Value and types of medicines returned by patients to sultan qaboos university hospital pharmacy, oman.

OBJECTIVES: Frequent physician visits, improper therapeutic adherence and treatment modification after hospitalisation could result in unused medicine accumulating at home. This study aims to examine the value and types of medicines returned by patients at a tertiary care unit in Oman. METHOD: All medicines voluntarily returned to Sultan Qaboos University Hospital main pharmacy between February and June 2003 were reviewed. The cost of these medicines and potential cost saving, if some were returned to the hospital distribution cycle, were computed. A method of determining by physical observation whether they can be recycled was developed based on institutional-based guidelines and criteria. RESULTS: Three hundred and eighty one patients returned their medicines (69% female). The patients returned a total of 1071 drugs (mean per patient 3.1 per month) corresponding to a total cost of Omani Rials (OR) 20,140 (mean per patient OR 10.6) (1 OR = 2.58 US dollar). Potential cost saving was OR 5,550 (mean per patient OR 2.9). Medicines of the cardiovascular group were returned in greatest number (24%) while anti-infective drugs had the highest share of the total cost (61%). CONCLUSION: The study identified values and types of medicines returned by patients at tertiary care unit in Oman. Medications used for cardiovascular and infectious diseases appeared as the most frequent and the most expensive returned medicines. It suggests that health care providers in Oman should devise health education programmes to improve proper utilization of medicine.

Eight-year study of childhood status epilepticus: midazolam infusion in management and outcome.

Sixty-eight children 2 months to 14 years of age were admitted with status epilepticus to Sultan Qaboos University Hospital from November 1993 to December 2001. Thirty-eight children (55.9%) had refractory status epilepticus and 30 (44.1%) had established status epilepticus. The children with refractory status epilepticus had received intravenous or per rectal diazepam and intravenous phenytoin/phenobarbital (either or both) before continuous infusion of midazolam was given. Fifty-one children received continuous midazolam infusion. In 38 children with refractory status epilepticus, the midazolam infusion was given in addition to the long-acting antiepilepsy drug, whereas 13 (18.8%) children needed only midazolam to control the established status epilepticus. Seventeen (25%) children were controlled with phenytoin sodium alone. Midazolam was given 0.15 mg/kg/minute initially as bolus in 1 minute, followed by 1 to 7 microg/kg/minute as continuous infusion. The status could not be controlled in one child (1.5%) suffering from neurodegenerative disease. Two children needed mechanical ventilation following prolonged apnea after diazepam administration in one and diazepam plus phenobarbital in the other. No metabolic derangements or compromise of vital functions was noted on midazolam infusion. All children made a complete recovery. There was one death related to meningoencephalitis.

Metered-dose inhaler technique among healthcare providers practising in Oman.

OBJECTIVE: To evaluate the correctness of metered-dose inhaler (MDI) technique in a sample of healthcare providers practising in Oman, considering that poor inhaler technique is a common problem both in asthma patients and healthcare providers, which contributes to poor asthma control. METHOD: A total of 150 healthcare providers (107 physicians, 33 nurses and 10 pharmacists) who were participants in symposia on asthma management conducted in five regions of Oman, volunteered for the study. After the participants answered a questionnaire aimed at identifying their involvement in MDI prescribing and counselling, a trained observer assessed their MDI technique using a checklist of nine steps. RESULTS: Of the 150 participants, 148 (99%) were involved in teaching inhaler techniques to patients, and 103 of 107 physicians (96%) had prescribed inhaled medications. However only 22 participants (15%) performed all steps correctly. Physicians performed significantly better than non-physicians (20% vs. 2%, p <0.05) Among the physicians, internists performed better (26%) than general practitioners (5%) and accident and emergency doctors (9%). CONCLUSION: The majority of health-care providers responsible for instructing patients on the correct MDI technique were unable to perform this technique correctly indicating the need for regular formal training programmes on inhaler techniques.