Exploring Patient Safety Culture: A Study of Community Pharmacies in Karachi, Pakistan.

Background Community pharmacies are integral to the healthcare system, actively contributing to patient safety through accurate dispensing, education, collaboration, monitoring, and the implementation of safety protocols. Their accessibility and role as medication experts make them key partners in promoting positive health outcomes for individuals and communities. Objective The current study will evaluate the patient safety culture (PSC) among community pharmacies in Karachi, Pakistan. Additionally, this study will measure the association between patient safety culture in community pharmacies and the demographic characteristics of the pharmacy staff. Methods A cross-sectional survey of pharmacy staff was conducted using a survey instrument developed by the US Agency for Healthcare Research and Quality (AHRQ). Demographic variables and assessments of safety culture in pharmacies were studied. The data were analyzed using descriptive statistics. Results Among the 102 participants, positive responses ranged from 30% to 87.5%. The highest positive response was for the dimension "mistakes in communication" (86.3%), followed by "communication across shifts" (82.2%) and "communication openness" (81.7%). The dimensions "overall perceptions of patient safety" and "response to mistakes" had the lowest positive responses (56.0% and 60.9%, respectively). Furthermore, many staff did not regularly record the errors, even if they impacted the practices. Conclusion There was an overall unfavorable perception of patient safety culture among the surveyed pharmacies of Karachi, Pakistan. However, the communication dimensions showed the highest positive response. There is a strong need to improve the overall perception of patient safety among the staff and develop an optimistic response to mistakes.

Novel Technique in Performing Standard Transperineal Template Prostate Biopsies Under Local Anaesthetic.

PURPOSE: Transperineal template prostate biopsies (TPTPB) are now increasingly commonly performed for the diagnosis of prostate cancer. TPTPB are traditionally performed under general anaesthetic. However, this poses a significant strain on hospital theatre capacity. As such, local anaesthetic (LA) TPTPB are becoming more popular. We describe a novel technique in performing the standard TPTPB under LA in the outpatient setting. MATERIALS AND METHODS: Between February 2019- February 2021, 254 consecutive men (median age 69; range: 44-80 years) with a median PSA of 8.7 ng/ml (range: 2.2-76) underwent L/A TPTPB using our novel technique. This is whereby 50mls of 1% prilocaine was injected partially around the perineal skin and partially deep bilateral periprostatic areas. Multiple simultaneous prostate biopsies were then taken with the standard template grid and stepper. RESULTS: A total of 250/254 (98.4%) men underwent successful L/A TPTPB with a median visual analogue pain score of 4 (range: 2-8). The median prostate volume was 49cc (range: 14-240cc). The median number of cores taken were 18 (range: 14-24). A total of 163/250 men (65.2%) had a positive histology for prostate cancer with a median of 5 cores being involved with prostate cancer (range: 1-18). In addition, 101/163 men (62.0%) diagnosed with prostate cancer had either Gleason score 3+4=7 or greater. None experienced urosepsis and only 2/250 men (0.8%) had temporary urinary retention. CONCLUSION: Our novel LA technique in performing the standard TPTPB is safe, feasible and well tolerated and associated with a high rate of prostate cancer detection.

Efficacy of a mobile lithotripsy service: a one-year review of 222 patients.

OBJECTIVE: Extracorporeal shockwave lithotripsy (ESWL) is the management of choice for ureteric and renal stones 20 mm or smaller, with a stone clearance rate of up to 89%. This study determined whether such a high success rate could apply to centres using mobile ESWL, by reviewing the performance at one centre that provides such a service. MATERIAL AND METHODS: Between July 2011 and July 2012, 222 patients (median age 51 years, range 18-90 years) underwent one to five sessions of ESWL for ureteric and renal stones (mean size 15 mm, range 4-22 mm). Stone clearance was regarded as residual fragments 2 mm or smaller after completion of sessions. RESULTS: In total, 110 out of 222 patients (49%) were clear of stones. Stones were radiopaque in 198 (89%) and radiolucent in 24 patients (11%), with clearance rates of 48% and 63%, respectively. Regarding size, 36 (16%) were 1-5 mm, 144 (65%) 5-10 mm, 28 (12%) 10-15 mm, eight (4%) 15-20 mm and six (3%) larger than 20 mm, with clearance rates of 61%, 55%, 18%, 13% and 50%, respectively. In total, 173 (78%) were renal stones and 49 (22%) ureteric, with respective clearance rates of 49% and 51%. For kidney stones, 15 (9%) were in the upper, 32 (18%) in the mid, 75 (43%) in the lower pole and 51 (30%) in the pelvis, with clearance rates of 52%, 59%, 49% and 41%; for ureteric stones, 32 (65%) were in the upper, 10 (20%) in the mid and seven (15%) in the lower ureter, with clearance rates of 47%, 70% and 43%, respectively. CONCLUSION: The performance of mobile ESWL was significantly poorer than expected, and this may be related to a lack of clinical ownership. The authors believe that such a service should be permanently placed on site.

Menstrual irregularities with excessive blood loss: a clinico-pathological correlation.

OBJECTIVE: To evaluate various histo-pathological features in endometrial curettings of patients complaining of menstrual irregularities with excessive blood loss and correlating them with clinical presentations. METHODS: A total of 260 endometrial curettings were obtained by Dilatation and Curettage done at the Department of Gynecology and Obstetrics, Railway Hospital, Rawalpindi. All the preserved specimens were processed under standard conditions at the Pathology Department, Islamic International Medical College (IIMC). The sections were studied after staining with Haematoxylin and Eosin stain. RESULTS: The patients presented with menorrhagia in 51.9%, metrorrhagia in 35.4%, polymenorrhoea in 9.2% and polymenorrhagia in 3.5% cases. History of hormonal intake was observed in 0.66% patients. Menstrual disorders were most common in 41-50 years age group accounting for 48% cases. Pathology was diagnosed in 40% of endometrial biopsies. The endometrial lesions included endometrial hyperplasia (24.7%), chronic nonspecific endometritis (13%), endometrial polyp (1.2%), pill pattern endometrium (2.3%) atrophic endometrium (0.8%) menopausal pattern endometrium, squamous metaplasia, squamous cell carcinoma and chorioncarcinoma (0.4% each). CONCLUSION: The dilatation and curettage was found to be an appropriate approach with a good diagnostic yield. Fortunately frequency of endometrial malignancy appeared to be very low. Endometrial hyperplasia was the leading causes of excessive menstrual bleeding.