Background Studies with children suggest that reactive attachment disorder (RAD) is associated with pathogenic early care. Little is known about RAD in adults with intellectual disabilities, many of whom experience adversity and abuse in early life. We investigated whether RAD symptoms occur in this population, and explored whether hypothesized risk factors are associated with higher RAD symptom scores. Method Fifty adults with intellectual disabilities residing in long-stay hospitals and their carers participated in a questionnaire survey of RAD symptoms, childhood experiences, and disabilities. Results Reactive attachment disorder symptoms were present in this sample, and symptom scores were independently associated with early childhood adversity, diminished with age, but were not associated with cognitive ability, gender, other disabilities, nor number of childhood years in institutional care.Conclusions As with children with RAD, it is possible that some maltreated adults with intellectual disabilities fail to develop stranger anxiety by the usual developmental age. Over decades, they may gradually learn.

Mentoring programs have been offered by organizations within and outside of healthcare for years. This commentary examines the literature under the prism of design fundamentals for these programs, drawing particular considerations for schemes aimed at pharmacy professionals. The central argument presented is that mentoring can be used as a vehicle to support pharmacists to learn from others and each other, to reinforce and own their professional identity so that the uniqueness of the pharmacy profession is established within a global health landscape of constant change. In this Part 1 of a series of papers, a wealth of literature, theories, and evidence are presented aiming to inform the general structure and logistical considerations for both in-person and distance mentoring programs.

The NMP lead plays a significant role in the development and implementation of NMP. Clear national guidance is needed with regards to the functions of this role, the necessary attributes for individuals recruited into this post and the time that should be designated to it. This is important as prescribing is extended to include other groups of non-medical healthcare professionals.

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PurposeTo describe the most effective model for managing, educating, and training pharmacist advanced clinical practitioners (ACPs) in the urgent care center (UCC) setting, role evolution and how to measure their effectiveness.Participants and methodsEthical approval was obtained to perform a qualitative longitudinal cohort study in three sites, with three pharmacists in each trained as ACPs from 2016 to 2017. ACP role, location, management, mentorship, and supervision were locally determined. ACPs attended focus groups (FGs) at 1 and 3 months (sites 1–3), 6 and 12 months (site 1 only), and the UCC staff were interviewed once with a topic guide regarding training, integration, role, and impact. Verbatim transcriptions were analyzed thematically.ResultsEight ACP FGs and 24 stakeholder interviews produced major themes of communication, management, education and training, role, and outcomes. Effective education, training, and integration required communication of role to address concerns regarding salary differentials, supportive management structure, and multi-professional learning. ACPs reported that the model of workplace training, experiential learning, and university-based education was appropriate. Training was better located in the minor injuries and general practitioner areas. Recommended measures of effectiveness included patient satisfaction and workload transfer.ConclusionThe education and training model was appropriate. Communication and management require careful consideration to ensure effective integration and role development. Pharmacists were better located initially in the minor illness rather than major trauma areas. Quality of patient experience resulting from the new role was important in addition to reassurance that the role represented a positive contribution to workload.

Background: Community pharmacies are recognised as an under-utilised, accessible resource that could support the urgent care agenda. This study aimed to provide a snapshot of the number and nature of urgent care requests presented to a sample of community pharmacies in three counties in southern England, to determine how requests are managed, whether management is appropriate, as assessed by a group of experts, and whether customers receiving the care are satisfied with pharmacists’ interventions. Methods: A representative sample of pharmacists across the region was invited to keep a log-book documenting all urgent care requests over a two-week period. Data were analysed to estimate frequency and type of requests and to compare consultations in core and non-core hours. Log-book entries were scrutinised blind by an expert panel to determine appropriateness of pharmacist’s responses. Customers receiving pharmacists’ interventions were surveyed to assess satisfaction. Results: Seventeen pharmacies kept log-books detailing 432 urgent care consultations, equating to 13 consultations per pharmacy per week. Of these, 70% (n = 302) were dealt with by the pharmacist in-house with 30% (n = 130) resulting in referrals. Locum pharmacists were significantly more likely to refer to other NHS services than regular pharmacists. Over half the requests were for symptom management, skin problems presenting most commonly (38% of all symptoms presented). Forty-seven percent of consultations were considered to have ‘averted the need for other NHS services’. Pharmacists’ referral (but not assessment of urgency) was deemed appropriate by the expert panel in 90% of consultations. Ninety-five percent of customers surveyed were satisfied with the service and would use the pharmacy again. Conclusion: Extrapolating findings across the study population (approximately 4.4 million) suggests that community pharmacists manage over 11 500 urgent care consultations per week, with 8050 managed independently. These prevent approximately 5400 other NHS encounters, while also meeting customer expectations and expert panel endorsement.

Objectives (i) To provide a preliminary indication of the performance of pharmacy undergraduate students and pre-registration pharmacy trainees in the Prescribing Safety Assessment (PSA). (ii) To determine the feasibility of administering and delivering the PSA in schools of pharmacy. (iii) To examine the potential relevance of the PSA and associated training materials to pharmacy education. (iv) To assess the attitudes of the cohort towards the PSA and their readiness to prescribe. Methods Four schools of pharmacy in England recruited final year undergraduate pharmacy students and pre-registration pharmacy trainees undertaking training with both hospital and community pharmacy employers in their locality to undertake the PSA. Performance data and feedback from candidates were obtained. Key findings Pre-registration pharmacy trainees in community (n = 27) and hospital (n = 209) settings mean average scores were 86.3% and 85.3%, respectively. There was a significant performance differential between undergraduate pharmacy students (n = 397) and those in pre-registration training, with the mean average score for undergraduate students being 73.0% (t test P < 0.05). Candidates felt their current course did prepare them for the PSA, some highlighted that additional curriculum content would be needed should this become a compulsory high-stakes assessment for pharmacy trainees. The majority of candidates felt that this assessment was useful and applicable to their training. Conclusions The PSA process and associated learning tools could be introduced to pre-registration pharmacy education to support trainees in their development towards future prescribing roles.

Objectives: The primary aim of the study was to pilot the Objective Structured Clinical Examination (OSCE) as a method of evaluating the clinical competency of pre-registration pharmacists trained in Brisbane and nearby hospitals. A secondary aim was to demonstrate that this model of assessment is transferable when used to evaluate preregistration pharmacists from the UK. Method: A 15-workstation OSCE was adapted from an examination used by the South Thames Clinical Pharmacy Network in the UK. The workstations were reviewed and updated to ensure their appropriateness to clinical pharmacy practice in Australia by a group of practising pharmacists and academics. The OSCE was first completed by pre-registration pharmacists from Brisbane and nearby hospitals in October 1998 (QLD98) and then in November 1999 (QLD99). A sample of pre-registration students from the UK who completed the same OSCE in 1998 (UK98) was used as the comparator group. Results: The OSCEs were completed by 10 students in 1998 (QLD98) and 13 in 1999 (QLD99). These results were compared with 52 students who completed the OSCEs in the UK in 1998 (UK98). In general, the students performed well in the 'medication focused' activities such as counselling, calculations and chart review. However, they were less successful in more holistic tasks such as drug history taking, information retrieval from medical notes and interpretive calculations. Conclusion: Having successfully piloted the OSCE model it was determined that the method is feasible to administer when students can be brought to an assessment centre. We recommend that the OSCE be considered a key component of assessing clinical competency as part of the registration requirements for pre-registration pharmacists in Australia.