Derby City Council

IMPACT This article examines an important area of public sector commodification: the medical assessments that determine eligibility for social security benefits. The commodification of this adjudication process has a significant impact on vulnerable welfare benefit claimants. The article has a particular focus on issues commonly experienced by claimants with mental health problems. Drawing on experience of working in the social welfare sector, the authors present professional reflections on the impact of commodification. Best practice guidelines for supporting claimants with social security medical assessments are presented; these make a new contribution by highlighting the approach needed by professionals to effectively navigate the privatized benefit assessment process.

This paper offers some insight into the benefits, impacts and challenges of the ‘creative mentor’ role. It links to a social pedagogy framework, supporting practice, and draws on creative mentors’ work with children and young people living in care. It aims to inform professionals and teams around a child about the transforming nature of working with creativity – beyond the obvious external experiences. Included are descriptions of how feelings of being ‘stuck’ can be shifted through engagement in a creative activity, moving a young person to a place of wellbeing, held within the safety of a trusting relationship. It is hoped that the reader will have a better understanding of the various stages of the creative mentoring process, and will reflect on some of the challenges faced when working with vulnerable children and young people who may have suffered early trauma. This paper describes how beginning work and establishing the relationship can be nerve-wracking for both, and how the skills of creative professionals bring a new dynamic into the work. Vignettes and discussions highlight the similarities in the creative mentor’s practice to that of the social pedagogue, and reflect on concepts and processes. We hope this work will encourage more discussion about the creative mentoring experience, to add to our community of learning around creative practices in care and in education.

ABSTRACT Research suggests that children with hearing loss face a number of difficulties in the education system, including socially. Although there has been much research with the severe to profound deaf population there has been little research into the life experiences of children with moderate hearing loss who attend mainstream secondary schools. This research sought to examine the experiences of social inclusion for five young people with moderate hearing loss. Data were gathered through semi-structured interviews in the young person’s school setting and were analysed using Interpretative Phenomenological Analysis (IPA). Although each participant had distinctive experiences, there were a number of common themes that emerged indicating the factors that support social inclusion and those which create barriers for deaf children in schools. Implications for educational psychologists are considered and the limitations of the research are outlined.

BackgroundThe absence of effective interventions in presence of increasing national incidence and case-fatality in acute kidney injury requiring dialysis (AKI-D) warrants a study of regional variation to explore any potential for improvement. We therefore studied regional variation in the epidemiology of AKI-D in English National Health Service over a period of 15 years.MethodWe analysed Hospital Episode Statistics data for all patients with a diagnosis of AKI-D, using ICD-10-CM codes, in English regions between 2000 and 2015 to study temporal changes in regional incidence and case-fatality.ResultsOf 203,758,879 completed discharges between 1st April 2000 and 31st March 2015, we identified 54,252 patients who had AKI-D in the nine regions of England. The population incidence of AKI-D increased variably in all regions over 15 years; however, the regional variation decreased from 3·3-fold to 1·3-fold (p<0·01). In a multivariable adjusted model, using London as the reference, in the period of 2000–2005, the North East (odd ratio (OR) 1·38; 95%CI 1·01, 1·90), East Midlands (OR 1·38; 95%CI 1·01, 1·90) and West Midlands (OR 1·38; 95%CI 1·01, 1·90) had higher odds for death, while East of England had lower odds for death (OR 0·66; 95% CI 0·49, 0·90). The North East had higher OR in all three five-year periods as compared to the other eight regions. Adjusted case-fatality showed significant variability with temporary improvement in some regions but overall there was no significant improvement in any region over 15 years.ConclusionsWe observed considerable regional variation in the epidemiology of AKI-D that was not entirely attributable to variations in demographic or other identifiable clinical factors. These observations make a compelling case for further research to elucidate the reasons and identify interventions to reduce the incidence and case-fatality in all regions.

SummaryAimsEpidemiology studies of acute kidney injury (AKI) have focused on cases requiring dialysis but those not requiring dialysis represent the majority. To address this gap, we interrogated hospital episode statistics (HES) to investigate population trends in temporal epidemiology of AKI not requiring dialysis between 1998 and 2013.MethodologyIn this retrospective observational study of HES data covering the entire English National Health Service, we identified 1,136,167 AKI events, not requiring dialysis, diagnosed between 1998 and 2013. We explored the effect of age, gender, ethnicity, Charlson's comorbidity score (CCS), method of admission, diagnosis period and AKI in diagnosis codes on temporal changes in the incidence and case‐fatality of AKI with specific examination of its predictors.ResultThe incidence of AKI increased from 15,463 cases (317 pmp) in 1998–1999 to 213,700 cases (3995 pmp) in 2012–2013. There was increase in proportion of people over 75 years from 51.1% in 1998–1999 to 63.4% in 2012–2013. Overall unadjusted case‐fatality decreased from 42.3% in 1998–2003 to 27.1% in 2008–2013, p < 0.001. Compared with 1998–2003, the multivariable adjusted odds ratio for death was 0.64 in 2003–2008 (95% CI 0.63–0.65) and 0.35 in 2008–2013 (95% CI 0.34–0.35). Odds for death were higher for patients over 85 years (2.93; 95% CI 2.89–2.97), CCS of more than five (2.75; 95% CI 2.71–2.79), emergency admissions (2.14; 95% CI 2.09–2.18) and AKI in the secondary diagnosis code (1.35; 95% CI 1.33–1.36) and AKI in other diagnoses codes (2.17; 95% CI 2.15–2.20).ConclusionsIn England, the incidence of AKI not requiring dialysis has increased and case‐fatality has decreased over last 15 years. Efforts to reduce the incidence of AKI and improve survival should focus on elderly people, emergency admissions and those with multi‐morbidity.