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"Spelman, Nicola"
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All the Madmen: Popular Music, Anti-Psychiatry and the Myths of Madness
To date, very little research has been conducted with respect to representations of madness in popular music, and yet comparative studies of classical opera, film, television, and literature have already demonstrated how constructions of madness may be referenced in order to stigmatise but also liberate protagonists in ways that reinforce or challenge contemporaneous notions of normality. In an effort to redress this balance, this study identifies links between the anti-psychiatry movement and representations of madness in popular music of the 1960s and 1970s, analysing the various ways in which ideas critical of institutional psychiatry are embodied both verbally and musically in specific songs by David Bowie, Lou Reed, Pink Floyd, Alice Cooper, the Beatles, and Elton John. It concentrates on meanings that may be made at the point of reception as a consequence of ideas about madness that were circulating at the time. These ideas are then linked to contemporary conventions of musical expression in order to illustrate certain interpretative possibilities. Supporting evidence comes from popular musicological analysis - incorporating discourse analysis and social semiotics - and investigation of socio-historical context. The uniqueness of the period in question is demonstrated by means of a more generalised overview of songs drawn from a variety of styles and eras that engage with the topic of madness in diverse and often conflicting ways. The conclusions drawn reveal the extent to which anti-psychiatric ideas filtered through into popular culture, offering insights into popular music's ability to question general suppositions about madness alongside its potential to bring issues of men's madness into the public arena as an often neglected topic for discussion.
Dissertation
Multicentre stepped-wedge cluster randomised controlled trial of an antimicrobial stewardship programme in residential aged care: protocol for the START trial
IntroductionAntimicrobial resistance is a growing global health threat, driven by increasing inappropriate use of antimicrobials. High prevalence of unnecessary use of antimicrobials in residential aged care facilities (RACFs) has driven demand for the development and implementation of antimicrobial stewardship (AMS) programmes. The Stepped-wedge Trial to increase antibiotic Appropriateness in Residential aged care facilities and model Transmission of antimicrobial resistance (START) will implement and evaluate the impact of a nurse-led AMS programme on antimicrobial use in 12 RACFs.Methods and analysisThe START trial will implement and evaluate a nurse-led AMS programme via a stepped-wedge cluster randomised controlled trial design in 12 RACFs over 16 months. The AMS programme will incorporate education, aged care-specific treatment guidelines, documentation forms, and audit and feedback strategies that will target aged care staff, general practitioners, pharmacists, and residents and their families. The intervention will primarily focus on urinary tract infections, lower respiratory tract infections, and skin and soft tissue infections. RACFs will transition from control to intervention phases in random order, two at a time, every 2 months, with a 2-month transition, wash-in period. The primary outcome is the cumulative proportion of residents within each facility prescribed an antibiotic during each month and total days of antibiotic use per 1000 occupied bed days. Secondary outcomes include the number of courses of systemic antimicrobial therapy, antimicrobial appropriateness, antimicrobial resistant organisms, Clostridioides difficile infection, change in antimicrobial susceptibility profiles, hospitalisations and all-cause mortality. Analyses will be conducted according to the intention-to-treat principle.Ethics and disseminationEthics approval has been granted by the Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/591). Research findings will be disseminated through peer-reviewed publications, conferences and summarised reports provided to participating RACFs.Trial registration numberNCT03941509.
Journal Article