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Background Open doctor-patient communication is essential for accurate diagnosis and effective treatment. However, the communication modality (video consultation vs. in-person visit) may impact the process and create tradeoffs. Previous research suggests that while online communication negatively affects creative thinking, it can also enhance disclosure. This study seeks to investigate how the communication modality utilized in medical settings influences both creative idea generation on the part of clinicians and disclosure on the part of patients. Drawing upon established frameworks in health literacy, social identity theory, and cognitive psychology, we aim to examine how different communication modalities impact doctors’ ability to generate solutions to clinical problems and patients’ willingness to open up about these problems. Methods/design This open-label, randomized controlled trial will recruit a sample of medical students in their final year and actors simulating patients. Participants will be randomly assigned to either online video consultations or in-person visits. During these consultations, medical students will be presented with patient cases involving participants told to act out conditions (i.e., real people given a script and told to pretend it represents their story and their symptoms) and tasked with interviewing the patients and generating potential diagnoses. The primary outcomes of the study will be threefold: (1) the number of ideas generated by medical students regarding the diagnosis (“differential diagnosis”—regardless of being correct or incorrect), (2) whether or not the accurate diagnosis is reached, and (3) patients’ tendency toward disclosure. Discussion This study will contribute insights into the impact of communication modality on the balance between creative problem-solving and disclosure in medical settings. By examining the complex links between communication modality, creativity, and disclosure, the findings can have implications for the rapidly growing telehealth field and help inform the design and implementation of effective communication strategies that enhance patient care. Trial registration Trial is registered on ClinicalTrials.gov (Number NCT06784635). We also aim to pre-register this study on the Open Science Framework, as this is a behavioral science study.

The level of personal health literacy of patients with venous leg ulcers is likely to affect their ability to self-manage their condition impacting on their adherence to treatment and influences healing and recovery outcomes. To scope existing research that examined the level of health literacy in venous leg ulcer patients, to identify how this may link to self-management behaviours (particularly physical activity and compression adherence), and venous leg ulcer healing outcomes. This scoping review was based on the PRISMA-ScR six-stage framework. We searched MEDLINE, EMBASE, the Cochrane Library, PsycInfo and Health, Open Grey, and Google Scholar for publications examining general and specific health literacy in those with venous leg ulcers and for those examining any potential links of health literacy with self-management/healing generally, published between 2000-2020. This search was guided by a published protocol; studies that described other types of ulcers or did not examine health literacy were excluded. After applying inclusion and exclusion criteria the initial search identified 660 articles. We included five articles. Four studies used randomised controlled trials or experimental designs to test the effect of specific health literacy interventions on venous leg ulcer knowledge, compression therapy use, or healing outcomes. One study was a cross- sectional survey with qualitative elements, assessing health literacy in venous leg ulcer patients. Broadly, the research suggested that health literacy was suboptimal amongst those with venous leg ulcers, and health literacy interventions had limited effects on improving key venous leg ulcer specific outcomes. This review provides a synthesis of extant literature examining health literacy in patients with venous leg ulcers. We identified a dearth of literature investigating the value of general and specific health literacy interventions in this space. Most importantly, no recent research on general health literacy and venous leg ulcers was identified, despite strong theoretical utility to do so. The few studies identified largely indicated that targeting health literacy of patients with venous leg ulcers is a viable area of research and intervention, encouraging future researchers and clinicians to consider patient health literacy in venous leg ulcer management.

Group therapy is a scalable and effective treatment for anxiety disorders. However, when performed online, the reduced ability to identify with group members and the reduced interactivity can limit its appeal and effectiveness. Extended reality (XR) technology, including virtual reality and augmented reality, may help address these limitations, thereby enhancing the reach of online group therapy and the benefits that can be drawn from it. To understand how the incorporation of XR technology may improve online group therapy for anxiety disorders, this viewpoint paper examines evidence related to the treatment of anxiety disorders using offline group therapy, online group therapy, and virtual reality, as well as ways to increase social identification and interactivity with the platform, the therapist, and other users. This viewpoint paper suggests ways to integrate these research streams to leverage the strengths of XR platforms and improve group therapeutic offerings.

Prejudice reduction messages have been shown to be effective through changing norms. Previous research suggests that Right Wing Authoritarianism (RWA) moderates the reaction to these messages, but it is unclear whether individuals high in RWA are more or less sensitive to prejudice-reduction campaigns. This research used the social identity approach to investigate the role of RWA in moderating the reactions to messages that look to reduce support for prejudicial policies and associated prejudice against an ethnoreligious group (Muslims). Americans (N = 388) were presented with statements on a real, proposed ban on Muslim immigration into the US from an in-group member (i.e., an American freight worker who disapproves of the Muslim ban), outgroup member (an Iraqi refugee who is in favour if the Muslim ban), or both, or control message. Those high in RWA showed consistently high levels of prejudice against Muslims in all conditions, but those low in RWA showed lower prejudice when presented with the anti-prejudice message from an in-group member (compared to control). This suggests that anti-prejudice messages primarily affect those with low RWA, clarifying that RWA likely leads to resistance to anti-prejudice messages regardless of the source. Future research aiming to reduce prejudice should examine how messages can be tailored to reduce prejudice in those with high RWA.

Artificial intelligence (AI), particularly large language models (LLMs), is increasingly integrated into mental health care. This study examined racial bias in psychiatric diagnosis and treatment across four leading LLMs: Claude, ChatGPT, Gemini, and NewMes-15 (a local, medical-focused LLaMA 3 variant). Ten psychiatric patient cases representing five diagnoses were presented to these models under three conditions: race-neutral, race-implied, and race-explicitly stated (i.e., stating patient is African American). The models' diagnostic recommendations and treatment plans were qualitatively evaluated by a clinical psychologist and a social psychologist, who scored 120 outputs for bias by comparing responses generated under race-neutral, race-implied, and race-explicit conditions. Results indicated that LLMs often proposed inferior treatments when patient race was explicitly or implicitly indicated, though diagnostic decisions demonstrated minimal bias. NewMes-15 exhibited the highest degree of racial bias, while Gemini showed the least. These findings underscore critical concerns about the potential for AI to perpetuate racial disparities in mental healthcare, emphasizing the necessity of rigorous bias assessment in algorithmic medical decision support systems.

Background Group singing has been shown to have positive effects on health and well-being. These interventions have been shown to generally be helpful in enhancing health outcomes in people with stigmatising conditions. However, the effect of these interventions on biological markers of health is less understood. This scoping review will map the existing evidence on the effect of group singing interventions on biomarkers in people with stigmatising health conditions, such as HIV. This scoping review aims to explore the relationship between group singing interventions and biomarkers in people with stigmatising health conditions. Methods This review will follow the Joanna Briggs Institute methodology for scoping reviews. We will search the following databases: PubMed, CINAHL, PsycINFO, EMBASE, and Cochrane Library. We will also search grey literature sources, such as conference proceedings and dissertations. Two reviewers will independently screen titles and abstracts, and full-text articles for inclusion. Data will be extracted using a standardised form (PRISMA-SCR), and a narrative synthesis will be conducted. This review will consider studies that include adults with stigmatising health conditions who have participated in group singing interventions. Studies must also include biomarkers as outcome measures. Discussion Our research will provide a significant contribution by taking a more specific approach to understanding how group singing interventions affect health biomarkers in populations that have been historically excluded due to stigma. Our focus on objective outcomes of this social intervention may inform future research on the best ways to use group singing interventions, including who is most affected, what specific health benefits can be derived from group singing, and the strength of evidence of group singing in general. Systematic review registration This review was pre-registered on OSF at https://osf.io/qbg7x/ .

We propose a framework integrating insights from computational social science, political, and social psychology to explain how extreme polarization can occur in deeply divided societies. Extreme polarization in a society emerges through a dynamic and complex process where societal, group, and individual factors interact. Dissent at different levels of analysis represents the driver of this process, where societal-level ideological dissent divides society into opposing camps, each with contrasting collective narratives. Within these opposing camps, further dissent leads to the formation of splinter factions and radical cells—sub-groups with increasingly extreme views. At the group level, collective narratives underpinning group identity become more extreme as society fragments. At the individual level, this process involves the internalization of an extreme group narrative and norms sanctioning radical behavior. The intense bonding within these groups and the convergence of personal and group identities through identity fusion increase the likelihood of radical group behavior.

IntroductionChronic venous leg ulcer (VLU) healing is a complex clinical problem. It requires intervention from skilled, costly, multidisciplinary wound-care teams, working with patients to manage their care. Compression therapy has been shown to help heal venous ulcers and to reduce recurrence, with some evidence suggesting the value of exercise as well. These activities require health education and health literacy (HL) as patients must process, understand and consistently apply health information for successful self-management. Research suggests that those most vulnerable to VLUs also tend to have limited HL, but there have been no reviews examining the state of HL in patients with previous or active VLUs. This scoping review aims to examine the level of HL in VLU patients and how HL may link to self-management behaviours (particularly exercise and compression adherence), and their VLU healing generally.Methods and analysisWe will use Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review guidelines and the Levac methodology framework to explore eligible papers that examine the effect of HL on their exercise and compression adherence. Electronic databases will be searched (MEDLINE, EMBASE, the Cochrane Library, PsycInfo and Health, OpenGray), examining for all papers on these subjects published between 2000 and 2020. All studies describing compression and or exercise during VLU management will be included. Study characteristics will be recorded; qualitative data will be extracted and evaluated. Quantitative data will be extracted and summarised.Ethics and disseminationWe will disseminate results through peer-reviewed publications. We will use data (ie, journal articles) from publicly available platforms; so, this study does not require ethical review. The consultation step will be carried out with patients, carers and health professionals as part of an established wound consumer group.

We investigated nurses' experiences of hospital‐acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence‐based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital‐acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self‐blame related to PI identification, and exacerbating impacts of the COVID‐19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital‐acquired PI.

BackgroundThe level of personal health literacy of patients with venous leg ulcers is likely to affect their ability to self-manage their condition impacting on their adherence to treatment and influences healing and recovery outcomes.ObjectivesTo scope existing research that examined the level of health literacy in venous leg ulcer patients, to identify how this may link to self-management behaviours (particularly physical activity and compression adherence), and venous leg ulcer healing outcomes.MethodsThis scoping review was based on the PRISMA-ScR six-stage framework. We searched MEDLINE, EMBASE, the Cochrane Library, PsycInfo and Health, Open Grey, and Google Scholar for publications examining general and specific health literacy in those with venous leg ulcers and for those examining any potential links of health literacy with self-management/healing generally, published between 2000-2020. This search was guided by a published protocol; studies that described other types of ulcers or did not examine health literacy were excluded. After applying inclusion and exclusion criteria the initial search identified 660 articles.ResultsWe included five articles. Four studies used randomised controlled trials or experimental designs to test the effect of specific health literacy interventions on venous leg ulcer knowledge, compression therapy use, or healing outcomes. One study was a cross- sectional survey with qualitative elements, assessing health literacy in venous leg ulcer patients. Broadly, the research suggested that health literacy was suboptimal amongst those with venous leg ulcers, and health literacy interventions had limited effects on improving key venous leg ulcer specific outcomes.ConclusionThis review provides a synthesis of extant literature examining health literacy in patients with venous leg ulcers. We identified a dearth of literature investigating the value of general and specific health literacy interventions in this space. Most importantly, no recent research on general health literacy and venous leg ulcers was identified, despite strong theoretical utility to do so. The few studies identified largely indicated that targeting health literacy of patients with venous leg ulcers is a viable area of research and intervention, encouraging future researchers and clinicians to consider patient health literacy in venous leg ulcer management.