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Objectives The aim of the present study was to evaluate the counselling services provided by outpatient pharmacists using the criteria specified by Medication Counseling Behaviour Guideline (US Pharmacopoeia (USP) 1997). The study also assessed the perceptions of patients and pharmacists with regard to counselling. Methods The study was carried out over a period of 5 months at outpatient pharmacies located in different regions of Dubai. The study design included structured observation of over 700 pharmacist–patient encounters, and performances were assessed based on USP Medication Counseling Behaviour Guidelines. Over 1600 patient surveys and pharmacist questionnaires were also carried out/completed to investigate perceptions on counselling. Data was computed and analysed using bivariate analysis and logistic regression. Results The majority of the pharmacist–patient interactions (72.1%) were classified as stage 1 of counselling (that is, the information exchanged was brief, basic and non-individualised). Less than 1% reached stage 4 (that is, a detailed, interactive and collaborative discussion). A significant correlation was found between the USP Medication Counseling Staging score and the pharmacists’ behaviour and communication assessment score. The overall mean patient satisfaction score was 4.71 (a score of 5 indicated most satisfied and 1 indicated least satisfied). Men, older patients and patients who considered the pharmacist to be competent and skilled were generally more satisfied with the consultations. Among patients with chronic conditions who came for medication refills, 41.8% believed that, although they needed counselling, it was not provided by the pharmacist. The majority of pharmacists cited the non-availability of a counselling room as the main barrier they encountered when counselling patients. Conclusions This study identifies the strong need to educate and train pharmacists with better counselling skills and also to provide them with better resources.

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Background Dabigatran etexilate is an oral anticoagulant. It was added to our hospital's formulary in 2010 for the indications of thromboprophylaxis in adult patients following total hip replacement (THR) and total knee replacement (TKR) surgeries and for prevention of thromboembolic stroke in patients with non-valvular atrial fibrillation (AF). Purpose To assess the rational drug use of dabigatran at a tertiary care hospital. Materials and methods The design of the study was a retrospective cross-sectional analysis of all the patients who received dabigatran from September 2011 to April 2012 at Tawam Hospital, United Arab Emirates. The required data were extracted from the electronic patient medical records database and relevant data were collected on patient demographics, indication, dosage regimen, adverse events, contraindications and drug interactions. All patients with AF were previously treated with warfarin and our study population did not include any anticoagulation-naïve patients. Patients with AF were followed every month for 6 months. The duration of treatment was 30 days for all patients who had THR, 10 days for four patients who had TKR and 14 days for two patients who had TKR. They were followed for the time period that they received dabigatran, initially in the ward and then in the outpatient clinic. The data were computed, encoded and statistical analysis was done using SPSS, V.17.0. Result A total of 61 patients (30 cardiology, 29 orthopaedic and 2 general medicine) were included in our study. In the cardiology department, the majority (n=28) of patients were prescribed dabigatran for stroke prevention in non-valvular AF, while two patients received dabigatran for off-label indications. An inappropriate dose was administered in seven patients. In the orthopaedic department, of the 29 patients, 6 had elective TKR, 2 had elective THR and the remaining 21 patients were receiving dabigatran for off-label orthopaedic indications. Hip fracture was the most common off-label indication. There was one documented case of upper gastrointestinal bleeding. Conclusions This study highlights the need to standardise a hospital protocol for dabigatran use within our facility, since a noteworthy proportion of patients were receiving it at incorrect doses and for off-label indications.

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We describe the case of a 76-year-old man who presented with bilateral lower limb weakness associated with decreased urine output. His initial blood results showed acute kidney injury (AKI) stage 3 with substantially raised serum creatine kinase concentration of 37 950 IU/L (normal range <171 U/L). He had been on high-dose rosuvastatin for 4 years with a recent brand change occurring 1 week prior to onset of symptoms. There was no history of pre-existing neuromuscular disease. Statin-related rhabdomyolysis was suspected and rosuvastatin was withheld. His muscle strength gradually improved. He required haemodialysis for 10 weeks. He was discharged home after a complicated course of hospitalisation. His renal function improved and he became dialysis-independent; however, he was left with residual chronic kidney disease.

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