Oral Fluid, Electrolytes, and Energy Management in Various Adult and Geriatric Illnesses beyond Diarrhea: An Indian Expert Panel Delphi Consensus Recommendation.

BACKGROUND: Dehydration is a highly prevalent clinical challenge in adults which can go undetected. Although dehydration is commonly associated with an increased risk of hospitalization and mortality, only a few international guidelines provide recommendations regarding oral fluids, electrolytes, and energy (FEE) management in adults/geriatrics with dehydration due to nondiarrheal causes. Currently, there is a lack of comprehensive recommendations on the role of oral FEE in nondiarrheal dehydration in adult and geriatric Indian patients. MATERIALS AND METHODS: A modified Delphi approach was designed using an online questionnaire-based survey followed by a virtual meeting, and another round of online surveys was used to develop this consensus recommendation. In round one, 130 statements, including 21 open-ended questions, were circulated among ten national experts who were asked to either strongly agree, agree, disagree, or strongly disagree with statements and provide responses to open-ended questions. The consensus was predefined at 75% agreement (pooling "strongly agree" and "agree" responses). Presentation of relevant literature was done during a virtual discussion, and some statements (the ones that did not achieve predefined agreement) were actively discussed and deliberately debated to arrive at conclusive statements. Those statements that did not reach consensus were revised and recirculated during round two. RESULTS: Consensus was achieved for 130/130 statements covering various domains such as assessment of dehydration, dehydration in geriatrics, energy requirement, impact of oral FEE on patient outcome, and fluid recommendations in acute and chronic nondiarrheal illness. However, one statement was not added as a recommendation in the final consensus (129/130) as further literature review did not find any supporting data. Oral FEE should be recommended as part of core treatment from day 1 of acute nondiarrheal illness and started at the earliest feasibility in chronic illnesses for improved patient outcomes. Appropriately formulated fluids with known electrolyte and energy content, quality standards, and improved palatability may further impact patient compliance and could be a good option. CONCLUSION: These consensus recommendations provide guidance for oral FEE recommendations in Indian adult/geriatric patients with various nondiarrheal illnesses.

Knowledge, Attitudes, and Practices regarding Oral Fluid, Electrolyte, and Energy Management in Acute Nondiarrheal Illnesses among Physicians in India.

BACKGROUND: Fluid, electrolytes, and energy (FEE) management is important in the treatment of acute nondiarrheal illnesses. However, the use of FEE drinks in managing such illnesses is not well-documented. OBJECTIVE: This study aimed to understand physicians' knowledge, attitude, and practices (KAP) and perceived patient outcomes in treating FEE deficits in acute nondiarrheal illnesses using FEE drinks in India. MATERIALS AND METHODS: A cross-sectional respondent-blinded survey was designed and administered among practicing physicians across various specialties and prescribing statuses in India. KAP among groups of physicians was assessed, and the correlations between knowledge- attitudes, knowledge-practice, and knowledge-perceived outcomes were explored. RESULTS: A total of 494 physicians participated in the study from September to October 2021. Overall, knowledge scores were moderate. Prescribers had a higher average knowledge score and more proactive attitudes and practices as compared to nonprescribers. Most physicians agreed that FEE management recommendations could improve patients' recovery speed. There were significant positive correlations between knowledge scores and physicians' attitudes toward the importance of FEE management awareness, the importance of FEE management for patient recovery, and a physician's perception that FEE drinks improved patients' recovery time. There was no significant correlation between knowledge score and practices. CONCLUSION: There may be benefits from improving the knowledge of physicians in India in FEE management and developing guidelines for the use of FEE drinks in acute nondiarrheal illnesses. Further research exploring the knowledge-practice gap and evaluating the clinical benefit of FEE drinks in acute nondiarrheal illnesses should also be undertaken to develop such guidelines.

Comparing the Knowledge, Attitude, and Practices on Oral Fluids, Electrolytes, and Energy Management in Non-diarrheal Illnesses across Different Physician Specialties in India.

Background: The management of non-diarrheal illnesses requires careful attention to maintaining the proper balance of fluids, electrolytes, and energy (FEE). Nevertheless, there is a limited amount of information accessible regarding the utilization of oral FEE formulations in the treatment of these conditions. Objective: The objective of this study was to assess and contrast the levels of knowledge, attitude, and practices (KAP) among various medical specialties in India when it comes to addressing FEE imbalances in non-diarrheal illnesses through the use of oral FEE formulations, as well as to examine how these approaches influence perceived patient outcomes. We also present a subgroup analysis of KAP in healthcare personnels (HCPs) whose practices include 25% or more diabetic or geriatric patients. Materials and methods: A cross-sectional online assessment was created and conducted among physicians (n = 494) representing different medical specialties in India, which include general practitioners (GPs) (n = 128), MD physicians (n = 121), gynecologists (n = 122), and pediatricians (n = 123). Results: A total of 494 physicians across specialties, including GPs, MDs (MD internal medicine physicians), obstetrics and gynecologists (OB-GYN), and pediatricians, participated in the online assessment from September to October 2021. Knowledge scores were moderate across specialties, and there was no significant difference in knowledge level across specialties. More pediatricians and GPs than other HCPs consider FEE deficit to have a high impact on recovery. Further, pediatrician prescribers consider FEE management to be of high importance compared to other specialties. A significantly higher percentage of pediatricians assess all their patients (100%) for hydration levels, and significantly more gynecologists spend >5 minutes providing hydration advice to their patients. Among all specialties, MD and gynecologist prescribers are more likely to recommend oral FEE for patient recovery. HCPs with diabetes practices agree slightly more than HCPs with geriatric practices that oral FEE management recommendations facilitate the speed of the recovery process from non-diarrheal illnesses in their patients. However, only approximately 30% of them recommend FEE to 70% of their eligible patients, of which approximately 70% of these HCPs give formal (written/electronic) prescriptions of ready-to-drink (RTD) fluids to their patients. Conclusion: Enhancing the understanding of physicians across diverse specialties in India regarding oral FEE management and formulating recommendations for the utilization of oral FEE formulations in non-diarrheal conditions could lead to better outcomes. While knowledge and awareness of oral FEE management are similar across specialties, their practice behaviors vary. Additional research into this disparity and the assessment of the clinical advantages of oral FEE formulations in non-diarrheal illnesses among various specialties should be conducted. How to cite this article: Sathe P, Chakravarty P, Tesado C, et al. Comparing the Knowledge, Attitude, and Practices on Oral Fluids, Electrolytes, and Energy Management in Non-diarrheal Illnesses across Different Physician Specialties in India. J Assoc Physicians India 2023;71(10):19-30.