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Background: A call to action is in effect for nurses to be change agents and bridge the gaps between the delivery of health care and the social needs of individuals, families, and communities. Response to this charge requires nurses to address long-standing inequity in health care policy and practice realms. Method: This article describes the creative teaching-learning approach of critical reflection practice as a first step in developing skills and attitude for nurses to do this work. Results: Early observations of the effect of critical reflection practice on learners show improved appreciation for the intersection of social, economic, and political dimensions operating in health care policy and practice that influence health inequities. Conclusion: When nurses engage in a practice of critical reflection, they are more likely to identify offensive social determinants, act to ameliorate disparities, and advance the agenda for health equity. [ J Nurs Educ . 2023;62(5):312–315.]

We report a clinicopathological case of a patient with a rapidly enlarging nonpigmented nodule on the chest wall. There was no personal or family history of skin disease or cutaneous malignancy.

Background and objectives Research indicates the value of targeting emotional regulation (ER) skills in psychological interventions for psychosis. These skills can be delivered in a group format, thereby increasing access to therapy. This pilot study examined the acceptability and clinical effects of teaching ER skills in The Living Through Psychosis (LTP) group programme. Methods Patients with a psychotic illness were offered the LTP programme, comprising eight sessions over four weeks. Measures were completed by 55 participants. Acceptability was assessed by attendance rates and group cohesion. Measures of intervention targets, recovery and clinical outcomes were completed at baseline, pre-group, post-group, and one-month follow-up. Results High group attendance and cohesion support the acceptability of the group. Participants reported less difficulty with ER (Coeff. = −8.29, 95% CI: −13.40 to −3.18, within participant uncontrolled effect size (ES) d = 0.29), increased mindful relating to distressing symptoms (Coeff. = 11.20, 95% CI: 7.02 to 15.38, d = 0.65), and improvements in recovery dimensions (Coeff. = 10.07, 95% CI: 5.6 to 14.54, d = 0.42) from pre-to post-intervention, and maintained at one-month follow-up. Participants’ hallucinations and delusions reduced from pre-intervention to follow-up (t(18) = 4.64, p < 0.001; t(18) = 5.34, p < 0.001). There was no change in fear of relapse. Limitations The uncontrolled, pre-post design precluded blinded assessments, and may have inflated effect sizes. Other factors may have contributed to the improvements. Conclusions The LTP programme was acceptable to people with psychosis. The preliminary findings indicate the potential utility of teaching ER and mindfulness skills in a brief group programme. Findings require replication in a randomized controlled trial.

Background People with schizophrenia are ten times more likely to commit homicide than a member of the general population. The relationship between symptoms of schizophrenia and acts of violence is unclear. There has also been limited research on what determines the seriousness and form of violence, such as reactive or instrumental violence. Moral cognition may play a paradoxical role in acts of violence for people with schizophrenia. Thoughts which have moral content arising from psychotic symptoms may be a cause of serious violence. Method We investigated if psychotic symptoms and moral cognitions at the time of a violent act were associated with acts of violence using a cross-sectional national forensic cohort (n = 55). We examined whether moral cognitions were associated with violence when controlling for neurocognition and violence proneness. We explored the association between all psychotic symptoms present at the time of the violent act, psychotic symptoms judged relevant to the violent act and moral cognitions present at that time. Using mediation analysis, we examined whether moral cognitions were the missing link between symptoms and the relevance of symptoms for violence. We also investigated if specific moral cognitions mediated the relationship between specific psychotic symptoms, the seriousness of violence (including homicide), and the form of violence. Results Psychotic symptoms generally were not associated with the seriousness or form of violence. However, specific moral cognitions were associated with the seriousness and form of violence even when controlling for neurocognition and violence proneness. Specific moral cognitions were associated with specific psychotic symptoms present and relevant to violence. Moral cognitions mediated the relationship between the presence of specific psychotic symptoms and their relevance for violence, homicide, seriousness of violence, and the form of violence. Conclusions Moral cognitions including the need to reduce suffering, responding to an act of injustice or betrayal, the desire to comply with authority, or the wish to punish impure or disgusting behaviour, may be a key mediator explaining the relationship between psychotic symptoms and acts of violence. Our findings may have important implications for risk assessment, treatment and violence prevention.

SummaryThe SARS-CoV-2 pandemic has affected more than 70 million people worldwide and resulted in over 1.5 million deaths. A broad deployment of effective immunization campaigns to achieve population immunity at global scale will depend on the biological and logistical attributes of the vaccine. Here, two adeno-associated viral (AAV)-based vaccine candidates demonstrate potent immunogenicity in mouse and nonhuman primates following a single injection. Peak neutralizing antibody titers remain sustained at 5 months and are complemented by functional memory T-cells responses. The AAVrh32.33 capsid of the AAVCOVID vaccine is an engineered AAV to which no relevant pre-existing immunity exists in humans. Moreover, the vaccine is stable at room temperature for at least one month and is produced at high yields using established commercial manufacturing processes in the gene therapy industry. Thus, this methodology holds as a very promising single dose, thermostable vaccine platform well-suited to address emerging pathogens on a global scale.

Background: Electronic patient-reported outcomes (ePROs) are a reliable method for collecting data in clinical trials and offer many advantages over paper collection. It is essential to consider patient preference and ease of use when employing this technology. Improving the usability of ePRO in COPD clinical trials could reduce subject burden and improve engagement. Methods: 103 subjects with chronic obstructive pulmonary disease (COPD) were surveyed regarding their preferences for ePRO display. Results: Subjects thought that underlining (33%) and capitalization (33%) best drew attention to emphasized words on an ePRO screen. Subjects saw screens of a multi-select question displayed to the left of or above the answer options. 46% could read and understand the screens equally; of those with a preference, 63% preferred the top to bottom format. Subjects saw screens of a tablet ePRO device with one question per screen or several questions per screen. 54% preferred one question per screen because it was easier to read (66%) and easier to understand the question (41%). 46% preferred multiple questions per screen because it was easier to read (51%) and faster to complete (40%). Subjects were shown two screens with “back” and “next” navigation buttons at either the top or bottom of the screen. 24% thought it was equally easy to find the buttons; of those with a preference, 74% preferred them at the bottom. Conclusions: Trial sponsors should consider incorporating these patient preference results into the design of ePRO instruments, potentially reducing subject burden and increasing patient engagement in COPD clinical trials.

Purpose: Telephone interviews may be a cost-effective alternative to administering stroke outcome measures for people who are living in the community following a stroke, but there is a lack of research that has compared the different modes of administering outcome measures. The aim of this study was to determine whether telephone administration of selected stroke outcome measures resulted in significantly different results to face-to-face administration of the same outcome measures. Method: Nineteen participants who were taking part in a randomised controlled trial (RCT) evaluating the effectiveness of a postdischarge education and support package for stroke patients and their carers were recruited for this study. Participants had the RCT follow-up outcome measures, at 3 months post discharge, administered by both telephone and face-to-face. Participants were randomised to receive either the telephone or face-to-face administration first and a period of 2 weeks separated the two administrations. Outcome measures were the Knowledge of Stroke Questionnaire, a stroke self-efficacy questionnaire, Hospital Anxiety and Depression Scale, Stroke and Aphasia Quality of Life Scale, and the Caregiver Strain Index. Results: There were no significant differences between scores obtained on any of the outcome measures that were administered by telephone and face-to-face (P>.05). Conclusion: The telephone can be used to administer the outcome measures that were evaluated in this study to stroke patients and carers. These findings may be of benefit to stroke researchers and clinicians who wish to incorporate the use of telephone measures into the follow-up care of stroke patients and their carers.

Background The benefit of patch testing patients with oral lichenoid lesions (OLL) is still debated. Objective We assessed the results of patch testing in patients with multiple amalgams and multiple OLL, where the etiology of the oral mucosal disease was unclear. Methods Patients referred from an oral medicine clinic were patch tested to the British Society of Cutaneous Allergy standard series, dental and materials series, and, in 1 patient, the dental methacrylate series also. Patients' responses to amalgam removal were assessed during a mean follow-up of 2.6 (range, 0-4.75) years. Results Thirty-one patients with OLL were referred for patch testing. Ten (32%) patients tested positively to mercury. Eight patients with positive reactions to mercury had amalgam removal, with complete or partial resolution of the OLL in all cases (100%). Conclusions Patients with OLL of unclear etiology adjacent to large amalgam restorations should be investigated for delayed contact hypersensitivity. Removal of amalgams in patients with positive patch test reactions to mercury results in improvement or resolution of the OLL in most patients.