global demonstrou uma redução estatisticamente significativa no odds ratio para taxa de mortalidade (odds ratio de 0,71 com 95% de intervalo de confiança entre 0,58-0,87), no número de pacientes com disfunções orgânicas no pósoperatório (odds ratio de 0,64 com 95% de intervalo de confiança entre 0,57- 0,73) e no tempo de internação hospitalar (diferença de médias de -1,06 com 95% de intervalo de confiança entre -1,19/-0,93). Ficando mais evidente nos estudos com taxa de mortalidade maior que 20%. Houve um benefício estatisticamente significativo na redução da taxa de mortalidade com a utilização do cateter da artéria pulmonar para aferição do débito cardíaco (odds ratio de 0,71 com 95% de intervalo de confiança entre 0,57-0,89) e utilização das... / Surgical patient with limited organic reserve are considered of high risk and possess a rate of larger mortality than the expected, needing, therefore, of a protocol of control hemodynamic more rigorous , in the sense of impeding situations of hypoperfusion tissue in the peroperative period. The objective of this dissertation is to review in a systematic way, the random clinical studies controlled that used some type of protocol of hemodynamic optimization of the perfusion tissue in patient surgical with high risk for complications in the postoperative one. A computerized search was accomplished in the bases of data of MEDLINE, BASE, LILACS, COCHRANE, using the crossing of medical terms, and recovered random clinical studies controlled of patient surgical submitted in the some type of protocol of hemodynamic optimization in the preoperative period with objective of reducing mortality rate, number of organic dysfunctions and length of hospital stay, being accomplished a meta-analysis of the obtained results. 31 clinical studies were recovered, whose global meta-analyses demonstrated a reduction significant in the odds ratio for mortality rate (odds ratio of 0,71 with 95% of confidence interval among 0,58-087), in the number of patients with organic dysfunctions in the postoperative (odds ratio of 0,64 with 95% of confidence interval among 0,57-073) and in the length of hospital stay (it differentiates of averages of -1,06 with 95% of confidence interval among - 1,19 /-093), being more evident in the studies with rate of larger mortality than 20%. There was a benefit significant in the reduction of the mortality rate with the use of the catheter of the lung artery for gauging of the heart debit (odds ratio of 0,71 with 95% of trust interval among 0,57-089) and use of the derived variables of the transport and consumption of oxygen (odds ratio of 0,75 with 95% oconfidencef interval among - ... (Complete abstrct click electronic access below)

A utilização de colóides é indicada em várias situações, mas nem sempre aplicável na clínica de eqüinos. O objetivo desse trabalho foi avaliar o uso de solução concentrada de albumina eqüina (diluída a 5%) durante fluidoterapia em eqüinos com desidratação leve a moderada, comparando-a com fluidoterapia apenas com solução fisiológica. Foram utilizados dois grupos de cinco eqüinos adultos, sem alterações clínicas. Cada animal passou pelo protocolo dos dois grupos experimentais (fluidoterapia apenas com solução fisiológica; fluidoterapia com solução de albumina eqüina e solução fisiológica). A desidratação foi induzida com duas aplicações de furosemida e jejum. Durante o experimento foram realizadas várias avaliações: pesagem; exame físico geral; hematócrito; osmolalidade plasmática; gasometria; proteína total; albumina; Na; K; débito cardíaco; pressão arterial; uréia e creatinina, e cálculo da pressão oncótica e volume plasmático. Com a aplicação da solução de albumina houve diferença em relação ao outro grupo, embora nem sempre demonstrada estatisticamente, na avaliação do turgor de pele, hematócrito, proteína total, albumina, Na plasmático, pressão arterial, débito cardíaco, pressão oncótica e volume plasmático. Concluiu-se que: a aplicação apenas de pequeno volume de solução de albumina é capaz de causar efeitos comparáveis aos da infusão sob pressão de metade do volume de solução fisiológica calculado para reidratar o mesmo animal; ao final da fluidoterapia, a solução de albumina leva a maior valor de pressão arterial e de albumina sérica e menor de proteína total, mesmo sem diferença estatística, do que apenas a aplicação de solução fisiológica; ao final da fluidoterapia, com o uso de solução de albumina o turgor de pele dos animais ainda indica presença de desidratação, ao contrário dos que recebem apenas solução fisiológica onde o mesmo indica boa hidratação em todos os animais; a solução concentrada de albumina eqüina é passível de ser usada em fluidoterapia nesta espécie, com facilidade de preparação e aplicação e não demonstrando efeitos deletérios. / The colloids utilization is indicated in several situations, but not always applicable in equine practice. The objective of this study was to evaluate the use of the equine concentrated albumin solution (diluted to 5%) during fluid therapy in horses with slight to moderate dehydration, making a comparison with fluid therapy only with physiologic saline solution. Two groups of five adult horses, without clinical alterations, were used. Each animal was submitted to the protocol of each experimental group (fluid therapy only with physiologic saline solution; fluid therapy with equine albumin solution and physiologic saline solution). The dehydration was induced with two administrations of furosemide and fasting. During the experimental period, several evaluations were made: weighing; gasometry; total protein; albumin; Na; K; cardiac output; arterial pressure; urea and creatinin, and calculation of the oncotic pressure and plasmatic volume. With the administration of albumin solution, there was difference, although not always statistically demonstrated in the evaluation of the skin turgor, packed cell volume, total protein and albumin, plasmatic Na, arterial pressure, cardiac output, oncotic pressure and plasmatic volume. It was concluded that: the administration of only a small volume of albumin solution is capable of causing effects comparable to the infusion under pressure of half of the calculated volume of physiologic saline solution necessary to rehydrated the animal; at the end of the fluid therapy, the albumin solution leads to higher values of arterial pressure and serum albumin and lower values of total protein, although without statistical difference, than the single administration of physiologic saline solution; at the end of the fluid therapy, with the use of the albumin solution, the skin turgor still indicates the presence of dehydration, the opposite that occurs with the animals when receiving only physiologic saline solution, where the test indicates good hydration in all the horses; the equine concentrated albumin solution is utilizable in fluid therapy in this species, with easy preparation and administration and with no demonstration of deleterial effects.

Source: Masters Abstracts International, Volume: 47-06, page: 3510. Adviser: Irwin B. Horwitz. Includes bibliographical references.

Thesis (M.S.)--University of Missouri-Columbia, 2008. / "May 2008" The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Includes bibliographical references.

Orientador: Paulo do Nascimento Junior / Banca: Yara Marcondes Machado Castiglia / Banca: Francisco Ricardo Marques Lobo / Resumo: Pacientes cirúrgicos com reserva orgânica limitada são considerados de alto risco e possuem uma taxa de mortalidade maior do que a esperada, necessitando, portanto, de um protocolo de controle hemodinâmico peroperatório mais rigoroso, no sentido de impedir situações de hipoperfusão tissular. O objetivo desta dissertação é rever de maneira sistemática, os estudos clínicos aleatórios controlados que utilizaram algum tipo de protocolo de otimização hemodinâmica da perfusão tissular em pacientes cirúrgicos com alto risco para complicações no pós-operatório. Foi realizada uma busca computadorizada nas bases de dados da MEDLINE, EMBASE, LILACS, COCHRANE, utilizando o cruzamento de termos médicos, e recuperado estudos clínicos aleatórios controlados, de pacientes cirúrgicos submetidos de maneira controlada, a algum tipo de protocolo de otimização hemodinâmica peroperatória com objetivo de reduzir taxa de mortalidade, número de disfunções orgânicas e dias de internação hospitalar, sendo realizada uma metanálise dos resultados obtidos. Foram recuperados 31 estudos clínico, cuja metanálise global demonstrou uma redução estatisticamente significativa no odds ratio para taxa de mortalidade (odds ratio de 0,71 com 95% de intervalo de confiança entre 0,58-0,87), no número de pacientes com disfunções orgânicas no pósoperatório (odds ratio de 0,64 com 95% de intervalo de confiança entre 0,57- 0,73) e no tempo de internação hospitalar (diferença de médias de -1,06 com 95% de intervalo de confiança entre -1,19/-0,93). Ficando mais evidente nos estudos com taxa de mortalidade maior que 20%. Houve um benefício estatisticamente significativo na redução da taxa de mortalidade com a utilização do cateter da artéria pulmonar para aferição do débito cardíaco (odds ratio de 0,71 com 95% de intervalo de confiança entre 0,57-0,89) e utilização das ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Surgical patient with limited organic reserve are considered of high risk and possess a rate of larger mortality than the expected, needing, therefore, of a protocol of control hemodynamic more rigorous , in the sense of impeding situations of hypoperfusion tissue in the peroperative period. The objective of this dissertation is to review in a systematic way, the random clinical studies controlled that used some type of protocol of hemodynamic optimization of the perfusion tissue in patient surgical with high risk for complications in the postoperative one. A computerized search was accomplished in the bases of data of MEDLINE, BASE, LILACS, COCHRANE, using the crossing of medical terms, and recovered random clinical studies controlled of patient surgical submitted in the some type of protocol of hemodynamic optimization in the preoperative period with objective of reducing mortality rate, number of organic dysfunctions and length of hospital stay, being accomplished a meta-analysis of the obtained results. 31 clinical studies were recovered, whose global meta-analyses demonstrated a reduction significant in the odds ratio for mortality rate (odds ratio of 0,71 with 95% of confidence interval among 0,58-087), in the number of patients with organic dysfunctions in the postoperative (odds ratio of 0,64 with 95% of confidence interval among 0,57-073) and in the length of hospital stay (it differentiates of averages of -1,06 with 95% of confidence interval among - 1,19 /-093), being more evident in the studies with rate of larger mortality than 20%. There was a benefit significant in the reduction of the mortality rate with the use of the catheter of the lung artery for gauging of the heart debit (odds ratio of 0,71 with 95% of trust interval among 0,57-089) and use of the derived variables of the transport and consumption of oxygen (odds ratio of 0,75 with 95% oconfidencef interval among - ... (Complete abstrct click electronic access below) / Mestre