The SECURE STAIRS framework: preliminary evaluation of the impact on therapeutic climate in a secure children's home (SCH)

PurposeThe SECURE STAIRS framework for integrated care is a trauma-informed approach to supporting staff and young people within the Children and Young People's Secure Estate (CYPSE) in the UK. Within secure settings, therapeutic climate is a concept that encapsulates an individual's perception of safety, connectedness with others and level of support within the environment. To support evaluation of the SECURE STAIRS framework, a Secure Children's Home (SCH) within the North East of England examined therapeutic climate for staff and young people annually using the Essen Climate Evaluation Schema (EssenCES) over a three-year period. This paper aims to present the findings.Design/methodology/approachOver the three years, a total of 71 young people and 214 staff EssenCES questionnaires were administered. Between 2020 and 2021, the setting also experienced significant changes resulting from the COVID-19 pandemic. Numbers of young people also decreased within the setting over the three-year period.FindingsResults indicated a positive trend for therapeutic climate sub-scores. For example, Experienced Safety for young people significantly increased from 2020 to 2021. Additionally, therapeutic hold for staff was significantly higher in 2020 and 2021 in comparison to 2018.Originality/valueFindings are discussed in relation to implementation of the SECURE STAIRS framework and providing trauma-informed care for vulnerable young people within secure settings. Implications for practice are explored.

The virtual patient group: an effective way of engaging patients and gathering essential feedback to improve service delivery and medical care for Chronic Hepatitis B patients

Chronic hepatitis B (CHB) patients require long term medical care, with regular monitoring blood tests and ultrasound scans. The COVID-19 pandemic disrupted outpatient services and many patients fell ‘out of sync’ with their routine care;missing scans, blood tests and running out of medication as a result. Telephone appointments are now routine in outpatient care, and fewer patients attend for F2F appointments than pre-pandemic. We developed a virtual patient forum for patient engagement and service evaluation.Patients were invited to take part in a virtual patient group during routine telephone appointments. Further information was sent by email with a link to virtual meeting. Meetings were scheduled in weekday evenings to allow those who are currently working to attend, with a duration of 1–1.5 hours. Feedback surveys were sent out via email, and notes from the meeting were sent to patient participants for approval.Results3 sessions were held virtually between November 2021 – June 2022. A total of 14 patient interactions across 3 sessions (Male n=5, Female n= 3). A doctor chaired the sessions and a nurse specialist was also in attendance. Topics raised varied but there was repeated discussion regarding treatment, patient support and disease information. Diagnosis was highlighted as particularly difficult;patients suggested increasing available resources. Patients on treatment reported difficulties obtaining repeat prescriptions, uncertainty about long-term implications of taking medication and requested more information on treatment and new therapies.Post feedback surveys were distributed within 1 week of the sessions and had a 78% completion rate. All respondents reported sessions were useful to them. Additional comments mentioned the utility of speaking to other CHB patients (n=5,) the value of being able to “contribute in a way which helps services develop/improve” (n=3,) having an avenue to “express concerns” (n=2) and opportunity to hear about treatment developments (n=2).Patient expectations of the sessions were as follows;wanting to engage with other patients (n=8,) engaging with the clinical team (n=5,) raising concerns/issues (n=4) and a desire for more information about CHB (n=4.) All patients stated the sessions met their expectations, and that they would be interested in attending similar sessions in future.ConclusionsVirtual patient groups were effective in our patient cohort for gathering feedback on service delivery and formulating goals for future work and service improvement. Patients respond positively to the opportunity to share their opinions, and this enables effective collaboration necessary to drive change.

Understanding Redeployment During the COVID-19 Pandemic: A Qualitative Analysis of Nurse Reported Experiences.

Introduction: The COVID-19 pandemic disrupted healthcare working conditions causing the redeployment of nurses. Redeployment refers to assigning healthcare workers to units or specialty areas where they do not regularly work. Objective: The purpose of this study was to explore the lived experiences of redeployed nurses during the COVID-19 pandemic from April 27, 2020 to May 7, 2020. Methods: Data collection occurred through a cross-sectional survey with demographic items and a single open-ended item. This open-ended item was part of a larger study regarding work conditions during the initial COVID-19 surge in the spring of 2020 in the Midwest United States (US). This analysis was performed separately due to the volume of qualitative responses and details provided. The survey was posted in private social media groups, and 298 nurses participated, 117 shared open-ended responses. Participants were asked what type of unit they worked on before COVID-19 and what unit they were deployed to. Findings: Twenty-three (19.7%) reported deployment to COVID-designated units. Twenty-eight (23.9%) participants reported deployment to a unit outside of their specialty. Sixteen (13.7%) reported deployment from a non-critical care unit to an intensive care unit. Three major themes developed from the open-ended responses: (1) challenges related to their scope of practice and specialization, (2) challenges with interpersonal dynamics, and (3) challenges related to the environment. Conclusion: The described challenges caused some nurses to report primarily negative experiences regarding redeployment during the COVID-19 pandemic. The findings add to the existing literature regarding redeployment and the vulnerability hospitals and their staff face during a disaster or pandemic-related events, such as COVID-19. Ultimately, aiding in the development of new policies to facilitate effective pandemic response in the future that would support nurses to participate in redeployment in a safe and nontraumatic way, is necessary.

The ß-NGF/TrkA Signalling Pathway Is Associated With the Production of Anti-Nucleoprotein IgG in Convalescent COVID-19.

Background: The presentation of SARS-CoV-2 infection varies from asymptomatic to severe COVID-19. Similarly, high variability in the presence, titre and duration of specific antibodies has been reported. While some host factors determining these differences, such as age and ethnicity have been identified, the underlying molecular mechanisms underpinning these differences remain poorly defined. Methods: We analysed serum and PBMC from 17 subjects with a previous PCR-confirmed SARS-CoV-2 infection and 10 unexposed volunteers following the first wave of the pandemic, in the UK. Anti-NP IgG and neutralising antibodies were measured, as well as a panel of infection and inflammation related cytokines. The virus-specific T cell response was determined by IFN-γ ELISPOT and flow cytometry after overnight incubation of PBMCs with pools of selected SARS-CoV-2 specific peptides. Results: Seven of 17 convalescent subjects had undetectable levels of anti-NP IgG, and a positive correlation was shown between anti-NP IgG levels and the titre of neutralising antibodies (IC50). In contrast, a discrepancy was noted between antibody levels and T cell IFN-γ production by ELISpot following stimulation with specific peptides. Among the analysed cytokines, ß-NGF and IL-1α levels were significantly different between anti-NP positive and negative subjects, and only ß-NGF significantly correlated with anti-NP positivity. Interestingly, CD4+ T cells of anti-NP negative subjects expressed lower amounts of the ß-NGF-specific receptor TrkA. Conclusions: Our results suggest that the ß-NGF/TrkA signalling pathway is associated with the production of anti-NP specific antibody in mild SARS-CoV-2 infection and the mechanistic regulation of this pathway in COVID-19 requires further investigation.

Differential immunogenicity of homologous versus heterologous boost in Ad26.COV2.S vaccine recipients.

BACKGROUND: Protection offered by coronavirus disease 2019 (COVID-19) vaccines wanes over time, requiring an evaluation of different boosting strategies to revert such a trend and enhance the quantity and quality of Spike-specific humoral and cellular immune responses. These immunological parameters in homologous or heterologous vaccination boosts have thus far been studied for mRNA and ChAdOx1 nCoV-19 vaccines, but knowledge on individuals who received a single dose of Ad26.COV2.S is lacking. METHODS: We studied Spike-specific humoral and cellular immunity in Ad26.COV2.S-vaccinated individuals (n = 55) who were either primed with Ad26.COV2.S only (n = 13) or were boosted with a homologous (Ad26.COV2.S, n = 28) or heterologous (BNT162b2, n = 14) second dose. We compared our findings with the results found in individuals vaccinated with a single (n = 16) or double (n = 44) dose of BNT162b2. FINDINGS: We observed that a strategy of heterologous vaccination enhanced the quantity and breadth of both Spike-specific humoral and cellular immunity in Ad26.COV2.S-vaccinated individuals. In contrast, the impact of the homologous boost was quantitatively minimal in Ad26.COV2.S-vaccinated individuals, and Spike-specific antibodies and T cells were narrowly focused to the S1 region. CONCLUSIONS: Despite the small sample size of the study and the lack of well-defined correlates of protection against COVID-19, the immunological features detected support the utilization of a heterologous vaccine boost in individuals who received Ad26.COV2.S vaccination. FUNDING: This study is partially supported by the Singapore Ministry of Health's National Medical Research Council under its COVID-19 Research Fund (COVID19RF3-0060, COVID19RF-001, and COVID19RF-008), The Medical College St. Bartholomew's Hospital Trustees - Pump Priming Fund for SMD COVID-19 Research.

Traumatic stress among frontline American nurses during the COVID-19 pandemic: A survey study

Nurses working on the front lines of the COVID-19 pandemic are at inherent risk of traumatic stress working in understaffed, poorly equipped, high acuity environments. Post-traumatic stress disorder (PTSD) may develop following exposure to trauma or stress associated with depressive symptoms, flashbacks, and mood disturbance. The purpose of this study was to assess the prevalence of traumatic stress among American frontline nurses following the initial COVID-19 surge in the United States during March 2020 using the Trauma Screening Questionnaire. This cross-sectional survey study was distributed via social media in May 2021 following the initial COVID-19 surge. The (TSQ) was selected for its strong psychometric performance in previous studies and high clinical reliability in detecting those at risk for PTSD. Results: Out of the 298 acute care nurses practicing in the United States who participated in the survey, 58.7% had a positive score of greater than 6 indicating the risk of PTSD. Front line nurses who provided care during the initial COVID-19 surge reported high levels of traumatic stress and demonstrated the risk of developing PTSD as measured by the TSQ. Health systems that employ frontline nurses must increase screening for mental health ramifications during the global pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Disparities of SARS-CoV-2 Nucleoprotein-Specific IgG in Healthcare Workers in East London, UK.

Introduction: SARS-CoV-2 antibody detection serves as an important diagnostic marker for past SARS-CoV-2 infection and is essential to determine the spread of COVID-19, monitor potential COVID-19 long-term effects, and to evaluate possible protection from reinfection. A study was conducted across three hospital sites in a large central London NHS Trust in the UK, to evaluate the prevalence and duration of SARS-CoV-2 IgG antibody positivity in healthcare workers. Methods: A matrix equivalence study consisting of 228 participants was undertaken to evaluate the Abbott Panbio™ COVID-19 IgG/IgM rapid test device. Subsequently, 2001 evaluable healthcare workers (HCW), representing a diverse population, were enrolled in a HCW study between June and August 2020. A plasma sample from each HCW was evaluated using the Abbott Panbio™ COVID-19 IgG/IgM rapid test device, with confirmation of IgG-positive results by the Abbott ArchitectTM SARS-CoV-2 IgG assay. 545 participants, of whom 399 were antibody positive at enrolment, were followed up at 3 months. Results: The Panbio™ COVID-19 IgG/IgM rapid test device demonstrated a high concordance with laboratory tests. SARS-CoV-2 antibodies were detected in 506 participants (25.3%) at enrolment, with a higher prevalence in COVID-19 frontline (28.3%) than non-frontline (19.9%) staff. At follow-up, 274/399 antibody positive participants (68.7%) retained antibodies; 4/146 participants negative at enrolment (2.7%) had seroconverted. Non-white ethnicity, older age, hypertension and COVID-19 symptoms were independent predictors of higher antibody levels (OR 1.881, 2.422-3.034, 2.128, and 1.869 respectively), based on Architect™ index quartiles; participants in the first three categories also showed a greater antibody persistence at 3 months. Conclusion: The SARS-CoV-2 anti-nucleocapsid IgG positivity rate among healthcare staff was high, declining by 31.3% during the 3-month follow-up interval. Interestingly, the IgG-positive participants with certain risk factors for severe COVID-19 illness (older age, Black or Asian Ethnicity hypertension) demonstrated greater persistence over time when compared to the IgG-positive participants without these risk factors.