Implementing psychological support for health and social care staff affected by the COVID-19 pandemic: a qualitative exploration of staff well-being hubs (‘Resilience Hubs’) using normalisation process theory

Objectives Evaluate the implementation of Hubs providing access to psychological support for health and social care keyworkers affected by the COVID-19 pandemic. Design Qualitative interviews informed by normalisation process theory to understand how the Hub model became embedded into normal practice, and factors that disrupted normalisation of this approach. Setting Three Resilience Hubs in the North of England. Participants Hub staff, keyworkers who accessed Hub support (Hub clients), keyworkers who had not accessed a Hub, and wider stakeholders involved in the provision of staff support within the health and care system (N=63). Results Hubs were generally seen as an effective way of supporting keyworkers, and Hub clients typically described very positive experiences. Flexibility and adaptability to local needs were strongly valued. Keyworkers accessed support when they understood the offer, valuing a confidential service that was separate from their organisation. Confusion about how Hubs differed from other support prevented some from enrolling. Beliefs about job roles, unsupportive managers, negative workplace cultures and systemic issues prevented keyworkers from valuing mental health support. Lack of support from managers discouraged keyworker engagement with Hubs. Black, Asian and minority ethnic keyworkers impacted by racism felt that the Hubs did not always meet their needs. Conclusions Hubs were seen as a valuable, responsive and distinct part of the health and care system. Findings highlight the importance of improving promotion and accessibility of Hubs, and continuation of confidential Hub support. Policy implications for the wider health and care sector include the central importance of genuine promotion of and value placed on mental health support by health and social care management, and the creation of psychologically safe work environments. Diversity and cultural competency training is needed to better reach under-represented communities. Findings are consistent with the international literature, therefore, likely to have applicability outside of the current context

An experimental and analytical investigation of reinforced concrete beam-column joints strengthened with a range of CFRP schemes applied only to the beam

This paper investigates the experimental and analytical behaviour of beam-column joints that are subjected to a combination of torque, flexural and direct shear forces, where different Carbon Fibre Polymer (CFRP) strengthening wraps have been applied only to the beam. These wrapping schemes have previously been determined by the research community as an effective method of enhancing the torsional capacities of simply supported reinforced concrete beams. In this investigation, four 3/4-scale exterior beam-column joints were subjected to combined monotonic loading; three different beam wrapping schemes were employed to strengthen the beam region of the joint. The paper suggests a series of rational formulae, based on the space truss mechanism, which can be used to evaluate the joint shear demand of the beams wrapped in these various ways. Further, an iterative model, based on the average stress-strain method, has been introduced to predict joint strength. The proposed analytical approaches show good agreement with the experimental results. The experimental outcomes along with the adopted analytical methods reflect the consistent influence of the wrapping ratio, the interaction between the combined forces, the concrete strut capacity and the fibre orientation on the joint forces, the failure mode and the distortion levels. A large rise in the strut force resulting from shear stresses generated from this combination of forces is demonstrated and leads to a sudden-brittle failure. Likewise, increases in the beams’ main steel rebar strains are identified at the column face, again influenced by the load interactions and the wrapping systems used

Management Challenges of Metastatic Spinal Cord Compression in Pregnancy

Primary and secondary spinal tumours with cord compression often represent a challenging condition for the patient and clinicians alike, even more so during pregnancy. The balance between safe delivery of a healthy baby and management of the mother’s disease bears many clinical, psychological, and ethical dilemmas. Pregnancy sets a conflict between the optimal surgical and oncological managements of the mother’s tumour and the well-being of her foetus. We followed the CARE guidelines from the EQUATOR Network to report an exemplificative case of a 39-year-old woman with a 10-year history of breast cancer, presenting in the second trimester of her first pregnancy with acute onset severe thoracic spinal instability, causing mechanical pain and weakness in lower limbs. Neuroradiological investigations revealed multilevel spinal deposits with a pathological T10 fracture responsible for spinal cord compression. The patient was adamant that she wanted a continuation of the pregnancy and her baby delivered. After discussion with her oncologist and obstetrician, we agreed to perform emergency spinal surgery—decompression and instrumented fixation. The literature search did not reveal a similar case of spinal metastatic breast cancer undergoing spinal instrumentation and delivery of a healthy baby a few months later. Following the delivery, the patient had further oncological treatment, including chemotherapy and radiotherapy. The paucity of such reports prompted us to present this case and highlight the relevance of a multidisciplinary approach involving obstetrician, oncologist, spinal surgeon, and radiologist to guide the optimal decision-making process