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Aims: The United Kingdom (UK) Prescribing Safety Assessment (PSA) is a 2‐h online assessment of basic competence to prescribe and supervise the use of medicines. It has been undertaken by students and doctors in UK medical and foundation schools for the past decade. This study describes the academic characteristics and performance of the assessment; longitudinal performance of candidates and schools; stakeholder feedback; and surrogate markers of prescribing safety in UK healthcare practice. Methods: We reviewed the performance data generated by over 70 000 medical students and 3700 foundation doctors who have participated in the PSA since its inception in 2013. These data were supplemented by Likert scale and free text feedback from candidates and a variety of stakeholder groups. Further data on medication incidents, collected by national reporting systems and the regulatory body, are reported, with permission. Results: We demonstrate the feasibility, high quality and reliability of an online prescribing assessment, uniquely providing a measure of prescribing competence against a national standard. Over 90% of candidates pass the PSA on their first attempt, while a minority are identified for further training and assessment. The pass rate shows some variation between different institutions and between undergraduate and foundation cohorts. Most responders to a national survey agreed that the PSA is a useful instrument for assessing prescribing competence, and an independent review has recommended adding the PSA to the Medical Licensing Assessment. Surrogate markers suggest there has been improvement in prescribing safety in practice, temporally associated with the introduction of the PSA but other factors could be influential too. Conclusions: The PSA is a practical and cost‐effective way of delivering a reliable national assessment of prescribing competence that has educational impact and is supported by the majority of stakeholders. There is a need to develop national systems to identify and report prescribing errors and the harm they cause, enabling the impact of educational interventions to be measured. [ABSTRACT FROM AUTHOR]

Authors felt the opportunity to use the PSA platform for local teaching would make the PSA relevant to all years of the medical school, not only those in final year. Lastly, aligning the PSA governance models with other national assessments, such as the MLA, will ensure that assessment has active oversight and robust quality assurance methods moving forward. The Prescribing Safety Assessment (PSA) is a high-stakes exam sat by approximately 8000 final-year UK medical students each year.[1] All doctors joining the NHS in foundation year 1 (FY1) are required to pass this assessment to progress through to their second year of foundation training.[2] The PSA has been a very successful initiative; since being first piloted in 2012, it has been adopted by every UK medical school, won awards, and attracted attention internationally. [Extracted from the article]

Aims: Candidates with disabilities are eligible for reasonable adjustments (RA) while undertaking the national Prescribing Safety Assessment (PSA). The PSA is a novel open‐book, time‐constrained, multiformat assessment that may pose challenges to candidates with dyslexia and other disabilities. Methods: Retrospective cohort analysis of 36 140 UK candidates undertaking first‐sitting of the PSA (2014–2018). Results: Of the 36 140 candidates, 9.1% (3284) were registered for RA. The RA group had lower pass rates (absolute difference 1.94%, 95% confidence interval 1.01–2.87%; P <.001) and assessment scores (1.16 percentage marks, 95% confidence interval 0.83–1.48; P <.001) compared with the non‐RA group. This absolute difference is small relative to overall variability. This difference persists after adjusting for confounding factors (medical school and paper), and was present for all 8 different question types. The attainment gap within each medical school is negatively correlated with the school's overall performance, both in terms of pass rate (P <.001) and scores (P =.01). The RA group were also less likely to perceive the PSA as an appropriate test, having easy to follow layout/presentation or clear/unambiguous questions, even after adjusting for candidate performance. Conclusion: This analysis identifies slight differences in academic performance of candidates requiring RA in a national undergraduate assessment. The study is limited by the unavailability of data on ethnicity, sex, age, diagnosis and time of diagnosis. While further research is required to determine the cause of the attainment gap, this study emphasises the need to maintain a careful review on the fairness and validity of all aspects of the assessment. [ABSTRACT FROM AUTHOR]

Aims: To identify and evaluate clinical pharmacology (CP) online curricular (e‐Learning) resources that are internationally available for medical students. Methods: Literature searches of Medline, EMBASE and ERIC databases and an online survey of faculty members of international English language medical schools, were used to identify CP e‐Learning resources. Resources that were accessible online in English and aimed to improve the quality of prescribing specific medications were then evaluated using a summary percentage score for comprehensiveness, usability and quality, and for content suitability. Results: Our literature searches and survey of 252 faculty (40.7% response rate) in 219 medical schools identified 22 and 59 resources respectively. After screening and removing duplicates, 8 eligible resources remained for evaluation. Mean total score was 53% (standard deviation = 13). The Australian National Prescribing Curriculum, ranked highest with a score of 77%, based primarily on very good ratings for usability, quality and suitable content. Conclusion: Using a novel method and evaluation metric to identify, classify, and rate English language CP e‐Learning resources, the National Prescribing Curriculum was the highest ranked open access resource. Future work is required to implement and evaluate its effectiveness on prescribing competence. [ABSTRACT FROM AUTHOR]

Online learning, an essential component of most traditional contact‐based educational programs, must be of high quality to contribute effectively to learning. The availability of first‐class web‐based materials is particularly valued by both learners and educators in resource‐poor nations. In this Practice article, we introduce the International Union of Basic and Clinical Pharmacology (IUPHAR) Pharmacology Education Project (PEP) (https://www.pharmacologyeducation.org/), a freely accessible online learning resource intended to support education and training in pharmacological sciences worldwide. [ABSTRACT FROM AUTHOR]

Harmonizing clinical pharmacology and therapeutics (CPT) education in Europe is necessary to ensure that the prescribing competency of future doctors is of a uniform high standard. As there are currently no uniform requirements, our aim was to achieve consensus on key learning outcomes for undergraduate CPT education in Europe. We used a modified Delphi method consisting of three questionnaire rounds and a panel meeting. A total of 129 experts from 27 European countries were asked to rate 307 learning outcomes. In all, 92 experts (71%) completed all three questionnaire rounds, and 33 experts (26%) attended the meeting. 232 learning outcomes from the original list, 15 newly suggested and 5 rephrased outcomes were included. These 252 learning outcomes should be included in undergraduate CPT curricula to ensure that European graduates are able to prescribe safely and effectively. We provide a blueprint of a European core curriculum describing when and how the learning outcomes might be acquired. [ABSTRACT FROM AUTHOR]

In this essay, we examine member state approaches to European development cooperation through the lens of collective action. We observe that successful collective action requires a combination of both culture and calculus. We suggest that the European debate sometimes suffers from an excess of one and a shortfall in the other - and vice-versa. We note that different perspectives can be explained by different geopolitical realities. We conclude that it is better to walk on two legs than hop along on one - and that judicious application of collective action theory can help this happen. [ABSTRACT FROM AUTHOR]

Aims Prescribing errors are common and inadequate preparation of prescribers appears to contribute. A junior doctor-led prescribing tutorial programme has been developed for Edinburgh final year medical students to increase exposure to common prescribing tasks. The aim of this study was to assess the impact of these tutorials on students and tutors. Methods One hundred and ninety-six tutorials were delivered to 183 students during 2010-2011. Each student completed a questionnaire after tutorial attendance which explored their previous prescribing experiences and the perceived benefits of tutorial attendance. Tutors completed a questionnaire which evaluated their teaching experiences and the impact on their prescribing practice. Student tutorial attendance was compared with end-of-year examination performance using linear regression analysis. Results The students reported increased confidence in their prescribing knowledge and skills after attending tutorials. Students who attended more tutorials also tended to perform better in end-of-year examinations ( Drug prescribing: r = 0.16, P = 0.015; Fluid prescribing: r = 0.18, P = 0.007). Tutors considered that participation enhanced their own prescribing knowledge and skills. Although they were occasionally unable to address student uncertainties, 80% of tutors reported frequently correcting misconceptions and deficits in student knowledge. Ninety-five percent of students expressed a preference for prescribing training delivered by junior doctors over more senior doctors. Conclusions A 'near-peer' junior doctor-led approach to delivering prescribing training to medical students was highly valued by both students and tutors. Although junior doctors have relatively less clinical experience of prescribing, we believe that this can be addressed by training and academic supervision and is outweighed by the benefits of these tutorials. [ABSTRACT FROM AUTHOR]

Junior doctors write the majority of hospital prescriptions but many indicate they feel underprepared to assume this responsibility and around 10% of prescriptions contain errors. Medical smartphone apps are now widely used in clinical practice and present an opportunity to provide support to inexperienced prescribers. This study assesses the contemporary range of smartphone apps with prescribing or related content. Six smartphone app stores were searched for apps aimed at the healthcare professional with drug, pharmacology or prescribing content. Three hundred and six apps were identified. 34% appeared to be for use within the clinical environment in order to aid prescribing, 14% out with the clinical setting and 51% of apps were deemed appropriate for both clinical and non-clinical use. Apps with drug reference material, such as textbooks, manuals or medical apps with drug information were the commonest apps found (51%), followed by apps offering drug or infusion rate dose calculation (26%). 68% of apps charged for download, with a mean price of £14.25 per app and a range of £0.62-101.90. A diverse range of pharmacology-themed apps are available and there is further potential for the development of contemporary apps to improve prescribing performance. Personalized app stores may help universities/healthcare organizations offer high quality apps to students to aid in pharmacology education. Users of prescribing apps must be aware of the lack of information regarding the medical expertise of app developers. This will enable them to make informed choices about the use of such apps in their clinical practice. [ABSTRACT FROM AUTHOR]

Aims The aim of the study was to explore and compare junior doctors' perceptions of their self-efficacy in prescribing, their prescribing errors and the possible causes of those errors. Methods A cross-sectional questionnaire study was distributed to foundation doctors throughout Scotland, based on Bandura's Social Cognitive Theory and Human Error Theory ( HET). Results Five hundred and forty-eight questionnaires were completed (35.0% of the national cohort). F1s estimated a higher daytime error rate [median 6.7 ( IQR 2-12.4)] than F2s [4.0 IQR (0-10) ( P = 0.002)], calculated based on the total number of medicines prescribed. The majority of self-reported errors (250, 49.2%) resulted from unintentional actions. Interruptions and pressure from other staff were commonly cited causes of errors. F1s were more likely to report insufficient prescribing skills as a potential cause of error than F2s ( P = 0.002). The prescribers did not believe that the outcomes of their errors were serious. F2s reported higher self-efficacy scores than F1s in most aspects of prescribing ( P < 0.001). Conclusion Foundation doctors were aware of their prescribing errors, yet were confident in their prescribing skills and apparently complacent about the potential consequences of prescribing errors. Error causation is multi-factorial often due to environmental factors, but with lack of knowledge also contributing. Therefore interventions are needed at all levels, including environmental changes, improving knowledge, providing feedback and changing attitudes towards the role of prescribing as a major influence on patient outcome. [ABSTRACT FROM AUTHOR]

Background: There are increasing opportunities for junior doctors to deliver teaching as well as formally develop teaching skills. Near-peer teaching (NPT) programmes, like that established in South-East Scotland, not only provide additional learning opportunities for students but also have potential benefits for the teachers. Context: Achieving the multiple competencies required of both the medical school and the foundation programme poses significant challenges. Medical students have reduced exposure to bedside teaching, which may be contributing to the concerns raised regarding the clinical skills of recently graduated junior doctors. NPT increases the pool of tutors available to students, helps facilitate both practical and small group teaching and has other advantages, such as peer tutors being more approachable than senior staff. Innovation: The NPT programme in South-East Scotland was devised by a group of junior doctors keen to improve, expand and formalise NPT. It started in 2006 as one NPT programme, with 73 tutorials delivered by 18 tutors. Last year across four NPT programmes, 324 tutorials were delivered by 108 tutors, with all tutors receiving formal tutor training. In this article we describe the South-East Scotland model, and offer guidance for those interested in setting up similar programmes elsewhere. Implications: NPT, delivered by trained junior doctors, is now well established in every hospital in South-East Scotland. Our NPT model facilitates evidence-based teaching by junior doctors, is popular amongst both junior doctors and students, is sustainable and can be used as a practical example for how to generate NPT programmes elsewhere. [ABSTRACT FROM AUTHOR]

Preparing medical students to prescribe is a major challenge of undergraduate education. They must develop an understanding of clinical pharmacology and acquire knowledge about drugs and therapeutics, as well as the skills to prescribe for individual patients in the face of multiple variables. The task of delivering the learning required to achieve these attributes relies upon limited numbers of teachers, who have increasingly busy clinical commitments. There is evidence that training is currently insufficient to meet the demands of the workplace. e-Learning provides an opportunity to improve the learning experience. The advantages for teachers are improved distribution of learning content, ease of update, standardization and tracking of learner activities. The advantages for learners are ease of access, greater interactivity and individual choice concerning the pace and mix of learning. Important disadvantages are the considerable resource required to develop e-Learning projects and difficulties in simulating some aspects of the real world prescribing experience. Pre-requisites for developing an e-Learning programme to support prescribing include academic expertise, institutional support, learning technology services and an effective virtual learning environment. e-Learning content might range from complex interactive learning sessions through to static web pages with links. It is now possible to simulate and provide feedback on prescribing decisions and this will improve with advances in virtual reality. Other content might include a student formulary, self-assessment exercises (e.g. calculations), a glossary and an on-line library. There is some evidence for the effectiveness of e-Learning but better research is required into its potential impact on prescribing. [ABSTRACT FROM AUTHOR]

Prescribing is one of the commonest tasks expected of new doctors and is a complex process involving a mixture of knowledge, judgement and skills. Preparing graduates to be prescribers is one of the greatest challenges of modern undergraduate medical education and there is some evidence to suggest that training could be improved. The aims of this article are (i) to review some of the challenges of delivering effective prescribing education, (ii) to provide a clear statement of the learning outcomes in clinical pharmacology and prescribing that should be expected of all medical graduates and (iii) to describe a curriculum that might enable students to achieve these outcomes. We build on the previous curriculum recommendations of the British Pharmacological Society and take into account those of other key bodies, notably the General Medical Council. We have also reviewed relevant evidence from the literature and set our work in the context of recent trends in medical education. We divide our recommended learning objectives into four sections: principles of clinical pharmacology, essential drugs, essential therapeutic problems and prescribing skills. Although these will not necessarily be accepted universally we believe that they will help those who design and map undergraduate curricula to explore potential gaps and identify improvements. [ABSTRACT FROM AUTHOR]

Prescribing of medicines is the key clinical activity in the working life of most doctors. In recent years, a broad consensus regarding the necessary competencies has been achieved. Each of these is a complex mix of knowledge, judgement and skills. Surveys of those on the threshold of their medical careers have revealed widespread lack of confidence in writing prescriptions. A valid and reliable assessment of prescribing competence, separate from an overall assessment of medical knowledge and skill, would have many benefits for clinical governance and patient safety, and would provide a measure of the success of training programmes in therapeutics. Delivering such an assessment presents many challenges, not least of which are the difficulty in identifying a surrogate marker for competent prescribing in clinical practice and the challenge of ensuring that competence assessed in a controlled environment predicts performance in clinical practice. This review makes the case for an on-line OSCE as the most valid form of assessment and sets out the requirements for its development, scope, composition and delivery. It describes an on-going attempt to develop a national assessment of prescribing skills towards the end of undergraduate medical training in the UK. [ABSTRACT FROM AUTHOR]

Clinical pharmacology and therapeutics is the academic discipline that informs rational prescribing of medicines. There is accumulating evidence that a significant minority of prescriptions in the UK National Health Service contain errors. This comes at a time when the approach to and success of undergraduate education in this area has been called into question. Various stakeholders are now in agreement that this challenging area of undergraduate education needs to be strengthened. The principles that should form the basis of future educational strategy include greater visibility of clinical pharmacology and therapeutics in the curriculum, clear learning outcomes that are consistent with national guidance, strong and enthusiastic leadership, a student formulary, opportunities to practice prescribing, a robust assessment of prescribing competencies and external quality control. Important new developments in the UK are Prescribe, a repository of e-learning materials to support education in clinical pharmacology and prescribing, and the Prescribing Skills Assessment, a national online assessment designed to allow medical students to demonstrate that they have achieved the core competencies required to begin postgraduate training. [ABSTRACT FROM AUTHOR]

In this article, the author discusses the challenges being faced by medical care systems in terms of safety and effectiveness of prescribing medicines. It highlights electronic format of summary of product characteristics (e-SPC), which help in developing new approaches to deliver drug information to prescribers. A Great Britain based study reveals that 10 percent of hospital prescriptions contain errors and senior doctors are almost as frequently culpable as those who have recently graduated.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • The computerization of health care has increased dramatically in the last decades in most European countries, but no standardization of any of the information support systems has been established on common ground. • The Summary of Product Characteristics (SmPC) is available all over Europe in written form and in some of the countries even electronically, but the structure and the content of the information vary. • The physicians' needs for useful and reliable information about drugs at point of care are a question of patient safety. WHAT THIS STUDY ADDS • A qualitative approach, in this case focus group discussions, proved advantagous compared with questionnaires. • Knowledge gained from physicians' experiences promoted the work of restructuring and organizing the e-SmPC database. • Most of the required information from physicians appeared to be possible to transfer from current SmPCs to clinical decisions support systems. AIMS Relevant and easily accessible drug information at point-of-care is essential for physicians' decision making when prescribing. However, the information available by using Clinical Decision Support Systems (CDSSs) often does not meet physicians' requirements. The Summary of Product Characteristics (SmPC) is statutory information about drugs. However, the current structure, content and format of SmPCs make it difficult to incorporate them into CDSSs and link them to relevant patient information from the Electronic Health Records. The aim of the study was to evaluate the perceived needs for drug information among physicians in Sweden. METHODS We recruited three focus group discussions with 18 physicians covering different specialities. The information from the groups was combined with a questionnaire administered at the beginning of the group discussions. RESULTS Physicians reported their needs for knowledge databases at the point of drug prescribing. This included more consistent information about existing and new drugs. They also wished to receive automatically generated alerts for severe drug-drug interactions and adverse effects, and to have functions for calculating glomerular filtration rate to enable appropriate dose adjustments to be made for elderly patients and those with impaired renal function. Additionally, features enhancing electronic communication with colleagues and making drug information more searchable were suggested. CONCLUSIONS The results from the current study showed the need for knowledge databases which provide consistent information about new and existing drugs. Most of the required information from physicians appeared to be possible to transfer from current SmPCs to CDSSs. However, inconsistencies in the SmPC information have to be reduced to enhance their utility. [ABSTRACT FROM AUTHOR]

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Dose calculation errors are an important cause of some of the most serious medication incidents in advanced healthcare systems. • A number of small studies have shown that dose calculations are poorly performed by hospital doctors, nurses and medical students. WHAT THIS PAPER ADDS • The performance of dose calculations was highly variable amongst a large cohort of medical students from a leading UK medical school. • Calculations that involved converting concentrations expressed as percentage or calculating infusion rates were identified as major weaknesses. • The availability of an online self-assessment and education package, coupled with encouragement and twice-yearly formative assessment, led to a significant improvement in performance. AIMS Dose calculation errors can cause serious life-threatening clinical incidents. We designed eDrugCalc as an online self-assessment tool to develop and evaluate calculation skills among medical students. METHODS We undertook a prospective uncontrolled study involving 1727 medical students in years 1-5 at the University of Edinburgh. Students had continuous access to eDrugCalc and were encouraged to practise. Voluntary self-assessment was undertaken by answering the 20 questions on six occasions over 30 months. Questions remained fixed but numerical variables changed so each visit required a fresh calculation. Feedback was provided following each answer. RESULTS Final-year students had a significantly higher mean score in test 6 compared with test 1 [16.6, 95% confidence interval (CI) 16.2, 17.0 vs. 12.6, 95% CI 11.9, 13.4; n= 173, P < 0.0001 Wilcoxon matched pairs test] and made a median of three vs. seven errors. Performance was highly variable in all tests with 2.7% of final-year students scoring < 10/20 in test 6. Graduating students in 2009 (30 months' exposure) achieved significantly better scores than those in 2007 (only 6 months): mean 16.5, 95% CI 16.0, 17.0, n= 184 vs. 15.1, 95% CI 14.5, 15.6, n= 187; P < 0.0001, Mann-Whitney test. Calculations based on percentage concentrations and infusion rates were poorly performed. Feedback showed that eDrugCalc increased confidence in calculating doses and was highly rated as a learning tool. CONCLUSIONS Medical student performance of dose calculations improved significantly after repeated exposure to an online formative dose-calculation package and encouragement to develop their numeracy. Further research is required to establish whether eDrugCalc reduces calculation errors made in clinical practice. [ABSTRACT FROM AUTHOR]

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Junior doctors feel poorly prepared by their training in Clinical Pharmacology and Therapeutics and commonly make prescribing errors. • Since 1993 the General Medical Council's guidance on undergraduate medical education ‘Tomorrow's Doctors’ has emphasized the integration of Clinical Pharmacology and Therapeutics teaching within the medical curriculum. • With the publication of a new version of Tomorrow's Doctors in 2009, medical schools will be further revising their Clinical Pharmacology and Therapeutics teaching. WHAT THIS STUDY ADDS • Although we know what the recommendations for undergraduate teaching of Clinical Pharmacology and Therapeutics teaching are, there are no published data describing what is currently happening in UK medical schools. • This paper describes the course structures, volume and range of teaching and assessment of Clinical Pharmacology and Therapeutics in the UK in 2009. • Our data provide a foundation for schools looking to revise the Clinical Pharmacology and Therapeutics Teaching in the light of Tomorrow's Doctors 2009. AIM To describe the current structure, delivery and assessment of Clinical Pharmacology and Therapeutics (CPT) teaching in UK medical schools. METHODS An online questionnaire was distributed to the person with overall responsibility for CPT teaching at all UK medical schools in June 2009. RESULTS Thirty of the 32 UK medical schools responded. 60% of schools have a CPT course although in 72% this was an integrated vertical theme. At 70% of schools pharmacologists have overall responsibility for CPT teaching (clinical 67%, non-clinical 33%); at 20% teaching is run by a non-specialist clinician and at 7% by a pharmacist. Teaching is commonly delivered by NHS clinicians (87%) and clinical pharmacists (80%) using lectures (90%) but additionally 50% of schools use e-Learning and 63% have a student formulary. CPT is assessed throughout the curriculum at many schools through written, practical examinations and course work. 90% of schools have specific CPT content in their written examinations. 90% of respondents believed that their students were ‘fairly’ to ‘well’ prepared for the foundation year but only 37% of schools gather data on the competence of their graduates. CONCLUSIONS CPT teaching in UK medical schools is very diverse. Most schools do not assess the performance of their graduates as prescribers and there is a lack of evidence that many of the teaching approaches employed are suitable for the development of prescribing skills. It is vital that developments in CPT teaching are driven by validated, real-world assessments of the prescribing skills of medical students and newly qualified doctors. [ABSTRACT FROM AUTHOR]

Eliminating World Poverty: Building Our Common Future. By the UK Department for International Development. [ABSTRACT FROM AUTHOR]

This is the first in an occasional series of DPR Debates, designed to illuminate specific issues of international development policy. Each debate will bring together two well-known researchers or practitioners, giving them the opportunity, over three rounds, to test and challenge each other's ideas. The debates are intended to be robust but accessible, rooted in rigorous research but useful to the wide readership of Development Policy Review. [ABSTRACT FROM AUTHOR]

Three challenges face development studies and development studies institutions—the three ‘C's’. The first ‘C’ is coverage: making sure that the sector has sufficient coverage of new topics. The second ‘C’ is capacities: recognising that growth in the number and strength of developing country institutions requires developed country institutions to re-think their role. The third ‘C’ is communications: using new technology to deliver policy messages faster and more effectively. With the geographical scope of the development studies ‘industry’ also changing, as more countries reach middle income status, change management becomes a high priority. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

1. Poor prescribing is probably the most common cause of preventable medication errors in hospitals, and many of these events involve junior doctors who have recently graduated. Prescribing is a complex skill that depends on a sound knowledge of medicines, an understanding of the principles of clinical pharmacology, the ability to make judgements concerning risks and benefits, and ideally experience. It is not surprising that errors occur. 2. The challenge of being a prescriber is probably greater now than ever before. Medical education has changed radically in the last 20 years, reflecting concerns about an overburdened curriculum and lack of focus on social sciences. In the UK, these changes have resulted in less teaching in clinical pharmacology and practical prescribing as guaranteed features of undergraduate training and assessment. There has been growing concern, not least from students, that medical school training is not sufficient to prepare them for the pressures of becoming prescribers. Similar concerns are being expressed in other countries. While irrefutable evidence that these changes are related to medication errors identified in practice, there is circumstantial evidence that this is so. 3. Systems analysis of errors suggests that knowledge and training are relevant factors in causation and that focused education improves prescribing performance. We believe that there is already sufficient evidence to support a careful review of how students are trained to become prescribers and how these skills are fostered in the postgraduate years. We provide a list of guiding principles on which training might be based. [ABSTRACT FROM AUTHOR]

Here we discuss 15 recommendations for reducing the risks of medication errors: 1. Provision of sufficient undergraduate learning opportunities to make medical students safe prescribers. 2. Provision of opportunities for students to practise skills that help to reduce errors. 3. Education of students about common types of medication errors and how to avoid them. 4. Education of prescribers in taking accurate drug histories. 5. Assessment in medical schools of prescribing knowledge and skills and demonstration that newly qualified doctors are safe prescribers. 6. European harmonization of prescribing and safety recommendations and regulatory measures, with regular feedback about rational drug use. 7. Comprehensive assessment of elderly patients for declining function. 8. Exploration of low-dose regimens for elderly patients and preparation of special formulations as required. 9. Training for all health-care professionals in drug use, adverse effects, and medication errors in elderly people. 10. More involvement of pharmacists in clinical practice. 11. Introduction of integrated prescription forms and national implementation in individual countries. 12. Development of better monitoring systems for detecting medication errors, based on classification and analysis of spontaneous reports of previous reactions, and for investigating the possible role of medication errors when patients die. 13. Use of IT systems, when available, to provide methods of avoiding medication errors; standardization, proper evaluation, and certification of clinical information systems. 14. Nonjudgmental communication with patients about their concerns and elicitation of symptoms that they perceive to be adverse drug reactions. 15. Avoidance of defensive reactions if patients mention symptoms resulting from medication errors. [ABSTRACT FROM AUTHOR]

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • It has been recognized for about 10 years that morphine is a veno-dilator in man and that this effect may be related to histamine release. WHAT THIS PAPER ADDS • This effect also occurs in the arteriolar system, with vasodilatation at doses of morphine that may have clinical relevance in patients with heart failure, or who abuse opioids. • The effect is mediated by histamine release and actions of nitric oxide. • The mechanisms of this effect of morphine are unclear, but suggest an alternative therapeutic target in vascular disease. AIM The mechanisms of action of morphine on the arterial system are not well understood. The aim was to report forearm vascular responses, and their mediation, to intra-arterial morphine in healthy subjects. METHODS Three separate protocols were performed: (i) dose ranging; (ii) acute tolerance; (iii) randomized crossover mechanistic study on forearm blood flow (FBF) responses to intrabrachial infusion of morphine using venous occlusion plethysmography. Morphine was infused either alone (study 1 and 2), or with an antagonist: naloxone, combined histamine-1 and histamine-2 receptor blockade or during a nitric oxide clamp. RESULTS Morphine caused an increase in FBF at doses of 30 µg min−1[3.25 (0.26) ml min−1 100 ml−1][mean (SEM)] doubling at 100 µg min−1 to 5.23 (0.53) ml min−1 100 ml−1. Acute tolerance was not seen to 50 µg min−1 morphine, with increased FBF [3.96 (0.35) ml min−1 100 ml−1] ( P = 0.003), throughout the 30-min infusion period. Vasodilatation was abolished by pretreatment with antihistamines ( P = 0.008) and the nitric oxide clamp ( P < 0.001), but not affected by naloxone. The maximum FBF with pretreatment with combined H1/H2 blockade was 3.06 (0.48) and 2.90 (0.17) ml min−1 100 ml−1 after 30 min, whereas with morphine alone it reached 4.3 (0.89) ml min−1 100 ml−1. CONCLUSIONS Intra-arterial infusion of morphine into the forearm circulation causes vasodilatation through local histamine-modulated nitric oxide release. Opioid receptor mechanisms need further exploration. [ABSTRACT FROM AUTHOR]

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Increasing numbers of people are accessing medicines from the internet. • This online market is poorly regulated and represents a potential threat to the health of patients and members of the public. WHAT THIS STUDY ADDS • Prescription-only analgesics, including controlled opioids, are readily available to the UK public through internet pharmacies that are easily identified by popular search engines. • The majority of websites do not require the customer to possess a valid prescription for the drug. • Less than half provide an online health screen to assess suitability for supply. • The majority have no registered geographical location. • Analgesic medicines are usually purchased at prices significantly above British National Formulary prices and are often supplied in large quantities. • These findings are of particular relevance to pain-management specialists who are trying to improve the rational use of analgesic drugs. AIMS To explore the availability to the UK population of prescription-only analgesics from the internet. METHODS Websites were identified by using several keywords in the most popular internet search engines. From 2000 websites, details of 96 were entered into a database. RESULTS Forty-six (48%) websites sold prescription analgesics, including seven opioids, two non-opioids and 18 nonsteroidal anti-inflammatory drugs. Thirty-five (76%) of these did not require the customer to possess a valid prescription. CONCLUSION Prescription-only analgesics, including controlled opioids, are readily available from internet websites, often without a valid prescription. [ABSTRACT FROM AUTHOR]

WHAT IS ALREADY KNOWN ON THIS SUBJECT • Adverse drug events are common in National Health Service (NHS) hospitals where junior doctors take responsibility for most of the prescribing. • Safe and effective prescribing of drugs is a core competency expected of all medical graduates. • There is a perception from some of those who supervise the prescribing of drugs in the NHS that undergraduate teaching in this area may be deficient, although this view is contested. WHAT THIS STUDY ADDS • Our study suggests that a large proportion of medical students and recent graduates from UK medical schools who responded also believe that their teaching and assessment in this area was inadequate. • This result implies that those responsible for overseeing undergraduate education should urgently review teaching and assessment of competency in relation to prescribing in all UK medical schools. AIMS To gather opinions from UK medical students and recent graduates about their undergraduate training to prescribe and their confidence about meeting the relevant competencies identified by the General Medical Council (GMC). METHODS We designed a web-based survey that was distributed to UK medical students and first year Foundation doctors (graduation years 2006–2008) via medical schools and postgraduate networks. RESULTS Analysis was restricted to 2413 responses from students graduating in 2006–2008 from the 25 UK medical schools (mean 96.5 per school) with a complete undergraduate curriculum. Distinct courses and assessments in ‘clinical pharmacology & therapeutics (or equivalent)’ were identified by 17% and 13%, respectively, with mode of learning described most commonly as ‘opportunistic learning during clinical attachments’ (41%). Only 38% felt ‘confident’ about prescription writing and only a minority (35%) had filled in a hospital prescription chart more than three times during training. The majority (74%) felt that the amount of teaching in this area was ‘too little’ or ‘far too little’, and most tended to disagree or disagreed that their assessment ‘thoroughly tested knowledge and skills’ (56%). When asked if they were confident that they would be able to achieve the prescribing competencies set out by the GMC, 42% disagreed or tended to disagree, whereas only 29% agreed or tended to agree. CONCLUSIONS Many respondents clearly perceived a lack of learning opportunities and assessment related to the safe and effective use of drugs and had little confidence that they would meet the competencies identified by the GMC. There is an urgent need to review undergraduate training in this area. [ABSTRACT FROM AUTHOR]

Evidence of poor prescribing is widespread including overuse of medicines, underuse of effective medicines, avoidable adverse drug reactions and medication errors. Junior doctors who have recently graduated are responsible for much of the prescribing that takes place in hospitals and are implicated in many of the adverse medication events. Analysis of such events suggests that lack of knowledge and training underlies many of them and it has been shown that dedicated training can increase prescribing performance. In the context of these problems, it is a matter of increasing concern that recent changes to undergraduate medical education may have reduced exposure to clinical pharmacology, a discipline dedicated to optimal practice in relation to medicines. For this reason, the European Association of Clinical Pharmacology and Therapeutics (EACPT) and British Pharmacological Society (BPS) jointly organized a meeting to explore (i) the state of undergraduate education in clinical pharmacology in Europe, (ii) the knowledge and competencies in relation to medicines that should be expected of a new graduate, (iii) assessments that might demonstrate that this minimum standard had been reached, (iv) a curriculum that might help medical students to achieve this standard and (v) how competence can be developed in the postgraduate phase. It was agreed that the lack of exposure to clinical pharmacology is a cause for concern at a time when the challenges facing junior prescribers have never been greater. The potential for undertaking further research was discussed. [ABSTRACT FROM AUTHOR]

Information about several papers discussed at a symposium which was held at the British Pharmacological Society in Great Britain in December 2005 is presented. The topics of the studies concentrated on the electronic-learning program, and on accounts of related issues and resources from a medical perspective. Furthermore, the second part of the conference tackled the different ways in which pharmacology education can be delivered effectively.

What is already known about this subject • Delivering education about an ever-increasing number of prescribable drugs to medical students represents a major challenge. • Drug names are generally not logical or intuitive, and many students find learning them akin to learning a foreign language. • Pharmacology and therapeutics teaching is struggling for visibility in some integrated medical curricula. What this study adds • Development of electronic tools allowing web delivery of a restricted student formulary facilitates dynamic access to core learning materials, improves the profile of this aspect of the curriculum and is highly appreciated by students. Aims Prescribing drugs is a key responsibility of a doctor and requires a solid grounding in the relevant scientific disciplines of pharmacology and therapeutics (PT). The move away from basic science disciplines towards a more system-based and integrated undergraduate curriculum has created difficulties in the delivery of PT teaching in some medical schools. We aimed to develop a web-based strategy to overcome these problems and improve the PT learning experience. Methods We designed and introduced ‘eDrug’, a dynamic interactive web-based student formulary, as an aid to teaching and learning of PT throughout a 5-year integrated medical curriculum in a UK medical school of 1300 students. This was followed by a prospective observational study of student-reported views about its impact on their PT learning experience. Results eDrug was rated highly by students and staff, with the main benefits being increased visibility of PT in the curriculum, clear identification of core drugs, regular sourcing of drug information via direct links to accredited sources including the British National Formulary, prioritization of learning, immediate access and responsiveness. It has also served as a focus of discussion concerning core PT learning objectives amongst staff and students. Conclusions Web-based delivery of PT learning objectives actively supports learning within an integrated curriculum. [ABSTRACT FROM AUTHOR]

Bridging research and policy is a topic of growing practical and scholarly interest in both North and South. Contributions by four experienced practitioners and in four papers by researchers illustrate the value of existing frameworks and add four new lessons: the need for donors and research foundations to foster research capacity and to protect it from political interference; the need for researchers to use detailed case material in order to inform high-level policy debates within and across national boundaries, often by working in cross-country teams; the importance of presenting research results in such a way that they cannot be over-simplified; and the value of creating alliances between researchers and civil society advocacy groups. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Book reviewed: Our Common Interest: The Report of the Africa Commission. By the Commission for Africa. London: Commission for Africa, 2005. 462pp. £10.00 pb. (forthcoming in June 2005 from Penguin Books Ltd, Our Common Interest: An Argument. 192pp. £5.00 pb.). [ABSTRACT FROM AUTHOR]

Rural development has not received the priority and attention warranted by the present and future concentration of poverty in rural areas. Is this perhaps because rural development agencies present conflicting narratives? A framework is presented within which to answer that question, and is then applied to the recent policy statements of the European Union (EU), Food and Agriculture Organization (FAO), International Fund for Agricultural Deveopment (IFAD), and the World Bank. Each policy statement is compelling in its own way, but the strategies are not consistent. A narrative is needed, which recognizes the rapid pace of change in rural areas, acknowledges the need for diversification out of agriculture, builds market institutions for growth, and works effectively within the current international consensus on poverty reduction, emphasising opportunity, empowerment, and security. [ABSTRACT FROM AUTHOR]

The character of the food system and the nature of food policy are both changing, as urbanisation, technical change and the industrialisation of the food system transform the way food is produced, marketed and consumed in developing countries. This overview presents an evaluation framework and explores new policy options. Some issues feature more prominently in richer, more urbanised, more industrialised developing countries, but the new food policy agenda is relevant in all countries — and it is in the poorest countries where challenges are set to emerge most rapidly. The agenda is more one of 'food policy' than food security': developing countries need both, but particularly a greater engagement with the new food policy. [ABSTRACT FROM AUTHOR]

There is a pressing need for medical graduates to be fully prepared to take on the responsibilities of prescribing and to be able to respond to continual inevitable rapid changes in therapeutics. The curricula in UK medical schools were greatly influenced by Tomorrow's Doctors, published by the General Medical Council in 1993. This has recently been updated. While it highlights the management of disease and use of drugs as key learning objectives, it offers little specific guidance. In this document we expand on these broad statements, provide a view of how these learning objectives might be achieved, and identify the key elements of a core curriculum in prescribing and therapeutics. [ABSTRACT FROM AUTHOR]

Rural development has been central to the development effort, but rural poverty persists and funding is falling: a new narrative is needed. This overview article describes a Washington Consensus on Food, Agriculture and Rural Development, and summarises from the various contributions here the elements of a post-Washington Consensus. Rural areas are changing, particularly with respect to demography, diversification, and strengthening links to national and global economies. Key issues include: agriculture as the engine of rural development; the future viability of small farms; the potential of the non-farm rural economy; the challenges of new thinking on poverty, participation and governance; and implementation problems. The article concludes with five general principles and ten specific recommendations for the future of rural development. [ABSTRACT FROM AUTHOR]

The current narrative on poverty reduction, summarized in WDR 2000/1, rehabilitates distribution as a central topic on the development agenda. WDR argues (i) that redistribution matters for instrumental reasons, as a route to faster growth and faster poverty reduction; (ii) that changes to income distribution result from complex changes in sectoral, geographical and individual performance; and (iii) that better distribution can be achieved in a win-win fashion, without undermining incentives or forcing a choice between equity and efficiency. The argument can be extended: (i) the case for redistribution is not simply instrumental, but can be rooted in a discourse about social inclusion and rights; (ii) observed changes are strongly associated with liberalization policies, and with changes to social norms; and (iii) governments can do more than the Bank suggests to achieve greater equality. A commitment to redistribution should be enshrined in a new international development target: a ceiling on Gini coefficients of 0.45. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Presents a question-and-answer advisory on poverty reduction and policies in the developing countries. Accommodation of a multi-dimensional definition for poverty issues; Effects of capital market liberalization on the local economy; Relocation of public expenditure to improve health and education accessibility.

Examines the management of a patient with an acute anterior myocardial infarction (MI). Effects of beta-adrenoceptor blockade on the prevention of MI; Benefits of aspirin therapy; Role of angiotensin-converting enzyme inhibitors in postinfarct patients.

Objectives . Oxygen-free radicals and lipid hydroperoxides may have an aetiological role in the development of lesions in the central nervous system in patients with Alzheimer's disease and in those with vascular dementia. This study aimed to make a cross-sectional comparison of blood markers of oxidative stress in two groups of patients with these disorders and a control group. Design . Cross-sectional comparative study. Setting . Established memory clinics in Cardiff organized by a University Department of Geriatric Medicine within an acute care NHS Trust. Methods . Following a dietary assessment, postprandial venous blood samples were obtained from the following: 25 subjects with probable Alzheimer's disease (AD) (mean age 74.3; 10 F, 15 M); 17 subjects with probable vascular dementia (VD) (mean age 75.5; 5 F, 12 M); and 41 controls (mean age 73.4; 24 F, 17 M) for measurement of circulating lipid peroxides (LP), total antioxidant capacity (TAC), vitamin C (VitC), vitamin E (VitE) and beta-carotene (BC). Results . Plasma levels of VitC were significantly lower in subjects with vascular dementia compared with controls (VD, 6.5 (4.8, 8.2); controls, 10.0 (8.38, 11.6); VD vs controls, p =0.015), but no significant difference was seen between controls and patients with Alzheimer's disease (AD, mean 8.3 (6.2, 10.4)). VitE levels were significantly lower in subjects with AD compared with controls (31.1 (28.2, 34.0) vs 36.0 (32.8, 39.2), p =0.035). BC levels were similar in subjects with AD and controls, but significantly elevated in those with VD (AD, 0.28 (0.2, 0.34); VD, 0.40, (0.27, 0.53); controls, 0.28 (0.22, 0.34); VD vs controls, p =0.046). There were no significant differences in LP or TAC between the three groups. Conclusions . Subjects with dementia attributed to Alzheimer's disease or to vascular disease have a degree of disturbance in antioxidant balance which may predispose to increased oxidative stress. This may be a potential therapeutic area for antioxidant supplementation. Copyright © 1998 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Several lines of evidence suggest that free radical-mediated oxidative damage to lipoproteins may be an important factor predisposing them to uptake into the vascular wall. This has led to interest in the factors that determine the susceptibility of lipoproteins to oxidation and their relationship to the development of coronary heart disease. Of these factors, the lipoprotein content of natural antioxidant vitamins such as vitamin E, and beta-carotene have aroused particular interest. Studies in animal models of atherosclerosis suggest that natural and synthetic antioxidants can retard the development of atheroma. Epidemiological comparisons between populations and studies within populations also support the contention that high plasma levels or dietary intake of natural antioxidant vitamins may protect against the development of coronary disease in man. Prospective randomized controlled trials of antioxidants in high risk groups are underway to test whether the theoretical promise of a beneficial role for antioxidants in coronary heart disease prevention will be fufilled. [ABSTRACT FROM AUTHOR]

The recent UK White Paper makes an admirable commitment to the idea of ‘partnership’, as the keystone of a new aid relationship with countries committed to poverty reduction and good governance. The concept is a difficult one, however, open to multiple interpretation. Genuine participation means joint ownership, with mutual rights and obligations; and it implies a contractual relationship, with procedures for redress in case of default. Other donors, notably the EU, have travelled this road with mixed success and much back-sliding. Can DFID learn from their experience? Can it devise its own institutional innovations to build true partnership? © 1998 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article reviews the book "Poor Economics: A Radical Rethinking of the Way to Fight Global Poverty" by Abhijit V. Banerjee and Esther Duflo.

The article discusses how the regulation of prescription-only medicine (POM) is being threatened by the growth of Internet drug sales. The number of online pharmacies offering to sell POM have significantly increased. Although some Internet pharmacies may offer medical support of apply a diagnostic questionnaire to gage suitability, many will sell drugs without a prescription and without requiring a visit to a doctor.

Adrian Wood is right to note a significant shift in official thinking since the publication in 2000 of the DFID White Paper on globalization. This is confirmed by the 2004 White Paper on the same subject, published by the Department for Trade and Industry: there is more emphasis on the institutional pre-conditions for successful liberalization, more on the specificity of individual country experience, more on the plight of losers, and more on the need for social protection. These themes are important and require some re-thinking of aid policy. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]