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Use of rice-based oral rehydration solution in a large diarrhoea treatment centre in Bangladesh: in-house production, use and relative cost.
JOURNAL OF TROPICAL MEDICINE AND HYGIENE. 1994 Dec; 97(6):341-6.Glucose-based oral rehydration salt (ORS) is an appropriate and cost-effective tool to treat diarrheal dehydration. In patients with a high purging rate, particularly due to cholera, rice-based ORS has been shown to substantially reduce stool output compared to glucose ORS. However, it is not used in the hospitals or diarrhea treatment centers largely because of the non-availability of a ready-to-use inexpensive packaged product and because of the problem of cooking. In a large diarrhea treatment center in Bangladesh (with an annual ORS consumption of approximately 140,000 liters), the authors have maintained in-house production of rice ORS and used it routinely for more than 600,000 patients over the last nine years. Semi-literate health workers cook rice ORS and supervise mothers in its use. Rice ORS is less costly (US $0.15/patient treated compared with US $0.37 for glucose ORS) and is well accepted. It is an attractive alternative to glucose ORS in many fixed facility treatment centers in countries where rice is a staple and cholera is endemic. The process of its in-house preparation and use is described in this report which may assist hospitals wishing to use rice ORS in treating diarrhea patients. Availability of a low cost ready-to-use rice ORS packet (which needs no cooking) with adequate shelf-life will increase its use at fixed facilities. (author's)
HOSPITAL FORMULARY. 1978; 467, 471.Patient and consumer interest has been responsible for the concept of patient package inserts (PPI). The Food and Drug Administration in the United States implemented regulations to enforce dispensing of a PPI with all estrogen-containing medications in October 1977. In community pharmacy practice, the law states that such a PPI must be included when a prescription for an estrogen-containing product is dispensed, but this regulation presented certain problems for a hospital. Original FDA regulations were subsequently modified to provide some flexibility, and volume 42, number 141, of the "Federal Register" clarified regulations for hospitals. A recent editorial by Archambault has presented some interesting legal interpretations and possible consequences of this new law. At Crozer-Chester Medical Center in Chester, Pennsylvania, the department of pharmacy-central service was directed and is responsible for ensuring that the estrogen PPI regulation is carried out. The pharmacist is responsible for dispensing the PPI directly to patients and clarifying the inserts so that the patients understand the content. The pharmacist is also responsible for documenting in the progress notes that such action was taken prior to dispensing any estrogen-containing product. The Center believes that the procedures which they have developed are in compliance with the law and take into account the patients' psychological well being.
American Journal of Hospital Pharmacy. 1978 Sep; 35(9):1071-1072.The Food and Drug Administration regulation on the distribution of patient package inserts (PPIs) to patients who receive estrogen drugs, became effective on October 18, 1977. The pharmacist at Kingsbrook Jewish Medical Center in Brooklyn, New York, devised a procedure for the distribution of PPIs to both outpatients and inpatients. The pharmacist dispenses the PPI and the drug to outpatients, and records in the patient's profile the name of the drug, the date, and his/her own initials. Information of the PPI is orally reinforced and the patient asked to sign the profile. For outpatients the medication is distributed with a preprinted double-tab label adhering on the PPI: one portion lists instructions to the physician; the other portion will record name of the drug, date, patient's name and physician's signature. After the physician has explained the PPI to the patients, he must affix this tab to the order sheet. Estrogens are not administered till this procedure is complied with. The pharmacy department, which uses a minicomputer to support its distribution program, issued, prior to implementation of this procedure, a special edition of Pharmacy Newsletter, which discussed the FDA regulation and the purpose of PPIs.