BackgroundThe majority of patients with asthma and chronic obstructive pulmonary disease (COPD) have been known to perform inhaler technique inadequately. We aimed to evaluate the benefit of hospital pharmacy intervention on the current status of dry powder inhaler (Rotahaler®) technique in such patients and the factors associated with the correct use.MethodsA pre–post interventional study was conducted at the outpatient pharmacy in a teaching hospital of the Central Development Region, Nepal, in patients with asthma and COPD currently using a Rotahaler device. Patients’ demographics and Rotahaler technique were assessed before intervention. Those who failed to demonstrate the correct technique were educated and trained by the pharmacist, and their technique was reassessed after 2 weeks of intervention. Descriptive statistics, including Wilcoxon signed rank test, Mann–Whitney U test, Spearman’s correlations and Kruskal–Wallis test, were performed for statistical analysis.ResultsBefore intervention, only 5.7% (10 of 174) of the patients demonstrated the correct Rotahaler technique and the most common errors observed were failure to breathe out gently before inhalation (98.8%) and failure to hold breath for about 10 seconds after inhalation (84.8%). After the intervention (n=164), 67.1% of the patients showed their technique correctly (p≤0.001) and failure to breathe out gently before inhalation was the most common error (27.44%). Age (p=0.003), previous instruction (p=0.007), patient’s education level (p=0.013) and source of instruction (p<0.001) were associated with an appropriate technique before intervention, while age (p=0.024), duration of therapy (p=0.010) and gender (p=0.008) were the factors correlated with correct usage after intervention.ConclusionThe current status of Rotahaler technique is inadequate in patients with asthma and COPD attending the Chitwan Medical College Teaching Hospital in the Central Development Region, Nepal. However, a single hospital pharmacy intervention can significantly improve the correct use of the technique, highlighting the role of hospital pharmacies in the improvement of inhaler technique.

Prescribing errors are harmful to the patients. The role of pharmacist in reducing potential harm from prescription errors have been highlighted by several studies. This study aimed to evaluate the drug related prescription error and pharmacist intervention at outpatient pharmacy of Chitwan Medical College Teaching Hospital. A cross-sectional study was conducted in the outpatient Pharmacy of Chitwan Medical College Teaching Hospital from November 2014 to December 2014. The outpatient pharmacist randomly selected 5000 prescription and checked for drug related prescription error using prescription error checklist. The pharmacist discussed the prescription errors with the prescriber. The prescriptions that were corrected by the prescribers were considered as pharmacist intervened prescriptions (pharmacist intervention). Descriptive statistics including Chi-square test were done for statistical analysis using IBM-SPSS version 20. Out of 5000 prescriptions 176 drug related prescription error was found. The commonest error was dose and dosing frequency error (39.2%), duplication (33.5%) and dosage form related error (19.3%). Most of the prescription errors were noted while prescribing antimicrobial drugs (27.8%), proton pump inhibitors (15.9%) and NSAIDs (12.5%). The pharmacist's recommendation was accepted by prescriber in 90.3% of prescription . Chi-square test showed significant association (p=0.019) between prescription errors and pharmacist intervention. Pharmacist intervention can reduce the drug related prescription error, so the pharmacist and clinician need to strongly work together for reducing overall prescriptions error.

In evaluation of genu valgum/varum Tibiofemoral angle (TF), Inter-condylar Distance (IC) and Inter-malleolar Distance (IM) are commonly measured. In this study normal limits and mean values of TF angle IC/IM distances was determined in 413 normal Nepalese children aged between 1-8 years using clinical methods. A significantly higher degree of valgus angle was noted compared to other studies performed in different races. The maximal mean valgus angle was 10.5 at 4-5 years for boys and 10.6 at 6-7 years for girls. Conclusion: A measurable varus or valgus angle higher than 11 degrees during this period should be considered abnormal.

Pharmacy profession is one of the most renowned and recognized professions in the world. Hospital pharmacy is a branch of pharmacy and is well practiced in theWestern society, but in the context of Nepal, the situation is quite different. Hospital pharmacy of Nepal is usually overcrowded with patients due to limited health facilities, inadequate human resources, infrastructure and technology. Most of the hospitals further lack Drug and Therapeutic Committee (DTC), Drug information centre (DIC) and Pharmacovigilance centre, and in practice, the established DTC, DIC and Pharmacovigilance centre are functioning at sub-optimal level. The hospital pharmacy seems to be a profession of pride for many pharmacists with lots of expectation. However, the reality is that many of the pharmacist fail to meet their own expectation mainly due to lack of self competency, and appreciation by patients and other healthcare professionals. Moreover, a pharmacist may frequently encounter with weak regulation and implementation of policies, inadequate human resources, hectic dispensing focused schedule, more money-oriented organizational policy and poor images left behind by the seniors, all of which contribute to slow growth of the hospital pharmacy practice in Nepal. Also, gap has been observed between pharmacy education and current need in hospital pharmacy practice.The understanding of patients towards pharmacy profession is poor. They often give less priority to appropriate use of medicines and medical devices. They do not seem to worry much about the side effects, interactions, contraindications, precautions to be taken and action needed to be taken in cases of missed dose. Patients are usually in rush to leave the pharmacy and frequently raise their voice to the pharmacist to draw circles and write time of administration on the primary packages of the medication (usually a permanent marker). Patients with chronic disease such as hypertension, diabetes, chronic obstructive pulmonary disease often refuse to attend the medication counseling centre despite the fact that we have found patients using their medication and medical devices incorrectly for a long time. Patients have been found to use their inhaler devices through nose and without breaking dry powder inhalers capsule, taking pessaries even through mouth and frequently visit emergency room due to exacerbation of diseases.Collaborative efforts between health authorities and educational institutions, integration of innovative approaches in hospital pharmacy practice, enriched patient awareness on appropriate use of medicines and medical devices together with patient focused services could overcome these barriers and achieve the transition towards good hospital pharmacy practice and pharmaceutical care. Urgent academic exercise aimed at attaining revamping of curriculum, keeping in pace with current and emerging trends in the field of hospital pharmacy practice and pharmaceutical care is needed. Further, hospital pharmacy practice should be evidence based, initiation of continue pharmacy education and innovative research on pharmacy practice need to be encouraged. Such approach may upgrade hospital pharmacy profession in Nepal in near future.

Introduction: Clavicle fractures are the common fractures around the shoulder. Conservative treatment is as­sociated with higher incidence of nonunion. We conducted this study to assess the functional outcome of plat­ing for displaced middle third clavicle fractures. Methods: This prospective study included 60 patients with displaced middle third clavicle fractures from April 2016 to March 2017. Fixation was done with a 3.5 mm reconstruction plate placed at the superior surface of the clavicle. Patients were followed-up for a minimum of one year. Functional outcome was assessed using Constant shoulder score. Results: There were 48 male and 12 female patients with a mean age of 33.17 years (range 18-74 years). The average follow-up period was 17.82 months. All fractures united at an average of 5.35 months. The mean Constant score at final follow-up was 89.12. There were two superficial infections and three implant failures. Conclusion: We conclude that treat­ment of displaced middle third clavicle fracture with plate gives good results.