A spectrophotometric measurment technique was employed to investigate the role of dietary factors in the aetiology of chlorhexidine staining. Standard solutings were prepared form a range of dietary components. Test perspex specimens were maintained n the standard solutions throughout a five day period being removed from the solutions three times a day and soaked in a 0.2% chlorhexidine gluconate solution. Control specimens were similarily treated but not exposed to chlorhexidine gluconate. Daily optical density recording demonstrated some staining of specimens by all dietary components. However of most there was no significant difference between test and control specimens and in visual terms such staining was very minimal. Navertheless, tea, red wine and port produced rapid and heavy staining on test specimens which was highly significantly increased when compared to control specimens. Coffee similarly produced more staining of test specimens compared to contrl specimens; however, the intensity of staining was coniderably less. Employing the sake experimental method, both cigarette smoke and cigarette smoke in colution Produced significantly more staining of control specimens compared to test specimens.

An in vivo study was carried out to investigate the role of tea, coffe and cigarette smoking upon the staining of teeth associated with the use of chlorhexidine gluconate. Three groups of volunteers, one of which consisted of cigarette smokers, rinsed with a 0.2% chlorhexidine gluconate mouthwash three times a day throughout two 10 day periods. The two non smoking groups were allocated tea and coffe respectively for consumptionduring on 10 day period. The smoking group were allocated coffee during one 10 day period. During the other 10 day periods the volunteers refrained from all hot beverages. A fourth group refrained from all hot bevrages during a 21 day period. The staining which developed on the previously cleaned teeth and tongues of the volnteers at the end of the respective rinsing periods was scored. All volunteers kept a diet record throughout the whole study. The drinking of tea and coffe significantly increased staining of teeth and tongue when compared with not drinking. Staining by tea was significantly worse than staining by coffee. Cigarette smoking appeard to have an additive effect on the staining. Dietary analysis indicated that other factors ar important to development of chlorhexidine staining and some apeared particularly chromogenic in this respect.

No abstract

Introduction Independent Prescribing Pharmacists (IPPs) can prescribe autonomously within their scope of practice. Their role is increasing within the community setting (1). The Welsh Pharmaceutical Committee has a vision to have at least one IPP in every community pharmacy by 2030 (1). In 2020, an Independent Prescribers’ Service (IPS) pilot was delivered in 13 pharmacies across six of the seven Health Boards in Wales (2), via Choose Pharmacy (CP), an IT platform that provides access to patients’ General Practitioner (GP) medical record. IPS allowed patients to access advice, and, where relevant, be treated in the community pharmacy setting, rather than the GP surgery. The consultation is recorded on CP and the patient’s GP informed of the outcome. As the IPS is a recent development there is little research on this service. Aim To explore the views of community IPPs delivering the IPS. Methods A qualitative methodology was utilised with semi-structured interviews, via telephone or MS Teams. Only thirteen pharmacies were commissioned to deliver the service. Purposive sampling was used to identify IPPs in these premises, who had completed at least one IPS consultation. Participants were informed of the study and written; informed consent obtained. An interview schedule utilised open questions to explore participants’ experiences of the service. Interviews were recorded, transcribed and analysed via deductive and inductive thematic analysis. Analysis was quality assured through discussion with the research team. All identifiable information in the transcripts were removed to ensure anonymity. Results Nine interviews were conducted, including participants from all Health Boards in the pilot. Interviewees had varied prescribing experience with some only prescribing since the roll out of the pilot. The IPPs’ scope of practice included acute minor ailments, contraception, urinary tract infections and asthma. Four themes were identified: 1.Impact of the IPS: Participants believed the service had impacted on the wider healthcare setting, patients and themselves. Patients had improved convenience and accessibility to a healthcare professional to manage their condition. Patient safety was of a high standard with access to patient notes ensuring informed, appropriate clinical decisions. 2.Relationship with GP: Positive relationships with local GPs was believed to be critical to the pilot’s success. 3.Future delivery: This will rely on support, funding, and ongoing review. A ‘blended approach’ whereby patients are seen with or without an appointment was believed to provide the flexibility that patients want. 4.Remote consultations: Can have an impact on patient safety, making non-verbal communication and language barriers more challenging. After nine interviews, no new information was gathered. Conclusion Participants were supportive of the service which will potentially benefit IPPs, patients and GPs, and improve patient care. Pharmacists, by providing a high quality, accessible service, ensures that forward thinking healthcare is delivered in a manner which makes use of the skills of those working in the community. The study, albeit small scale, explored the thoughts of the majority of IPPs conducting the IPS service at that time. More information is needed to understand the impact of the service and effect on practice, from the practitioner and patient perspective. References (1) Walsh A. All Welsh pharmacies to have independent prescribers. Wales; 2019 [accessed 5 February 2021]. Available from: http://www.pharmacymagazine.co.uk/all-welsh-pharmacies-to-have-independent-prescribers (2) NHS Wales Informatics Service. Choose Pharmacy. Wales; 2021 [accessed 5 Feb 2021]. Available from: http://www.nwis.nhs.wales/systems-and-services/in-the-community/choose-pharmacy/

Book reviews 'THE STRUCTURE AND MANAGEMENT OF THE BRITISH WATER INDUSTRY' Water Practice Manuals, The Institution of Water Engineers and Scientists, London, 1979; price £13 UK and overseas, including surface postage; £16 overseas including air mail postage. The Water Act of 1973 dealt comprehensively with water management in England and Wales and this book describes the new organizational arrangements and their operations. It is the first of a series by the newly formed Institution of Water Engineers and Scientists, which like the Act of 1973, amalgamated previous organizations that dealt separately with water quantity and water quality. The results of the reorganization that followed the 1973 Act are viewed with pride and offered for possible consideration abroad. There is of course, much of value to be learned here as experience enfolds. The environmental movement, in seeking managerial or non-structural alternatives to engineering works, has kindled great interest in organizational arrangement, water laws and regulations. Physical structures of the past are to be replaced to the greatest extent possible by managerial structures. The management of demand is to supplement the management of supply. Minimizing the hazards of drought, the maintenance of water quality and solving the problems of waste treatment and waste disposal were perceived to exceed the capacity of the old institutional arrangements. Before the Act, the number of water supply units (public and private) in England and Wales had decreased gradually from about 2 000 in 1915 to 187 in 1973. On the sewerage side, there were still 1 400 organizational units in 1973, all publicly owned. In relation to the size of England and Wales, these were still considerable numbers and some means of management seemed necessary to achieve economies of scale and of combination. The Water Act of 1973 confronted these problems by giving virtually plenary powers over water management (quantity and quality) in England and Wales to 10 regional water authorities, the boundaries of which in general coincide with hydrographic divides. Each authority combines in its membership national and local representation, with the latter members being in the majority. National (England and Wales, not the United Kingdom) responsibilities are shouldered by the National Water Council composed of the chairmen of the 10 water authorities and 10 others who are appointed by the relevant ministries of the national government, mainly the Department of the Environment. The Act disbanded the former Water Resources Board, (itself barely ten years old) which operated at the national level with respect to planning, water data and water research, and which served to represent England and Wales and often the UK as a focal point for international cooperation. Its major functions devolved upon the regional water authorities. Overview planning as advisory to the Government and the National Water Council was retained in a small planning unit;* likewise a small unit was retained for national data services,...