Synchronous Web-Based Psychotherapy for Mental Disorders From a Health Quality Perspective: Scoping Review.

BACKGROUND: The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues. OBJECTIVE: This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention. METHODS: This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety. RESULTS: From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome. CONCLUSIONS: In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy.

Incidence of acute lymphocytic leukemia in Calgary, Alberta, Canada: a retrospective cohort study.

OBJECTIVE: Acute lymphocytic leukemia (ALL) is a rare malignant neoplasm that develops from abnormal lymphoid stem cells. ALL incidence is highest among children and declines towards adolescence. There is limited data on the epidemiology of ALL, especially in Canada. This retrospective cohort study used patient data from the Calgary Laboratory Services Cancer Cytogenetics Laboratory to report the incidence rate of ALL in Calgary, Alberta, Canada. New cases of ALL were identified for the 5-year period of January 1, 2011 until December 31, 2015. Reported incidence rates were categorized by sex and age groups, and age-standardized to the Canadian population. RESULTS: There were an average of 11.4 new cases of ALL diagnosed per year between 2011 and 2015. The total incidence rate per 100,000 person-years was 0.84. Incidence rates peaked in children aged 0-4 with 7.55 and 3.32 cases per 100,000 person-years for males and females, respectively. The median age of diagnosis was 8 years. Incidence rates were generally lowest for adults aged 20 and over. The ratio of males to females diagnosed with ALL was 1.59. Overall, the recent incidence of ALL in Calgary is comparatively low with a preference for males and children below 5 years of age.

Use of the Papanicolaou test in women under 25 years of age in Southern Alberta.

OBJECTIVES: The introduction of the Papanicolaou (Pap) test in Canada has led to a decline in both the incidence of, and mortality from, cervical cancer. However, cervical cancer in women under the age of 25 is rare, and the updated Canadian Task Force on Preventive Health Care recommendations advise against screening by Pap test in this age group. Screening under the age of 25 can lead to false-positive results or to treatment of lesions that may spontaneously regress. The purpose of this observational study was to determine how many Pap tests are performed in women less than 25 years of age despite current guidelines. METHODS: Data were obtained from the Laboratory Information System of Calgary Laboratory Services for women under and over the age of 25 who underwent Pap testing between September and December 2012 and between February and May 2013. RESULTS: Approximately 4% of women aged 15 to 19 and 33% of women aged 20 to 24 had Pap tests after the new guidelines were released. CONCLUSION: Women under the age of 25 continue to undergo unnecessary screening for cervical cancer. This excessive screening may cause physical and psychological harm and may result in unnecessary health care expenditures.

Objectifs : La mise en œuvre du test de Papanicolaou (Pap) au Canada a mené à une baisse de l'incidence du cancer du col utérin et de la mortalité lui étant attribuable. Toutefois, le cancer du col utérin est rare chez les femmes de moins de 25 ans et les recommandations mises à jour du Groupe d'étude canadien sur les soins de santé préventifs se prononcent contre la tenue du test de Pap chez les femmes de ce groupe d'âge. Chez celles-ci, le dépistage peut mener à l'obtention de résultats faux positifs ou à la mise en œuvre d'un traitement visant des lésions qui pourraient en venir à connaître une régression spontanée. Cette étude observationnelle avait pour but de déterminer le nombre des tests de Pap qui sont menés chez des femmes de moins de 25 ans malgré l'avis énoncé par les lignes directrices actuelles. Méthodes : Nous avons obtenu des données au sujet des femmes de moins et de plus de 25 ans ayant subi des tests de Pap entre septembre et décembre 2012, et entre février et mai 2013, en consultant le Laboratory Information System de Calgary Laboratory Services. Résultats : Près de 4 % des femmes de 15 à 19 ans et de 33 % des femmes de 20 à 24 ans ont subi des tests de Pap à la suite de la publication des nouvelles lignes directrices. Conclusion : Les femmes de moins de 25 ans continuent à être soumises à des mesures inutiles de dépistage du cancer du col utérin. Ce dépistage excessif pourrait causer des torts physiques et psychologiques, ainsi qu'entraîner d'inutiles dépenses en santé.