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Quality-related events (QREs), including medication errors and near misses, are an inevitable part of community pharmacy practice. As QREs have significant implications for patient safety, pharmacy regulatory authorities across North America are increasing their expectations regarding QRE reporting and learning. Such expectations, commonly encapsulated as standards of practice (SoP), vary greatly between pharmacy jurisdictions and may range from the simple requirement to document QREs occurring within the pharmacy, all the way to requiring that quality improvement plans have been put in place. This research explores the uptake of QRE reporting and learning SoP and how this uptake varies based on pharmacy characteristics including location, prescription volume, and pharmacy type. Secondary data analysis of 91 community pharmacy assessments in Nova Scotia, Canada, was used to explore uptake of QRE standards. Overall, pharmacies are performing relatively well on reporting QREs. However, despite initial success with basic QRE reporting, community pharmacy uptake of QRE learning activities is lagging., (© The Author(s) 2014.)

Background: Community pharmacists have been transitioning from traditional dispensing roles toward a much broader scope of practice. The objective of this research was to explore public perceptions of expanded scope of practice (ESOP) services as they relate to pharmacy and pharmacist characteristics., Methods: The Survey on New Services Offered by Nova Scotia Pharmacists was developed and deployed using in-pharmacy intercept surveys and online public surveys in Nova Scotia. The survey focused on 4 key ESOP elements/services: 1) prescribing for minor ailments (ambulatory conditions), 2) injections and vaccinations, 3) prescription renewals and 4) medication reviews. Data were analyzed using comparisons between groups (multivariate analysis of variance) and principal component analysis., Results: A total of 385 surveys were obtained from the public regarding their perceptions and use of ESOP services (online n = 237, in-pharmacy intercept n = 148). A number of significant differences were found on the basis of respondent sex, age and the location of survey deployment., Discussion: Overall, public perceptions of pharmacists' knowledge and skills in providing ESOP services are positive. A pharmacist's ability to communicate, protect confidentiality and provide quality information regarding medications is important to the public., Conclusion: Respondents who already have a good relationship with their pharmacist are more likely to see value in ESOP services. Future public education strategies should focus on factors positively affecting the public's perceptions of ESOP services and should encourage public use of these services through intentional patient education of the benefits of ESOP services and strengthening of the patient-provider relationship.

Background: Continuous quality improvement (CQI) programs provide an effective means to improve the safety and quality of community pharmacy practice. The role of formal support processes in ensuring the success of these CQI programs is explored in this research using the SafetyNET-Rx project., Objective: The primary objectives of this research were to determine how knowledge of, and confidence in, mandated CQI standards differs among pharmacies with access to formal support mechanisms and those without and the challenges faced by both., Methods: A survey questionnaire was mailed to 179 community pharmacies in Nova Scotia, Canada, in spring 2011. Quantitative results were analyzed using the Mann-Whitney U test for nonparametric data. Qualitative open-ended responses were analyzed using content analysis., Results: Performing the Mann-Whitney U test indicated that a number of differences exist between the 2 groups with respect to: (1) staff knowledge of reporting quality-related events (QREs) to an anonymous database; (2) conducting annual pharmacy safety self-assessments; (3) confidence in meeting these 2 elements; and (4) documenting changes to address QREs. A number of challenges were identified by respondents through the open-ended questions., Conclusions: This research highlights the value of the active provision of formal support when developing standards related to quality improvement.

Background: Given the demanding nature of providing pharmacy services, coupled with the expanded scope of practice of the professions in jurisdictions around the world, greater commitment to continuous quality improvement through adoption of quality-related event (QRE) reporting is necessary to ensure patient safety. Pharmacy regulatory authorities (PRAs) are in a unique position to enhance QRE reporting and learning through the standardization of expected practice., Objective: This study was aimed to gain a better understanding of the perceived roles of PRAs in enhancing QRE reporting and learning in community pharmacies, and identifying regulatory best practices to execute such roles., Methods: A purposive case sampling approach was used to identify PRA staff members from two groups (Deputy registrars and pharmacy inspectors) in 10 Canadian jurisdictions to participate in focus groups in the fall of 2011. Focus groups were used to explore perceptions of the role of PRAs in enhancing and promoting QRE reporting and learning, and perceived barriers to effective implementation in practice. Thematic analysis was used to analyze the qualitative data., Results: Two focus groups were conducted, one with seven Deputy registrars/Practice managers, and one with nine pharmacy inspectors. Five themes were identified, including (1) defining QRE reporting and compliance, (2) navigating role conflict, (3) educating for enhanced QRE reporting and learning, (4) promoting the positive/removing the fear of QREs, and (5) tailoring QRE reporting and learning consistency., Conclusions: Overall, participants perceived a strong role for PRAs in enhancing QRE reporting and learning and providing education for pharmacies to support their compliance with reporting standards. However, PRAs must navigate the conflict inherent in both educating and promoting a process for achieving a standard while simultaneously inspecting compliance to that standard. Ensuring pharmacies have autonomy in operationalizing standards may help to mitigate this conflict. Finally, greater education for PRAs themselves to better inspect compliance and in order to better communicate the benefits of QRE reporting and learning to pharmacies would be beneficial., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Virulent and avirulent strains of Aerococcus viridans (var.) homari were used to extend previous studies to determine and confirm differences between the 2 types. Virulent strains possessed polysaccharide capsules and were not agglutinated by lobster hemolymph serum; avirulent strains did not have capsules, were agglutinated by the lobster hemolymph serum, and most did not grow well in lobster hemolymph serum. Growth of the avirulent strains in sterile lobster hemolymph serum induced the production of capsules (which reached a maximum after 5 to 7 d incubation), eliminated susceptibility of the strains to the lobster serum agglutinin, and restored their virulence against lobsters. The factor(s) in lobster hemolymph serum inducing the long-lasting phenotypic response of virulence was (were) heat labile.

In a randomized double-blind study in 50 patients (38 men, 12 women of medium age 52.2 +/- 8 years) the new non-ionic low-osmolal x-ray contrast agent Iomeprol 400 is compared with the high-osmolal contrast medium natrium-meglumine-diatrizoate (Urografin 76). Electrocardiographic, hemodynamic as well as general effects and side-effects such as bradycardias, tachyarrhythmias, allergic reactions, attacks of hyperhidrosis, nausea, vertigo, thoracal pain, cephalgies after selective coronary angiography and levocardiography were registered. Between the two groups of patients there were no major differences concerning age, sex, weight, and coronary status. After coronary angiography in the two groups the following parameters were statistically significant: Iomeprol 400 led to a smaller reaction of heart rate (P = 0.001 during left coronary injection or P = 0.003 during right coronary injection), to a lower rise of the QT-time (P = 0.0005 for right coronary injection or P = 0.0001 for left coronary injection) as well as to a mild change of the T-vector (P = 0.0002 in right coronary injection or P = 0.0001 in left coronary injection). After levocardiography using natrium-meglumine-diatrizoate versus Iomeprol 400 a significantly stronger decrease in systolic (P = 0.0001) and diastolic (P = 0.0001) aortic pressure was registered. The increase of heart rate was less frequent with Iomeprol 400 than using the ionic contrast medium, which was compared to it (P = 0.048). In the general effects with Iomeprol 400 a statistically significantly less frequent appearance of bradycardias was registered (P = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

In 72 pregnant women with culture-proved vaginal candidiasis, and an equal number of controls matched for parity, size, stage of gestation and age, the intravenous glucose tolerance curves were compared using Silverstone's method. The results in both study and control groups did not differ and resembled closely those in Silverstone's series. Half the study group were treated using nystatin alone, while the other half also received tolbutamide. The cure rate was equal in the two groups. Candidiasis in pregnancy does not appear to be related to altered glucose metabolism nor does the addition of this hypoglycemic drug (tolbutamide) improve results. No ill effects, fetal or maternal, were apparent following the use of tolbutamide.