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Patients with blood cancer continue to have a greater risk of inadequate immune responses following three COVID-19 vaccine doses and risk of severe COVID-19 disease. In the context of the CAPTURE study (NCT03226886), we report immune responses in 80 patients with blood cancer who received a fourth dose of BNT162b2. We measured neutralizing antibody titers (NAbTs) using a live virus microneutralization assay against wild-type (WT), Delta, and Omicron BA.1 and BA.2 and T cell responses against WT and Omicron BA.1 using an activation-induced marker (AIM) assay. The proportion of patients with detectable NAb titers and T cell responses after the fourth vaccine dose increased compared with that after the third vaccine dose. Patients who received B cell-depleting therapies within the 12 months before vaccination have the greatest risk of not having detectable NAbT. In addition, we report immune responses in 57 patients with breakthrough infections after vaccination.

Patients with cancer have higher COVID-19 morbidity and mortality. Here we present the prospective CAPTURE study, integrating longitudinal immune profiling with clinical annotation. Of 357 patients with cancer, 118 were SARS-CoV-2 positive, 94 were symptomatic and 2 died of COVID-19. In this cohort, 83% patients had S1-reactive antibodies and 82% had neutralizing antibodies against wild type SARS-CoV-2, whereas neutralizing antibody titers against the Alpha, Beta and Delta variants were substantially reduced. S1-reactive antibody levels decreased in 13% of patients, whereas neutralizing antibody titers remained stable for up to 329 days. Patients also had detectable SARS-CoV-2-specific T cells and CD4+ responses correlating with S1-reactive antibody levels, although patients with hematological malignancies had impaired immune responses that were disease and treatment specific, but presented compensatory cellular responses, further supported by clinical recovery in all but one patient. Overall, these findings advance the understanding of the nature and duration of the immune response to SARS-CoV-2 in patients with cancer.

Not all patients with cancer, in particular those with hematogic malignancies, develop functional immunity against SARS-CoV-2 variants of concern (VOC) following COVID-19 vaccines. Durability of vaccine-induced immunity after two doses and the impact of a third dose were evaluated in CAPTURE (NCT03226886), a longitudinal prospective cohort study of vaccine responses in patients with cancer. In evaluating 316 patients, at a median of 111 days following two doses of either BNT16b2 or ChadOX, we observed a time-dependant decline in neutralising antibody titres (NAbT) in a proportion of patients, where NAbTs became undetectable against Delta and Beta in 17% and 15% of patients, respectively. Vaccine-induced T cell responses declined in 44% of patients. Patients with breakthrough infections following two vaccines doses were characterised by absent/low NAbT to Delta prior to infection. Administration of the third vaccine dose boosted NAb responses against VOC in the majority of patients with cancer, especially those with solid cancer. In patients with hematologic malignancies who had undetectable NAbT against Delta after two vaccine doses, 54% did not develop NAb against both Beta and Delta following the third dose. Third vaccine dose boosted T cell responses were boosted in patients with both solid and hematologic malignancies. These results provide critical information on vaccine responses in patients with cancer, especially against VOCs and support widespread access to a third COVID-19 vaccination in this patient group.

Coronavirus disease 2019 (COVID-19) antiviral response in a pan-tumor immune monitoring (CAPTURE) (NCT03226886) is a prospective cohort study of COVID-19 immunity in patients with cancer. Here we evaluated 585 patients following administration of two doses of BNT162b2 or AZD1222 vaccines, administered 12 weeks apart. Seroconversion rates after two doses were 85% and 59% in patients with solid and hematological malignancies, respectively. A lower proportion of patients had detectable titers of neutralizing antibodies (NAbT) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOC) versus wild-type (WT) SARS-CoV-2. Patients with hematological malignancies were more likely to have undetectable NAbT and had lower median NAbT than those with solid cancers against both SARS-CoV-2 WT and VOC. By comparison with individuals without cancer, patients with hematological, but not solid, malignancies had reduced neutralizing antibody (NAb) responses. Seroconversion showed poor concordance with NAbT against VOC. Previous SARS-CoV-2 infection boosted the NAb response including against VOC, and anti-CD20 treatment was associated with undetectable NAbT. Vaccine-induced T cell responses were detected in 80% of patients and were comparable between vaccines or cancer types. Our results have implications for the management of patients with cancer during the ongoing COVID-19 pandemic.

Objectives: Hallucinations can be traumatic. However, research into 'post-traumatic growth' in relation to hallucinations is scarce. This study aims to further our understanding of personal growth in the context of hallucinations. Design: A phenomenological qualitative approach was used to explore experiences of personal growth with hallucinations, adopting Interpretative Phenomenological Analysis (IPA) methodology. Methods: Semi-structured interviews were conducted with seven people who experience hallucinations. Participants were asked about experiences of personal growth, their expectations of individual transformation, and facilitating and hindering factors in the attainment of personal growth. Transcripts were analysed ensuring suitable saturation and representation of the data was achieved. Results: One overall theme (A journey towards personal growth) and five subthemes were identified: A difficult journey taken day by day, Stigma, Acceptance, Finding the right support, and Personal growth. Conclusions: Findings supported personal growth in the context of hallucinations and highlighted facilitators and barriers. Practitioner points • There is scarce literature supporting the development of personal growth with hallucinatory experiences and it is empirically limited. The present research provides greater information into the phenomenon to inform service provision. • The importance of acceptance and maintaining hope for change was highlighted. • Services and the use of coping strategies were both identified as facilitative and hindering of personal growth. • This research provides a necessary alternative to the often negative literature; challenging societal perceptions and helping promote much needed hope in clinicians, the public and individuals experiencing hallucinations.

OBJECTIVE The current study sought to explore how, if at all, people construct an understanding of the origin and maintenance of their experience of hearing voices. METHOD A social constructionist grounded theory method was adopted throughout the research process. Eight voice hearers, who were distressed by this experience, were recruited and interviewed. RESULTS Three overarching descriptive categories were constructed regarding participants' understanding of the development and maintenance of hearing voices; search for meaning, view of self, and framework for understanding voices. The "essence" of the developing grounded theory was that individuals actively searched for meaning of their voices through different frameworks, but the relative "success" of this pursuit, and potential usefulness of an understanding, is influenced by the individual's perceptions of agency, stigma, and hope(lessness). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This research illustrates how voice hearers actively searched for meaning in relation to their voices and the challenges they encountered during this process. One clinical implication from this study emphasizes the potential role of psychological formulation in generating a shared understanding of the voices. Future research is warranted to explore voice hearers from a wider range of cultural, religious, and spiritual backgrounds.

Objective: To investigate the effectiveness of an educational Quality Use of Medicines program, delivered at the level of general practice, on medicines use, falls and quality of life in people aged 65 years. Design: Cluster randomised controlled trial conducted in 2002. Setting: General practices in the Hunter Region, New South Wales, Australia. Participants: Twenty general practitioners recruited 849 patients to participate in the study. Intervention: Education (academic detailing, provision of prescribing information and feedback); medication risk assessment; facilitation of medication review; financial incentives. Main outcome measures: Primary measures: a composite score reflecting use of benzodiazepines, non-steroidal anti-inflammatory drugs (NSAIDs) and thiazide diuretics; secondary measures: use of medication reviews, occurrence of falls, quality of life (as assessed by SF-12 and EQ-5D survey scores. Results: Compared with the control group, participants in the intervention group had increased odds of having an improved medication use composite score (odds ratio [OR], 1.86; 95% CI, 1.21–2.85) at 4-month follow-up but not at 12 months. At 4-month followup, the intervention group had reduced odds of using NSAIDs (OR, 0.62; 95% CI, 0.39– 0.99) and showed a non-significant reduction in use of benzodiazepines (OR, 0.51; 95% CI, 0.20–1.30) and thiazide diuretics (OR, 0.70; 95% CI, 0.48–1.01). Changes in drug use were not significant at 12-month follow-up. At 12 months, intervention-group participants had lower adjusted ORs (AORs) for having a fall (AOR, 0.61; 95% CI, 0.41– 0.91), injury (AOR, 0.56; 95% CI, 0.32–0.96), and injury requiring medical attention (AOR, 0.46; 95% CI, 0.30–0.70). Quality-of-life scores were unaffected by the intervention. Conclusion: Education and systems for medication review conducted by GPs can be used to improve use of medicines. These interventions are associated with a reduction in

Purpose The purpose of this review was to identify, appraise, and synthesize the current peer-reviewed qualitative literature which explores the phenomenon of hearing voices from a first person perspective. Methods A comprehensive systematic search of the literature was conducted. Seven studies utilizing various qualitative methodologies met the criteria to be included in the synthesis. An appraisal tool (Walsh & Downe, 2005, J. Adv. Nurs., 50, 204–211) was used to assess their quality. A meta-ethnographic approach was used to synthesize the data extracted from them. Results The interpretation of the findings suggested five key themes: identity of the voice(s), power of the voice(s), impact of hearing voices on relationships, relationship with the voice(s), and the distinction between thoughts and voices. The identity of the voices seemed inextricably linked to the perceived power the voice(s) wielded over the voice hearer. The quality of the studies included in the synthesis varied greatly. Conclusions The findings of this synthesis highlight the importance of the voice hearer's individual frame of reference for understanding their experience. Clinical implications include the need for mental health professionals to explore an individual's understanding of their experience of hearing voices and address the perceived power of the voice(s). Further research is indicated in this area with a focus of improving the quality of qualitative research studying this phenomenon. Practitioner points There are multiple frames of reference in which to understand an individual's experience of hearing voices. Mental health professionals should attend to the meaning and understanding voice hearers give to the experience.