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Don’t use rapid tests to rule out strep throat, many pharmacists directed

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As efforts to bring $15 rapid strep tests to Canada’s pharmacies continue, the Nova Scotia College of Pharmacists says using them in the absence of a consultation with a physician or nurse practitioner does not meet the « standard of care » for diagnosing strep throat, especially in children. 

The Neighbourhood Pharmacy Association of Canada, a national association representing pharmacy business owners, says the rapid tests can help save patients with sore throats a trip to the doctor’s office and reduce unnecessary antibiotic prescriptions. That’s because many sore throats are caused by viruses, not bacteria, rendering antibiotics useless. 

The association’s members include Shoppers Drug Mart, which started providing the tests about three years ago through pilot projects in the three provinces: Nova Scotia, Alberta and British Columbia.

For the rapid tests, pharmacists take a throat swab and test for Group A streptococcus bacteria (which cause strep throat) on site within minutes. If it comes back positive for strep, they advise the patient to go see a doctor or nurse practitioner for an antibiotic prescription.

If the test comes back negative, the association says, the patient may be able to just go home and rest instead of braving crowded waiting rooms. 

But many pediatric infectious disease specialists say the in-pharmacy tests aren’t accurate enough to rule out strep throat on their own — and it’s risky to miss strep diagnoses in children, because they can suffer from complications.

The Nova Scotia College of Pharmacists shares that concern. In May, it instructed pharmacists in that province to stop doing the rapid strep tests for diagnosis.  

‘It needed to stop’

Rapid strep tests seemed like a good idea when they first arrived, said Beverley Zwicker, registrar of the Nova Scotia College of Pharmacists.

Pharmacists « really saw this as providing a service to people, » she told CBC News. 

But as the tests became more widely available, the college began hearing concerns from children’s health-care providers. They included reports of pediatric patients showing up at a Halifax emergency department with positive strep tests from local pharmacies when they didn’t actually have strep throat, Zwicker said.

When the college looked into the issue further, it determined that having a pharmacist swab a child’s throat to test for strep without a complete medical examination was contrary to the clinical practice guidelines established by the Infectious Diseases Society of America, which are regularly used by health-care providers in Canada. 

Those guidelines say that for children, even a negative rapid strep test should be backed up by a throat « culture » test — which definitively confirms the presence of strep by seeing if it grows in a lab setting from the throat sample. That’s the test doctors routinely use when they suspect strep throat in kids.

So in May, the college « made it very clear to all pharmacists that conducting this test without the patient first having that physical assessment by a physician or nurse practitioner was inappropriate and that it needed to stop, » Zwicker said.  

The Nova Scotia College of Pharmacists issued this notice in May 2018. (Nova Scotia College of Pharmacists)

The point-of-care tests may still have a role to play if pharmacists work in conjunction with doctors and nurse practitioners, she said.

If a doctor examines a patient and believes they have strep throat, for example, they can send the patient to the pharmacy with an antibiotic prescription contingent on the result of the point-of-care test. If it’s positive, the patient can start antibiotics right away, instead of waiting for the results of a traditional « throat culture test, » which is sent to a lab and takes a couple of days.

It’s too early to tell whether doctors and nurse practitioners will use that option, Zwicker said, since the strep throat « season » has just begun.  

Pharmacists do ‘thorough assessment,’ association says

When asked to respond to the concerns expressed by the Nova Scotia College of Pharmacists, the Neighbourhood Pharmacy Association said it agreed « that an assessment of symptoms by a healthcare provider is required prior to determining the appropriateness of the point of care testing » and that pharmacists have « the training and the expertise » required. 

« Pharmacists are healthcare providers and we do perform a thorough assessment of the patient before determining whether to perform the test, » said Sandra Hanna, a practising Toronto-area pharmacist and the association’s vice-president of pharmacy affairs, in an email to CBC News.   

« Like any test there are always certain limitations and pharmacists use their professional judgment when determining whether the test is appropriate for a given patient, » Hanna said. 

« In some circumstances pharmacists would refer to a physician, and age is one of the criteria used in considering the appropriate care plan for a patient. »

But Zwicker told CBC News that the « assessment » Nova Scotia pharmacists were asked to use in conjunction with the rapid strep tests was a questionnaire about symptoms. The college concluded that was not an adequate replacement for the examinations conducted in a doctor’s or nurse practitioner’s office, she said. 

New guidelines for Alberta pharmacists

In Alberta and British Columbia, the colleges governing pharmacy practice have not issued similar directives to Nova Scotia’s. 

However, in an emailed statement to CBC News, Jeff Whissell, deputy registrar of the Alberta College of Pharmacy, said the college had completed new practice standards and guidelines on the use of point-of-care testing in pharmacies to take effect on Jan. 1.  

As consumer demand increases, pharmacists need to understand « the limitations » of rapid strep tests, « especially for children, » he said.  

« If a rapid strep test or any other point of care test produces a negative result, pharmacists should discuss the sensitivity limitations of the test with their patient, and provide appropriate information for the patient on the need for follow-up, including the possibility of consulting with their physician for further investigation. »

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Anglais

Nostalgia and much more with Starburst XXXtreme

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Get a taste of adventure with Starburst XXXtreme based on the legendary NetEnt Game. The nostalgic themes are sure to capture fans of the classic version as they get treated to higher intensity, better visuals, and features. The most significant element of the game is its volatility. Patience will not be an essential virtue considering the insane gameplay, and there is a lot of win potential involved. It retains the original makeup of the previous game while adding a healthy dose of adrenaline. 

Starburst Visuals and Symbols

The game is definitely more conspicuous than before. The setting happens over a 5-reel, 3-row game grid with nine fixed win lines, which function if a succession from the left to the right reel is present. Only those players that that attain the highest win per bet line are paid. From a visual standpoint, the Starburst XXXtreme slots illustrates lightning effects behind the reels, which is not surprising as it is inherited from the original version. Available themes include Classic, Jewels, and Space. The game is also available in both desktop and mobile versions, which is advantageous for players considering the global pandemic. According to Techguide, American gamers are increasingly having more engaging gaming experiences to socialize to fill the gap of in-person interaction. Starburst XXXtreme allows them to fill the social void at a time when there is so much time to be had indoors. 

Starburst XXXTreme Features

Players get to alternate on three features which are Starburst Wilds, XXXtreme Spins, and Random Wilds. The first appears on reels 2,3, or 4. When these land, they expand to cover all positions while also calculating the wins. They are also locked for a respin. If a new one hits, it also becomes locked while awarding another respin. Starburst XXXtreme offers a choice between two scenarios for a higher stake. In one scenario with a ten times stake, the Starburst Wild is set on random on reels 2,3, or 4, and a multiplier starts the respin. The second scenario, which has a 95 times stake, starts with two guaranteed starburst wilds on reels 2,3, or 4. it also plays out using respin game sequence and features. The game also increases the potential with the Random Wilds feature to add Starburst Wilds to a vacant reel at the end of a spin. Every Starburst Wild gives a random multiplier with potential wins of x2, x3, x5, x10, x25, x50, x100, or even x150.

The new feature is sure to be a big hit with the gaming market as online gambling has shown significant growth during the lockdown. AdAge indicates the current casino customer base is an estimated one in five Americans, so Starburst XXXtreme’s additional features will achieve considerable popularity. 

What We Think About The Game

The gambling market has continued to diversify post-pandemic, so it is one of the most opportune times to release an online casino-based game. Thankfully Starburst XXXtreme features eye-catching visuals, including the jewels and space themes. These attract audience participation and make the gameplay inviting. The game also has a nostalgic edge. The previous NetEnt iteration featured similar visuals and gameplay, so the audience has some familiarity with it. The producers have revamped this version by tweaking the features to improve the volatility and engagement. 

That is characterized by the potential win cap of 200,000 times the bet. Starburst XXXtreme does not just give betting alternatives for players that want to go big. The increase of multipliers also provides a great experience. If the respins in the previous version were great, knowing that multipliers can go hundreds of times overtakes the game to a new level. 

Players should get excited about this offering. All of the features can be triggered within a single spin. Whether one plays the standard game or takes the XXXtreme spin route, it is possible to activate all of the features. Of course, the potential 200,000 times potential is a huge carrot. However, the bet size is probably going to be restricted and vary depending on the casino. It is also worth pointing out that a malfunction during the gameplay will void all of the payouts and progress. Overall, the game itself has been designed to provide a capped win of 200,000 times the original bet. 

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Anglais

‘We’re back’: Montreal festival promoters happy to return but looking to next year

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In downtown Montreal, it’s festival season.

In the city’s entertainment district, a musical act was conducting a sound check on stage Friday evening — the second day of the French-language version of the renowned Just For Laughs comedy festival. Tickets for many of the festival’s free outdoor shows — limited by COVID-19 regulations — were sold out.

Two blocks away, more than 100 people were watching an acoustic performance by the Isaac Neto Trio — part of the last weekend of the Festival International Nuits d’Afrique, a celebration of music from the African continent and the African diaspora.

With COVID-19 restrictions continuing to limit capacity, festival organizers say they’re glad to be back but looking forward to next year when they hope border restrictions and capacity limits won’t affect their plans.

Charles Décarie, Just For Laughs’ CEO and president, said this is a “transition year.”

“Even though we have major constraints from the public health group in Montreal, we’ve managed to design a festival that can navigate through those constraints,” Décarie said.

The French-language Juste pour rire festival began on July 15 and is followed by the English-language festival until July 31.

When planning began in February and March, Décarie said, organizers came up with a variety of scenarios for different crowd sizes, ranging from no spectators to 50 per cent of usual capacity.

“You’ve got to build scenarios,” he said. “You do have to plan a little bit more than usual because you have to have alternatives.”

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Anglais

MELS new major movie studio to be built in Montreal

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MONTREAL — MELS Studios will build a new film studio in Montreal, filling some of the gap in supply to meet the demand of Hollywood productions.

MELS president Martin Carrier said on Friday that MELS 4 studio construction will begin « as soon as possible », either in the fall or winter of next year. The studio could host productions as early as spring 2023.

The total investment for the project is $76 million, with the Quebec government contributing a $25 million loan. The project will create 110 jobs, according to the company.

The TVA Group subsidiary’s project will enable it to stand out « even more » internationally, according to Quebecor president and CEO Pierre Karl Péladeau. In the past, MELS Studios has hosted several major productions, including chapters of the X-Men franchise. The next Transformers movie is shooting this summer in Montreal.

Péladeau insisted that local cultural productions would also benefit from the new facility, adding that the studio ensures foreign revenues and to showcase talent and maintain an industry of Quebec producers.

STUDIO SHORTAGE

The film industry is cramped in Montreal.

According to a report published last May by the Bureau du cinéma et de la télévision du Québec (BCTQ), there is a shortage of nearly 400,000 square feet of studio space.

With the addition of MELS 4, which will be 160,000 square feet, the company is filling part of the gap.

Carrier admitted that he has had to turn down contracts because of the lack of space, representing missed opportunities of « tens of millions of dollars, not only for MELS, but also for the Quebec economy. »

« Montreal’s expertise is in high demand, » said Montreal Mayor Valérie Plante, who was present at the announcement.

She said she received great testimonials from « Netflix, Disney, HBO and company » during an economic mission to Los Angeles in 2019.

« What stands out is that they love Montreal because of its expertise, knowledge and beauty. We need more space, like MELS 4, » she said.

There is still not enough capacity in Quebec, acknowledged Minister of Finance, the Economy and Innovation Eric Girard.

« It is certain that the government is concerned about fairness and balance, so if other requests come in, we will study them with the same seriousness as we have studied this one, » he said.

Grandé Studios is the second-largest player in the industry. Last May, the company said it had expansion plans that should begin in 2022. Investissement Québec and Bell are minority shareholders in the company.

For its part, MELS will have 400,000 square feet of production space once MELS 4 is completed. The company employs 450 people in Quebec and offers a range of services including studio and equipment rentals, image and sound postproduction, visual effects and a virtual production platform.

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