Medication administration errors for older people in long-term residential care

Background Older people in long-term residential care are at increased risk of medication errors. The purpose of this study was to evaluate a computerised barcode medication management system designed to improve drug administrations in residential and nursing homes, including comparison of error rates and staff awareness in both settings. Methods All medication administrations were recorded prospectively for 345 older residents in thirteen care homes during a 3-month period using the computerised system. Staff were surveyed to identify their awareness of administration errors prior to system introduction. Overall, 188,249 attempts to administer medication were analysed to determine the prevalence of potential medication administration errors (MAEs). Error classifications included attempts to administer medication at the wrong time, to the wrong person or discontinued medication. Analysis compared data at residential and nursing home level and care and nursing staff groups. Results Typically each resident was exposed to 206 medication administration episodes every month and received nine different drugs. Administration episodes were more numerous (p < 0.01) in nursing homes (226.7 per resident) than in residential homes (198.7). Prior to technology introduction, only 12% of staff administering drugs reported they were aware of administration errors being averted in their care home. Following technology introduction, 2,289 potential MAEs were recorded over three months. The most common MAE was attempting to give medication at the wrong time. On average each resident was exposed to 6.6 potential errors. In total, 90% of residents were exposed to at least one MAE with over half (52%) exposed to serious errors such as attempts to give medication to the wrong resident. MAEs rates were significantly lower (p < 0.01) in residential homes than nursing homes. The level of non-compliance with system alerts was low in both settings (0.075% of administrations) demonstrating virtually complete error avoidance. Conclusion Potentially inappropriate administration of medication is a serious problem in long-term residential care. A computerised barcode system can accurately and automatically detect inappropriate attempts to administer drugs to residents. This tool can reliably be used by care staff as well as nurses to improve quality of care and patient safety

Study protocol for a multi-level cross-sectional study on the equitable reach and implementation of coordinated specialty care for early psychosis

Abstract Background Approximately 115,000 young adults will experience their first episode of psychosis (FEP) each year in the USA. Coordinated specialty care (CSC) for early psychosis is an evidence-based early intervention model that has demonstrated effectiveness by improving quality of life and reducing psychiatric symptoms for many individuals. Over the last decade, there has significant increase in the implementation of CSC programs throughout the USA. However, prior research has revealed difficulties among individuals and their family members accessing CSC. Research has also shown that CSC programs often report the limited reach of their program to underserved populations and communities (e.g., ethnoracial minorities, rural and low socioeconomic neighborhoods). Dissemination and implementation research focused on the equitable reach and implementation of CSC is needed to address disparities at the individual level. Methods The proposed study will create a novel integrative multi-level geospatial database of CSC programs implemented throughout the USA that will include program-level data (e.g., geocoded location, capacity, setting, role availability), provider-level data (race, ethnicity, professional credentials), and neighborhood-level census data (e.g., residential segregation, ethnic density, area deprivation, rural-urban continua, public transit time). This database will be used to characterize variations in CSC programs by geographical location and examine the overall reach CSC programs to specific communities. The quantitative data will be combined with qualitative data from state administrators, providers, and service users that will inform the development of dissemination tools, such as an interactive dashboard, that can aid decision making. Discussion Findings from this study will highlight the impact of outer contextual determinants on implementation and reach of mental health services, and will serve to inform the future implementation of CSC programs with a primary focus on equity

No money shot?: commerce, pornography and new sex taste cultures

This paper examines two Internet websites – Nerve, a magazine devoted to ‘smart smut’ and SuicideGirls, an ‘altporn’ site where softcore sexual display is a major component of a participatory taste culture. Through a consideration of the ways such sites present their commercial and community elements as part of a shared taste and aesthetic, the paper investigates how some new forms of pornography are developing to construct sexual display as a form of recreation, self-presentation and community building.</p

Top 10 FAIR Data Software Things

The Top 10 FAIR Data & Software Global Sprint was held online over the course of two-days (29-30 November 2018), where participants from around the world were invited to develop brief guides (stand alone, self paced training materials), called "Things", that can be used by the research community to understand FAIR in different contexts but also as starting points for conversations around FAIR. The idea for "Top 10 Data Things" stems from initial work done at the Australian Research Data Commons or ARDC (formerly known as the Australian National Data Service). The Global Sprint was organised by Library Carpentry, Australian Research Data Commons and the Research Data Alliance Libraries for Research Data Interest Group in collaboration with FOSTER Open Science, OpenAire, RDA Europe, Data Management Training Clearinghouse, California Digital Library, Dryad, AARNet, Center for Digital Scholarship at the Leiden University, and DANS. Anyone could join the Sprint and roughly 25 groups/individuals participated from The Netherlands, Germany, Australia, United States, Hungary, Norway, Italy, and Belgium. See the full list of registered Sprinters. Sprinters worked off of a primer that was provided in advance together with an online ARDC webinar introducing FAIR and the Sprint titled, "Ready, Set, Go! Join the Top 10 FAIR Data Things Global Sprint." Groups/individuals developed their Things in Google docs which could be accessed and edited by all participants. The Sprinters also used a Zoom channel provided by ARDC, for online calls and coordination, and a Gitter channel, provided by Library Carpentry, to chat with each other throughout the two-days. In addition, participants used the Twitter hashtag #Top10FAIR to communicate with the broader community, sometimes including images of the day. Participants greeted each other throughout the Sprint and created an overall welcoming environment. As the Sprint shifted to different timezones, it was a chance for participants to catch up. The Zoom and Gitter channels were a way for many to connect over FAIR but also discuss other topics. A number of participants did not know what to expect from a Library Carpentry/Carpentries-like event but found a welcoming environment where everyone could participate. The Top 10 FAIR Data & Software Things repository and website hosts the work of the Sprinters and is meant to be an evolving resource. Members of the wider community can submit issues and/or pull requests to the Things to help improve them. In addition, a published version of the Things will be made available via Zenodo and the Data Management Training Clearinghouse in February 2019

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes