Care homes’ use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people

Introduction: Care home residents are at particular risk from medication errors, and our objective was to determine the prevalence and potential harm of prescribing, monitoring, dispensing and administration errors in UK care homes, and to identify their causes. Methods: A prospective study of a random sample of residents within a purposive sample of homes in three areas. Errors were identified by patient interview, note review, observation of practice and examination of dispensed items. Causes were understood by observation and from theoretically framed interviews with home staff, doctors and pharmacists. Potential harm from errors was assessed by expert judgement. Results: The 256 residents recruited in 55 homes were taking a mean of 8.0 medicines. One hundred and seventy-eight (69.5%) of residents had one or more errors. The mean number per resident was 1.9 errors. The mean potential harm from prescribing, monitoring, administration and dispensing errors was 2.6, 3.7, 2.1 and 2.0 (0 = no harm, 10 = death), respectively. Contributing factors from the 89 interviews included doctors who were not accessible, did not know the residents and lacked information in homes when prescribing; home staff’s high workload, lack of medicines training and drug round interruptions; lack of team work among home, practice and pharmacy; inefficient ordering systems; inaccurate medicine records and prevalence of verbal communication; and difficult to fill (and check) medication administration systems. Conclusions: That two thirds of residents were exposed to one or more medication errors is of concern. The will to improve exists, but there is a lack of overall responsibility. Action is required from all concerned

Mixed methods, materialism and the micropolitics of the research-assemblage

We assess the potential for mixing social research methods, based upon a materialist and micropolitical analysis of the research-assemblage and of what individual research techniques and methods do in practice. Applying a DeleuzoGuattarian toolkit of assemblages, affects and capacities, we document what happens when research methods and techniques interact with the events they wish to study. Micropolitically, many of these techniques and methods have unintended effects of specifying and aggregating events, with the consequently that the knowledge produced by social inquiry is invested with these specifications and aggregations. We argue that rather than abandoning these social research tools, we may use the micropolitical analysis to assess precisely how each method affects knowledge production, and engineer the research designs we use accordingly. This forms the justification for mixing methods that are highly aggregative or specifying with those that are less so, effectively rehabilitating methods that have often been rejected by social researchers, including surveys and experiments

‘It’s the best thing I’ve done in a long while’: teenage mothers’ experiences of educational alternatives

Pregnant and mothering schoolgirls have been identified as an educationally vulnerable group. Many are not welcomed in their mainstream schools and as a consequence, access a range of educational alternatives. This article presents the views and experiences of 14 young women in the English Midlands, who became pregnant while still of statutory school age, 12 of whom spent time in alternative educational settings. It is based on data gathered from repeat interviews over an 18-month period and shows that all who attended the educational alternatives rated them highly and benefitted from what they had to offer. Using the concept of ‘difference’ as a central analytic theme, the article examines how and why this was the case. The analysis shows that it was through recognising some differences but not others that the educational alternatives were successful in supporting young women’s learning and well-being. Importantly, those that were recognised were done so in non-stigmatising ways. The research also highlights some limitations of the alternatives, alongside the ways in which gender and class continue to impact the educational outcomes and career trajectories of this particular group of students

Associations Between Anticholinergic Medication Exposure and Adverse Health Outcomes in Older People with Frailty: A Systematic Review and Meta-analysis

Introduction There are robust associations between use of anticholinergic medicines and adverse effects in older people. However, the nature of these associations for older people living with frailty is yet to be established. Objectives The aims were to identify and investigate associations between anticholinergics and adverse outcomes in older people living with frailty and to investigate whether exposure is associated with greater risks according to frailty status. Methods MEDLINE, CINAHL, EMBASE, Cochrane Database of Systematic Reviews, Web of Science and PsycINFO were searched to 1 August 2019. Observational studies reporting associations between anticholinergics and outcomes in older adults (average age ≥ 65 years) that reported frailty using validated measures were included. Primary outcomes were physical impairment, cognitive dysfunction, and change in frailty status. Risk of bias was evaluated using the Cochrane Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Meta-analysis was undertaken where appropriate. Results Thirteen studies (21,516 participants) were included (ten community, one residential aged-care facility and two hospital studies). Observed associations included reduced ability for chair standing, slower gait speeds, poorer physical performance, increased risk of falls and mortality. Conflicting results were reported for grip strength, timed up and go test, cognition and activities of daily living. No associations were observed for transitions between frailty states, psychological wellbeing or benzodiazepine-related adverse reactions. There was no clear evidence of differences in risks according to frailty status. Conclusions Anticholinergics are associated with adverse outcomes in older people living with frailty; however, the literature has significant methodological limitations. There is insufficient evidence to suggest greater risks based on frailty, and there is an urgent need to evaluate this further in well-designed studies stratifying by frailty

The sexuality-assemblages of young men: a new materialist analysis

This article presents a new materialist exploration of young men and sexuality that shifts the focus away from bodies and individuals, toward the affective flow within assemblages of bodies, things, ideas and social institutions, and the sexual capacities this flow produces. Using data from two empirical studies, we explore the sexuality assemblages of teen boys and young men, and the micropolitics of these assemblages. We find that the sexuality produced in the bodies of young men is highly territorialised and aggregated by various materialities. However, we also reveal how young men resist these conventional sexualities

'You were quiet - I did all the marching': Research processes involved in hearing the voices of South Asian girls

This article is available open access through the publisher’s website at the link below. Copyright @ 2011 A B Academic Publishers.This article provides insights into the outcomes of reflection following two interview approaches used to explore narratives of the lived, individual experiences of South-Asian girls living in West London. In attempting to illuminate and re-present the cultural experiences as told by these girls, the choice of interview approach became critical in allowing the voices to be effectively heard (Rogers, 2005). This article therefore considers how a semi-structured interview approach offered valuable insights into the girls' experiences but became constraining for both researcher and participant in unveiling the complexity and depth of their lives. These constraints emerged through reflection by both participants and researcher. As a result of reflexivity during the research process, the researcher moved towards the use of research conversations during the second phase of the study. Ultimately the study revealed how the girls felt empowered by the opportunity to narrate their individual experiences and tell of their lives. In narrating their reflections on being part of the research, there was a clear recognition that the process facilitated the articulation of new voices and ‘multi-voicedness’ (Moen, 2006

A queer politics of emotion: reimagining sexualities and schooling

peer-reviewedThis paper draws together Hochschild’s (1979; 1983) concepts of emotional labour and feeling rules with Ahmed’s affective economies (2004a, 2004b; 2008; 2010) and queer phenomenology (2006a, 2006b) as a way to address wider questions about sexuality and schooling. It highlights the value of the everyday politics of emotion for elucidating and clarifying the specificities, pertinence and complementarities of Hochschild’s and Ahmed’s work for reimagining the relationship between sexualities and schooling. The combination of their approaches allows for a focus on the individual, bodily management of emotions while demonstrating the connectedness of bodies and spaces. It enables disruption of ‘inclusive’ and ‘progressive’ educational approaches that leave heterosexuality uninterrupted and provides insight into how power works in and across the bodies, discourses, practices, relations and spaces of schools to maintain a collective orientation towards heterosexuality. It also counters linear narratives of progressive change, elucidating how change is a hopeful but messy process of simultaneous constraint, transgression and transformation. Key moments from a three-year study with LGBT-Q teachers entering into civil partnerships (CP) in Ireland serve as exploratory examples of the theoretical ideas put forward in this paper.ACCEPTEDpeer-reviewe

Inside the research-assemblage: new materialism and the micropolitics of social inquiry

This paper explores social inquiry in terms of the ‘research-assemblages’ that produce knowledge from events. We use the precepts of new materialism (and specifically DeleuzoGuattarian assemblage ontology) to develop understanding of what happens when social events are researched. From this perspective, research is not at root an enterprise undertaken by human actors, but a machine-like assemblage of things, people, ideas, social collectivities and institutions. During social inquiry, the affect economies of an event-assemblage and a research-assemblage hybridise, generating a third assemblage with its own affective flow. This model of the research-assemblage reveals a micropolitics of social research that suggests a means to interrogate and effectively reverse-engineer different social research methodologies and methods, to analyse what they do, how they work and their micropolitical effects. It also suggests a means to forward-engineer research methods and designs to manipulate the kinds of knowledge produced when events are researched

New materialist social inquiry: designs, methods and the research-assemblage

This paper discusses issues of research design and methods in new materialist social inquiry, an approach that is attracting increasing interest across the social sciences as an alternative to either realist or constructionist ontologies. New materialism de-privileges human agency, focusing instead upon how assemblages of the animate and inanimate together produce the world, with fundamental implications for social inquiry methodology and methods. Key to our exploration is the materialist notion of a ‘research-assemblage’ comprising researcher, data, methods and contexts. We use this understanding first to explore the micropolitics of the research process, and then – along with a review of 30 recent empirical studies – to establish a framework for materialist social inquiry methodology and methods. We discuss the epistemological consequences of adopting a materialist ontology

Sexualisation's four faces: sexualisation and gender stereotyping in the Bailey Review

This paper explores the considerations of sexualisation and gender stereotyping in the recent UK government report Letting Children be Children. This report, the Bailey Review, claimed to represent the views of parents. However, closer reading reveals that, while the parents who were consulted were concerned about both the sexualisation and the gender stereotyping of products aimed at children, the Bailey Review focuses only on the former and dismisses the latter. ‘Sexualisation’ has four faces in the Bailey Review: it is treated as a process that increases (1) the visibility of sexual content in the public domain, (2) misogyny, (3) the sexuality of children, and (4) the mainstream position of ‘deviant’ sexual behaviours and lifestyles. Through this construction of ‘sexualisation’, gendered relations of power are not only hidden from view but also buttress a narrative in which young women are situated as children, and their sexuality and desire rendered pathological and morally unacceptable as judged by a conservative standard of decency. Comparison of the treatment of sexualisation and gender stereotyping in the review is revealing of the political motivations behind it, and of wider discourse in these areas