‘Connectivity’: Seeking conditions and connections for radical discourses and praxes in health, mental health and social work

This paper begins with reflections on the development and spread of the ideas, discourse and praxis of radical social work in the 1970s and the cross-fertilisation of these discourses and praxes with discourses and praxes within radical health and mental health initiatives. During these years, for many in the fields of health, mental health and social work, their work and their lives were characterised by active involvement in a range of campaigns focused upon health, mental health and social work issues, together with shared values of more transparent and supportive work with users of health, mental health and social work services and a commitment to greater understanding through social and political theorising. This analysis is compared with the present where workplace cultures in health and social work emphasise meeting delivery and performance targets. It is argued that workers currently in health, mental health and social work with children and with adults share many similar experiences. Hegemonic discourses and praxes appear immoveable, but dissatisfaction with the status quo can become a disinhibiting factor. Building from experiences and analysis, exploration is begun into what conditions and connections might be needed now to develop radical discourses and praxes in health, mental health and social work

An unusual cause of caecal perforation in a child

Faecolith impaction leading to caecal perforation is a rare cause of acute abdominal pain in children. We present a case of an 11-year-old boy who was admitted to our department with a perforated caecum caused by faecolith impaction. Histology demonstrated a normal appendix with ganglion cells present. No mechanism of action could be detected for the faecolith impaction. This is a previously unreported cause of caecal perforation in children

Association of haemodynamic changes measured by serial central venous saturation during ultrafiltration for acutely decompensated heart failure with diuretic resistance and change in renal function.

BACKGROUND: Patients with acute decompensated heart failure with diuretic resistance (ADHF-DR) have a poor prognosis. The aim of this study was to assess in patients with ADHF-DR, whether haemodynamic changes during ultrafiltration (UF) are associated with changes in renal function (Δcreatinine) and whether Δcreatinine post UF is associated with mortality. METHODS: Seventeen patients with ADHF-DR underwent 20 treatments with UF. Serial bloods (4-6 hourly) from the onset of UF treatment were measured for renal function, electrolytes and central venous saturation (CVO2). Univariate and multivariate analysis were performed to assess the relationship between changes in markers of haemodynamics [heart rate (HR), systolic blood pressure (SBP), packed cell volume (PCV) and CVO2] and Δcreatinine. Patients were followed up and mortality recorded. Cox-regression survival analysis was performed to determine covariates associated with mortality. RESULTS: Renal function worsened after UF in 17 of the 20 UF treatments (baseline vs. post UF creatinine: 164±58 vs. 185±69μmol/l, P<0.01). ΔCVO2 was significantly associated with Δcreatinine [β-coefficient of -1.3 95%CI (-1.8 to -0.7), P<0.001] and remained significantly associated with Δcreatinine after considering changes in SBP, HR and PCV [P<0.001]. Ten (59%) patients died at 1-year and 15(88%) by 2-years. Δcreatinine was independently associated with mortality (adjusted-hazard ratio 1.03 (1.01 to 1.07) per 1μmol/l increase in creatinine; P=0.02). CONCLUSIONS: Haemodynamic changes during UF as measured by the surrogate of cardiac output was associated with Δcreatinine. Worsening renal function at end of UF treatment occurred in the majority of patients and was associated with mortality