Improving nurses' blood transfusion knowledge and skills.

The World Health Organization (2019) has determined that patient safety is a global public health challenge. In UK clinical areas, policies and procedures are in place for the safe prescribing and delivery of blood and blood product transfusions, yet patient safety incidences continue. Undergraduate nurse education and training may provide the underlying knowledge to practitioners, while postgraduate standalone training sessions support skill development. However, over time, without regular experience, competence will diminish. Nursing students may have little exposure to transfusion practice and COVID-19 may have exacerbated this challenge with a reduction in placement availability. The use of simulation to support theory with follow-up and ongoing drop-in training sessions may help to inform practitioners and improve patient safety in the management and delivery of blood and blood product transfusion.

Safety and immunogenicity of the inactivated whole-virus adjuvanted COVID-19 vaccine VLA2001: A randomized, dose escalation, double-blind phase 1/2 clinical trial in healthy adults.

OBJECTIVES: We aimed to evaluate the safety and optimal dose of a novel inactivated whole-virus adjuvanted vaccine against SARS-CoV-2: VLA2001. METHODS: We conducted an open-label, dose-escalation study followed by a double-blind randomized trial using low, medium and high doses of VLA2001 (1:1:1). The primary safety outcome was the frequency and severity of solicited local and systemic reactions within 7 days after vaccination. The primary immunogenicity outcome was the geometric mean titre (GMT) of neutralizing antibodies against SARS-CoV-2 two weeks after the second vaccination. The study is registered as NCT04671017. RESULTS: Between December 16, 2020, and June 3, 2021, 153 healthy adults aged 18-55 years were recruited in the UK. Overall, 81.7% of the participants reported a solicited AE, with injection site tenderness (58.2%) and headache (46.4%) being the most frequent. Only 2 participants reported a severe solicited event. Up to day 106, 131 (85.6%) participants had reported any AE. All observed incidents were transient and non-life threatening in nature. Immunogenicity measured at 2 weeks after completion of the two-dose priming schedule, showed significantly higher GMTs of SARS-CoV-2 neutralizing antibody titres in the highest dose group (GMT 545.6; 95% CI: 428.1, 695.4) which were similar to a panel of convalescent sera (GMT 526.9; 95% CI: 336.5, 825.1). Seroconversion rates of neutralizing antibodies were also significantly higher in the high-dose group (>90%) compared to the other dose groups. In the high dose group, antigen-specific IFN-γ expressing T-cells reactive against the S, M and N proteins were observed in 76, 36 and 49%, respectively. CONCLUSIONS: VLA2001 was well tolerated in all tested dose groups, and no safety signal of concern was identified. The highest dose group showed statistically significantly stronger immunogenicity with similar tolerability and safety, and was selected for phase 3 clinical development.

Advances for future working following an online dramatherapy group for adults with intellectual disabilities and mental ill health during the COVID-19 pandemic: A service evaluation for Cumbria, Northumberland Tyne and Wear NHS Foundation Trust.

Background: During the COVID-19 pandemic, social distancing measures were enforced and the national lockdown underlined our reliance on virtual means as a way to communicate. This new way of interacting highlighted that people with an intellectual disability were a large proportion of a digitally excluded population. Methods: A service evaluation, using a mixed method design in the form of four self-reported outcome measures and qualitative feedback. Findings: Clinical services need to continue when face to face sessions are not possible. Remote groups can be an alternative option not only when self-isolating due to pandemics but when living in remote locations, having physical health problems or excessive expenses and travel costs. Conclusions: Online dramatherapy groups can be a beneficial alternative when face to face groups are not possible or challenging to attend due to access difficulties. Online groups can offer opportunities to meet with peers, build relationships, improve confidence and learn new skills in technology.

High rates of diabetic ketoacidosis in children with new onset type 1 diabetes during the SARS-CoV-2 pandemic

BackgroundIn the UK, around 25% of children and young people with type 1 diabetes mellitus (T1D) present in life-threatening diabetic ketoacidosis (DKA), a state of acute metabolic decompensation requiring hospitalisation. This carries significant morbidity and is associated with higher HbA1c (glycosylated haemoglobin), a maker of blood glucose exposure, both at diagnosis and in the long-term, which is a predictor of long-term complications.The SARS-CoV-2 (Covid-19) pandemic has changed how people access healthcare. In order to determine the impact that the pandemic has had on children presenting with T1D, we compared the presentation of new cases before and during the pandemic.ObjectivesTo compare presentations of new-onset T1D to the Oxford Children’s diabetes service during two time points: pre-Covid-19 (Cohort 1;February 2019 to July 2019) Vs. the first Covid-19 peak (Cohort 2;February 2020 to July 2020).MethodsMedical records of patients aged under 18 years with new-onset T1D were reviewed retrospectively. Data were collected using a standardised proforma, which included symptom duration, route of referral, presence of DKA, presenting HbA1c and C-peptide.ResultsWe identified 13 patients in cohort 1 and 17 in cohort 2;median age was 11.92 years (range 1.5 - 17.4 years) vs 9.1 years (range 3.76 to 14.9 years).DKA rates were higher during the first phase of the pandemic;Cohort 1: 23% (n=3/13) vs Cohort 2: 71% (n=12/17);p=0.01. There was a trend towards a longer symptom duration during the pandemic, (Cohort 1: 2.3 weeks vs Cohort 2: 5.7 weeks) though this was not statistically significant (p=0.06). Presenting symptoms were comparable in the two cohorts with polydipsia being most frequently reported. There was no difference in mean HbA1c (HbA1c 109.6 mmol/mol vs 109.9 mmol/mol;p=0.98) or C-peptide levels (173.6 vs 189.8, p=0.98). The increased rates of DKA were seen in all severities (mild, moderate and severe).ConclusionsDKA rates are higher during the first wave of the pandemic and there was a trend towards a longer duration of symptoms preceding diagnosis. The reasons behind these findings are multifactorial involving changes to health-seeking behaviours, and reduced access to same day appointments in primary care. The increased DKA rate may be attributed to longer symptom duration prior to presentation, however a pro-inflammatory state associated with SARS-CoV-2 infection in paediatric populations is being increasingly recognised.

The association between COVID-19, personal wellbeing, depression, and suicide risk factors in Australian autistic adults.

The COVID-19 pandemic has had a significant impact on the mental health and wellbeing of the world's population, with particularly negative effects on vulnerable populations, including autistic people. Although some consensus regarding specific impact on aspects of wellbeing and mental health in autism is starting to emerge, it is unclear whether the pandemic has increased suicide risk. The goals of this study were to examine (a) potential associations between COVID-19 impact and depression, personal wellbeing, and suicide risk factors in Australian autistic adults and (b) age and gender effects. The COVID-19 Impact Scale (CIS), Personal Wellbeing Index, Patient Health Questionnaire, and the Suicide Behavior Questionnaire, Revised (SBQ-R), were administered to 111 autistic adults aged 20 to 71 years during the second wave of the COVID-19 pandemic in Australia. COVID-19 impact showed small associations with poorer personal wellbeing (r = -0.224, p = 0.023, [-0.409, -0.016]) and higher depressive symptoms (r = 0.268, p = 0.006, [0.056, 0.445]) and was not associated with the SBQ-R suicide risk score (r = 0.081, p = 0.418, [-0.118, 0.264). No significant effects were identified for age. Although model results were similar for women and men, the strength of the associations between personal wellbeing and depression (z = -2.16, p = 0.015), and depression and SBQ-R suicide risk (z = 1.961, p = 0.025), were stronger in women than in men. Qualitative analysis of an open response question from the CIS suggested that the pandemic had both positive and negative impacts on participants. The COVID-19 pandemic has had a large impact on the mental health and wellbeing of the world's population, particularly vulnerable populations such as autistic people. It is not known if these impacts on mental health and wellbeing have increased suicide risk. Our findings suggest that the impact of the COVID-19 pandemic may be associated with poorer wellbeing and higher depression, but is not associated with suicide risk. Overall, autistic people reported both positive and negative impacts of the pandemic on their lives.