Evaluation of pause

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Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Transitional Safeguarding: Exploring opportunities and challenges in systems supporting young people and young adults who experience extra-familial risks

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Safeguarding young people in transition to adulthood: unsettling binaries and spanning boundaries

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‘I was detecting a kind of, a from the heart kind of dialogue’: understanding the role of reflective spaces for Transitional Safeguarding innovation

Over the past four years the Innovate Project, an ESRC funded research project, has been exploring how innovation is undertaken and experienced by local authority task staffed with the responsibility of introducing new approaches in welfare provision for young people at risk of harm outside the home. This paper reports on our experiences of facilitating reflective discussion groups for professionals engaged in introducing Transitional Safeguarding in local authority contexts. Within this reflective space we became aware of how the emotional impact of innovation is under-recognised and must be attended to to ensure that the investment of people’s time and energy, alongside local authority finances, is not compromised. We draw on the psychoanalytic concept of the analytic third to highlight how such reflective spaces can provide the ‘emotional infrastructure’ to protect and promote the efficacy of innovation in challenging contexts.</p

Contemporary pespectives on adolescent safeguarding: ‘Holding young people in mind’ as part of transitional safeguarding development journey

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Born into care: newborn babies subject to care proceedings in England

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Evaluation of the implementation of a contextual safeguarding system in the London Borough of Hackney

This report presents the evaluation of the design and implementation of a pilot Contextual Safeguarding system in the London Borough of Hackney. The project was funded by the second round of the Department for Education’s (DfE’s) Innovation Programme. The project was led by Hackney Children and Families Service, working with an Academic Development Team at the University of Bedfordshire, led by Dr Carlene Firmin. The evaluation was conducted by the University of Sussex and Research in Practice. The setup and implementation phase of the project was April 2017 to March 2019, followed by an embedding phase April 2019 to March 2020

Evaluation of the process and impact of embedding Contextual Safeguarding in the London Borough of Hackney

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