Microemulsification of essential oils for the development of antimicrobial and mosquito repellent functional coatings for textiles.

AIMS: To develop an essential oil (EO)-loaded textile coating using an environmentally friendly microemulsion technique to achieve both antimicrobial and mosquito repellent functionalities. METHODS AND RESULTS: Minimum inhibitory concentrations and fractional inhibitory concentrations of litsea, lemon and rosemary EOs were determined against Staphylococcus aureus, Escherichia coli, Staphylococcus epidermidis, Pseudomonas aeruginosa and Trichophyton rubrum. A 1 : 2 mixture of litsea and lemon EOs inhibited all the microorganisms tested and was incorporated into a chitosan-sodium alginate assembly by a microemulsification process. The EO-loaded microemulsions were applied to cotton and polyester fabrics using a soak-pad-dry method. The textile challenge tests demonstrated 7-8 log10 reductions of S. epidermidis, S. aureus and E. coli after 24 h and T. rubrum after 48 h. Aedes aegypti mosquito repellency was also assessed which demonstrated 71·43% repellency compared to 52·94% by neat EO-impregnated cotton. CONCLUSIONS: Textiles treated with the litsea and lemon EO microemulsion showed strong antimicrobial activity against the skin associated microorganisms E. coli, S. aureus, S. epidermidis and T. rubrum and potential mosquito repellent properties. SIGNIFICANCE AND IMPACT OF THE STUDY: EOs could be useful for the development of natural, environmentally friendly functional textiles to protect textiles and users from microbial contamination in addition to possessing other beneficial properties such as mosquito repellency.

Diary cards and the assessment of cough symptoms in community pharmacies.

The aim of this study is to compare cough symptom assessment and medication efficacy as recorded in a diary card with that obtained through direct questioning by a pharmacist. Clients visiting six pharmacies, purchasing a cough medication and meeting the inclusion criteria were recruited. They were asked to fill out diary cards to obtain a daily retrospective assessment of symptoms and medication efficacy. After three days the subjects returned to the pharmacy and were asked to recall their symptoms through a structured questionnaire administered by the pharmacist. 48 clients were recruited to the study and of these 44 (92%) completed the study. A good correlation was obtained between ratings of medication efficacy as recorded by diary cards and recall. Symptom assessment also showed a statistically significant correlation for days two and three only. For studies assessing symptoms over a 48 hour period, detailed post-study assessments may not be required. The study provides further evidence for the viability of clinical trials conducted through community pharmacies.

Safety of iodine based water sterilization for travelers.

The recent report by Khan et al. of an unexpectedly high concentration of free iodine in water filters, which may have led to the high proportion of abnormal thyroid function tests in Peace Corps workers, is of concern for travel advisors when asked to recommend suitable means of water sterilization. Many travelers use iodine based filters and/or chemicals for purification of water when traveling in areas with contaminated water supplies and may therefore be at risk of excess iodine intake. Aside from iodine impregnated resin filtration systems, tetraglycine hydroperiodide tablets, tincture of iodine 2% and more commonly, chlorine-based proprietary products are widely used to sterilize water for drinking, and usually purchased by travelers without advice on how they should be used. A single tetraglycine hydroperiodide tablet in a liter of water releases 8 mg of iodine in comparison to the 10 mg/liter released from the iodinated resin pumps described by Khan et al. Although the instructions for using iodine tincture are imprecise, the normal recommendation is 5 drops per liter of water, increasing this to 12 drops where Giardia cysts may be present. The lower of the two doses would yield about 2 mg/liter of free iodine per liter depending on the pipette used, although, because of the potassium iodide present in the formulation, a total of 4 mg iodine would be available for absorption.

'Brown bag' medication reviews as a means of optimizing patients' use of medication and of identifying potential clinical problems.

BACKGROUND: 'Brown bag' medication reviews carried out by community pharmacists collaborating with GPs have become established, in the USA and elsewhere, as an effective means of helping primary care patients to derive maximum benefit from their medicines, of identifying medication-related problems and of reducing wastage of medicines. OBJECTIVE: We aimed to determine whether 'brown bag' medication review could be used successfully in the UK, and particularly whether it represents an efficient and potentially cost-effective means of identifying medication problems. METHOD: 'Brown bag' medication reviews were carried out on 205 volunteer patients in 23 pharmacies in south-east London. Pharmacists' interventions to improve patients' knowledge and usage of their medicines were analysed. Potential clinical problems identified by pharmacists were analysed in order to identify the drug groups most likely to cause problems. RESULTS: Interventions were made in 87% of reviews; interventions to improve patients' knowledge of the purpose and correct usage of their drugs were made in 65% of reviews. In 12% of reviews, problems were identified that could potentially result in a hospital admission, and the potential for an improved outcome for the patient if drug therapy was changed was identified in a further 34% of cases. Beta-blockers, NSAIDs and verapamil were identified as being associated with potential problems of the highest clinical significance. Patients taking psychoactive medication were at greatest risk of a medication-related problem from any cause. CONCLUSION: Pharmacists could contribute to patients' welfare and reduce health care costs by carrying out 'brown bag' medication reviews on behalf of GPs.

Short report: The safety and toxicity of insect repellents.

In recent years, concerns have been raised regarding the safety of diethyltoluamide (DEET), one of the most widely used and reliable insect repellents available. This paper summarizes the recent evidence and concludes that concerns over safety appear largely unfounded.

Views of Asians and non-Asians on sources of drug information and the desirability for medication to be made available over the counter.

Differences do exist between Asians and non-Asians on the range of products they feel should be available over the counter (OTC) and the amount of information they wish to receive. This should be taken into account when considering proposals for changes in the legal status of prescription-only medicines. The profile of the pharmacist as a provider of drug information to patients could be raised in both groups.

Drug history taking and the identification of drug related problems in an accident and emergency department.

OBJECTIVE: To determine the incidence of drug related problems that fail to be noted on casualty cards in patients subsequently admitted, and to compare medication histories as recorded by accident and emergency (A&E) senior house officers (SHOs) and a pharmacist. METHODS: An initial retrospective survey of 1459 acute inpatient admissions through A&E over a three month period was followed by a prospective study of 33 elderly patients. RESULTS: In the retrospective survey, 52 medication related problems were confirmed after examination of the medical records, of which only 16 were identified in A&E. In the prospective study, 125 currently prescribed items were identified by the pharmacist compared to 77 by A&E SHOs; 66% of the missed information was clinically relevant. Of 17 previous adverse drug reactions identified by the pharmacist only six were also recorded by the A&E officer. Only four over the counter medicines were identified by the A&E SHOs compared to 30 by the pharmacist. CONCLUSIONS: More accurate recording of drug history on casualty cards should be undertaken, particularly in respect of over the counter medication and the identification of drug related problems.

Does encouraging good compliance improve patients' clinical condition in heart failure?

The aim of this study was to determine whether improved compliance by intensive medication counselling, given by a pharmacist, to elderly patients with chronic stable heart failure can influence both objective and subjective measures of heart failure. Elderly patients were randomly allocated to receive a 3-month counselling programme, or no counselling. Measures recorded at the beginning and end of the study included; submaximal 6-minute exercise tests, visual analogue scores of breathlessness, the Nottingham Health Profile, and clinical signs of heart failure. Compliance was measured by a tablet count and medication knowledge assessed by means of a questionnaire. There was no significant difference between the groups in their initial level of compliance, medication knowledge or other assessments. Compliance improved for the counselled group by 32% (P < 0.001) but remained unchanged for controls. Medication knowledge improved for the counselled group only. The 6-minute exercise test improved by 20 metres from a baseline of 137 m for the counselled group (P < 0.005) but worsened by 22 m for the control group (P < 0.01). Distance to breathlessness improved for the counselled patients and worsened for controls. In contrast bodyweight, jugular venous pressure and Nottingham Health Profile scores did not change significantly for either group. Peripheral and pulmonary oedema scores improved for the counselled group (P < 0.01) but remained unchanged for controls. A small improvement was seen in the visual analogue scores (P < 0.05) for the counselled group only. Improved compliance due to intensive medication counselling had a small but measurable beneficial effect on objective measures of heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)