Background
Breaking Free Online (BFO), a computer-assisted therapy (CAT) program for substance use disorders (SUD), has been available across UK treatment services for the past decade and has demonstrated efficacy. The Covid-19 pandemic has contributed to digital and ‘telehealth’ approaches to healthcare delivery becoming more common and accepted, and has in parallel, increased numbers of referrals to SUD services because of the impact pandemic-related stress has had on substance using habits in the general population. Digital and telehealth approaches, such as BFO, have the potential to support the treatment system to meet this increased demand for SUD services.

Methods
Parallel-group randomized controlled trial of eight-week BFO as an adjunct to standard treatment for SUD, in comparison to standard treatment only, at a National Health Service (NHS) Mental Health Trust in North-West England. Participants will be service users aged 18 years and over with demonstrable SUD for at least 12-months. Interventional and control groups will be compared on multiple measures from baseline to post-treatment assessment at eight-weeks, and then three and six-months follow-up. Primary outcome will be self-reported substance use, with secondary outcomes being standardized assessments of substance dependence, mental health, biopsychosocial functioning and quality of life.

Discussion
This study will examine whether BFO and telehealth support, when delivered as an adjunct to standard SUD interventions, improves outcomes for services users receiving NHS SUD treatment. Findings from the study will be used to inform both developments to the BFO program and guidance around augmenting the delivery of CAT programs via telehealth.

Trial registration registered with ISRCTN on 25th May 2021—registration number: 13694016. Protocol version: 3.0 05th April 2022. Trial status: This trial is currently open to recruitment—estimated to be completed in May 2023.

Dysphagia is a common consequence of head and neck radiation and may be mitigated by performance of swallowing exercises during radiation treatment. Given historically poor adherence to such exercise protocols, we created a mobile health application, HNC Virtual Coach as an adjunct to standard clinical care. This randomized control trial investigated the impact of HNC Virtual Coach on adherence as well as swallowing outcomes by comparing those using the mobile app to those receiving only standard clinical care and paper logs. Both treatment groups were provided with the same exercise protocol as well as the same baseline educational information. Outcome measures included adherence rates, physiologic measures obtained during a Modified Barium Swallow Study (PAS, MBS-ImP, DIGEST), patient-reported outcomes (MDADI), diet levels (FOIS, PSS-HN), and quality of information received (INFO-25). Patients using the HNC Virtual Coach tended to have better adherence to treatment recommendations during radiation therapy. Increased adherence was associated with better patient-reported quality of life, but not physiologic function 2–3 months following completion of radiation. Results suggest that a mobile health application may provide benefit for some patients undergoing head and neck radiation.

Objectives: To conduct a scoping systematic review of the literature on the use of telemedicine to evaluate, diagnose, and manage patients with dizziness.

Data Sources: Web of Science, SCOPUS, and MEDLINE PubMed databases.

Study Selection: The inclusion criteria included the following: pertaining to telemedicine and the evaluation, diagnosis, treatment, or management of dizziness. Exclusion criteria included the following: single-case studies, meta-analyses, and literature and systematic reviews.

Data Extraction: Outcomes recorded for each article included the following: study type, patient population, telemedicine format, dizziness characteristics, level of evidence, and quality assessment.

Data Synthesis: The search returned 15,408 articles, and a team of four screened the articles for inclusion criteria status. A total of 9 articles met the inclusion criteria and were included for review. Of the nine articles, four were randomized clinical trials, three were prospective cohort studies, and two were qualitative studies. The telemedicine format was synchronous in three studies and asynchronous in six studies. Two of the studies involved acute dizziness only, four involved chronic dizziness only, one involved both acute and chronic dizziness, and two did not specify dizziness type. Six of the studies included the diagnosis of dizziness, two involved the evaluation of dizziness, and three involved treatment/management. Some of the reported benefits of telemedicine for dizziness patients included cost savings, convenience, high patient satisfaction, and improvement in dizziness symptoms. Limitations included access to telemedicine technology, Internet connectivity, and dizziness symptoms interfering with the telemedicine application.

Conclusions: Few studies investigate the evaluation, diagnosis, or management of dizziness using telemedicine. The lack of protocols and standards of care for telemedicine evaluation of dizzy patients creates some challenges in care delivery; however, these reviewed studies provide examples of the breadth of care that has been provided remotely.

Background and Purpose: Home exercise programs (HEPs) improve quality of life (QoL), physical function, and fatigue in individuals recovering from cancer; however, they often lack supervision and individualization. Use of a weekly telephone call by a physical therapist (PT) may provide substantial guidance to improve outcomes and adherence. The purpose of this study was to determine the effect of weekly calls in addition to an individualized HEP on physical function, QoL, fatigue, and adherence in people with cancer.

Methods: A prospective 2-armed single-cohort design implemented with survivors of cancer in early recovery. Control and intervention groups received in-home instruction of a PT-prescribed, 8-week HEP. The intervention group received weekly phone calls while the control group had no formal follow-up or program monitoring. Outcome measures assessed pre-/postintervention: 6-minute walk test (6MWT), Fullerton Advanced Balance Scale, European Organization of Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ-C30), and Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT). Nonparametric statistics were used to analyze changes within and between groups.

Results: Fifteen participants (n = 7 intervention and n = 8 control) completed the study. The intervention group improved significantly in all outcomes except the 6MWT (P < .05). The control group did not demonstrate any significant improvements. Between groups, there was a significant difference at program completion in the FACIT (P = .007) and EORTC QLQ-C30 physical function subscale (P = .042).

Limitations: A small, heterogeneous sample.

Conclusions: An individualized HEP with weekly calls may be a safe and effective way to improve outcomes of physical function, QoL, and fatigue in individuals with cancer during early recovery.

Background: Individuals with breast cancer-related lymphedema (BCRL) require self-management strategies to reduce risk of infection, exacerbation, and/or progression of lymphedema. The coronavirus pandemic thrust the medical field into the world of telehealth; both patients and providers were forced to reduce in-person treatments and engage in this new platform of rehabilitation delivery. The role of telehealth in promotion of self-management for BCRL is unknown.

Purpose: This study examines self-efficacy during cancer rehabilitation for in-clinic versus telehealth visits among individuals with BCRL during the pandemic quarantine April to November 2020.

Methods: Forty women who recently completed oncology rehabilitation for BCRL were asked to complete demographics and 2 Likert surveys, including the Exercise Self-Efficacy Scale (ESES) and the Self-Care Self-Efficacy Scale (SCSE), to compare the efficacy of telehealth versus in-person treatment modalities.

Results: Thirty-two participants completed the survey and indicated that the percentage of telehealth visits was less than face-to-face visits. Despite this, the participants indicated numerous positive moderately strong correlations between self-care self-efficacy and exercise self-efficacy for both types of visits (P < .05).

Limitations: Self-report surveys by a convenience sample, multifactorial characteristics of rehabilitation treatment across modes, and varying severity of lymphedema may limit study findings.

Conclusion: Telehealth provided safe and effective care to participants and bolstered confidence in self-care and self-management of BCRL. Data support that telehealth visits can be considered an essential part of comprehensive cancer rehabilitation care. Future research is needed to establish and optimize practice guidelines in both health delivery systems.

Objective To understand the impact of virtual visits on primary care physician (PCP) work flows.

Design Qualitative semistructured interviews.

Setting Primary care practices within 5 regions in southern Ontario.

Participants Physicians representing primary care practices of various sizes and remuneration models (eg, capitation and fee-for-service models).

Methods Interviews were conducted with PCPs involved in a large-scale pilot project implementing virtual visits (via a Web-based application) into clinical practices. Convenience and purposive sampling were used to recruit PCPs between January 2018 and March 2019. To obtain a representative sample, participants were sought from a variety of practice types and geographic regions. High and low users of virtual visits were included. Interviews were audiorecorded and transcribed. An inductive thematic analysis was used to identify prominent themes and subthemes.

Main findings Twenty-six physicians were interviewed (n=15 using convenience sampling and n=11 through purposive sampling). Four themes were identified: PCPs employ diverse approaches to integrate virtual care into their work flow; PCPs recognize that implementing virtual visits requires upfront time and effort but have variable perceptions regarding long-term impact of virtual care on processes; asynchronous messaging is preferable to synchronous audio or video visits; and strategies were identified to improve the integration of virtual visits.

Conclusion The potential of virtual care to improve work flow is dependent on the way these visits are implemented and used. Dedicated time for implementation, emphasis on using asynchronous secure messaging, and access to clinical champions and structured change management support were associated with more seamless integration of virtual visits.

Virtual visits in primary care have proven to be an invaluable tool during the COVID-19 pandemic,1-3 and many physicians anticipate they will become a ubiquitous mode of care delivery.4 However, clinics have been forced to implement virtual visits out of necessity and at a fast pace, so optimal operationalization of virtual visits has yet to be determined. Importantly, how virtual visits impact the organization of work in primary care settings is not well known. While research has established that virtual visits in primary care can offer benefits such as improved convenience, patient satisfaction, and patient access to care,5-7 current evidence regarding their impact on clinical work flows is mixed at best. A systematic review suggests that virtual visits require extensive changes to work practices and substantive time for training in new techniques, and that these demands affect both the efficiency and the effectiveness of care.8 Conversely, other studies have reported that virtual visits can potentially improve communication, information flow, and work organization in primary care settings.7,9 Most studies have also concentrated on a single health care organization10-12 and used in-clinic appointment frequencies as the primary metric for work flow impact with minimal consideration given to effects on broader daily routines.11

We conducted a qualitative study to better understand how the integration of virtual visits (consultations via asynchronous messaging [such as texting or online messaging], synchronous telephone calls, and synchronous video communication) affects the clinical work flows of primary care physicians (PCPs) across heterogeneous practices in Ontario. We defined work flow as the orchestrated activities, resources, and communication and information processes required to operationalize organizational goals.13 To our knowledge, this is the first study to use qualitative methods to examine both the ways in which PCPs coordinate their work activities to deliver a multimodal virtual service and the subsequent effects of that service on clinic work flows within Canada. While this study was conducted before the rapid virtualization of health services during the COVID-19 pandemic, the results provide valuable insight on how virtual visits can be integrated into clinical practice to deliver care conveniently and efficiently.

With the onset of the COVID-19 pandemic, telehealth became a widely used method to provide patient care. Providers had to quickly learn how to adapt traditional clinical care to the virtual environment. The existing literature focuses on the technological aspects of telehealth with only a few publications addressing optimization of communication, with even fewer looking at the use of simulation to fill the knowledge gap in this area. Simulation training is one such avenue that can be used to practice virtual encounters. This review outlines how to effectively use simulation as an educational method to teach clinical skills needed for effective telehealth communication. The experiential nature of simulation provides learners with an opportunity to adapt their clinical skills to a telehealth encounter, and an opportunity to practice challenges unique to a telehealth environment, such as patient privacy, patient safety, technology disruption, and performance of an examination virtually. The goal of this review is to discuss how simulation may be used to train providers for best practices in telehealth.

Objective To understand the impact of virtual visits on primary care physician (PCP) work flows.

Design Qualitative semistructured interviews.

Setting Primary care practices within 5 regions in southern Ontario.

Participants Physicians representing primary care practices of various sizes and remuneration models (eg, capitation and fee-for-service models).

Methods Interviews were conducted with PCPs involved in a large-scale pilot project implementing virtual visits (via a Web-based application) into clinical practices. Convenience and purposive sampling were used to recruit PCPs between January 2018 and March 2019. To obtain a representative sample, participants were sought from a variety of practice types and geographic regions. High and low users of virtual visits were included. Interviews were audiorecorded and transcribed. An inductive thematic analysis was used to identify prominent themes and subthemes.

Main findings Twenty-six physicians were interviewed (n=15 using convenience sampling and n=11 through purposive sampling). Four themes were identified: PCPs employ diverse approaches to integrate virtual care into their work flow; PCPs recognize that implementing virtual visits requires upfront time and effort but have variable perceptions regarding long-term impact of virtual care on processes; asynchronous messaging is preferable to synchronous audio or video visits; and strategies were identified to improve the integration of virtual visits.

Conclusion The potential of virtual care to improve work flow is dependent on the way these visits are implemented and used. Dedicated time for implementation, emphasis on using asynchronous secure messaging, and access to clinical champions and structured change management support were associated with more seamless integration of virtual visits.

Lors du premier confinement général en France en réponse à la pandémie de Covid-19, les structures extrahospitalières et les services à domicile furent fermés, entraînant une rupture des liens thérapeutiques et sociaux pour de nombreux patients. Dans ce contexte inédit, les professionnels du Pôle Clamart du Groupe hospitalier Paul Guiraud ont créé un blog comme une tentative de rétablir le lien interrompu. Très rapidement la dynamique de participation, de partage et de consultation du blog a largement dépassé les attentes initiales. Nous proposons ici des hypothèses pour expliquer le succès de cette expérience et son impact clinique à partir d’une réflexion sur les représentations de soins en psychiatrie et sur l’utilisation de l’outil numérique dans le lien soignant.

Abstract: This study examined the efficacy of internet-delivered cognitive and behavioural interventions for adults with chronic pain AND explored the role of clinical and study characteristics as moderators of treatment effects. PubMed, Embase, PsycINFO, CENTRAL and CINAHL were searched to identify randomized controlled trials published up to October 2021. A meta-analysis of 36 studies (5778 participants) was conducted, which found small effect sizes for interference/disability (Hedges' g = 0.28; 95% confidence interval [CI] 0.21-0.35), depression (g = 0.43; 95% CI 0.33-0.54), anxiety (g = 0.32; 95% CI 0.24-0.40), pain intensity (g = 0.27; 95% CI 0.21-0.33), self-efficacy (g = 0.39; 95% CI 0.27-0.52) and pain catastrophizing (g = 0.31; 95% CI 0.22-0.39). Moderator analyses found that interventions which involved clinician guidance had significantly greater effect sizes for interference/disability (g = 0.38), anxiety (g = 0.39), and pain intensity (g = 0.33) compared with those without (g = 0.16, g = 0.18, and g = 0.20, respectively). Studies using an inactive control had greater effects for depression (g = 0.46) compared with active control trials (g = 0.22). No differences were found between treatments based on traditional cognitive behaviour therapy vs acceptance and commitment therapy. Sample size, study year, and overall risk of bias (Cochrane rating) did not consistently moderate treatment effects. Overall, the results support the use of internet-delivered cognitive and behavioural interventions as efficacious and suggest guided interventions are associated with greater clinical gains for several key pain management outcomes.

Purpose of review: To summarize the current literature on the psychological impact of COVID-19 on patients with cancer, both in terms of the impact of the virus itself and of changes in the healthcare system; and to describe current recommendations for supporting patients with cancer during the pandemic.

Recent findings: Multiple studies have shown that patients with cancer experience high levels of psychological distress during COVID-19. Factors of greater vulnerability have been described as: being young, being female, low socioeconomic status, lower educational level, having low levels of hope or optimism, lower social support, and having cancer with curative intent. The severe acute respiratory syndrome-coronavirus-2pandemic has accelerated the healthcare digitization process. All departments involved in the diagnosis and treatment of cancer have made contingency plans to minimize the impact on patients.

Summary: Psychological distress is one of the most frequently occurring symptoms in patients with cancer during the pandemic. The COVID-19 pandemic has led to a restructuring of the healthcare system. The paradigm shift may pose a challenge for both healthcare professionals and patients.

Purpose of review: A rapid review was conducted to synthesize evidence of palliative care delivery changes during the COVID-19 pandemic. Changes were synthesized according to the eight domains of high-quality palliative care and enduring implications for oncology nurses beyond the pandemic discussed.

Recent findings: The most significant changes occurred in the structure and processes of palliative care (Domain 1), where increased utilization of telehealth was critical in circumventing barriers imposed by COVID-19 mitigation. The suboptimal availability of community-based psychosocial supports for patients and caregivers and inadequate health system-based psychosocial supports for healthcare providers were highlighted (Domains 3-5). The pandemic also ushered in an increased emphasis on the need for advance care planning (ACP), where integrating its delivery earlier in the outpatient setting and shifting policy to promote subsequent virtual documentation (Domain 8) were essential to ensure care preferences were clarified and accessible before health crises occurred.

Summary: Continuing to embrace and sustain systems-level changes with respect to telehealth, psychosocial supports, and ACP are critical to bridging gaps in palliative care delivery underscored by the pandemic. Oncology nurses are well positioned to fill these gaps in care beyond the pandemic by providing evidence-based, palliative care throughout the cancer continuum.

Purpose of review: The purpose of this review is to outline the impact of the COVID-19 pandemic on movement disorder holistic care, particularly in the care of people with Parkinson disease (PWP).

Recent findings: As the pandemic unfolds, a flurry of literature was published regarding the impact of COVID-19 on people with Parkinson disease including the direct impact of infection, availability of ambulatory care, loss of community-based team care, and acceptability of telemedicine.

Summary: COVID-19 has impacted the care of PWP in numerous ways. Recognizing infection in PWP poses challenges. Specific long-term complications, including emerging reports of long COVID syndrome is a growing concern. Caregivers and PWP have also been impacted by COVID-19 social isolation restrictions, with radical changes to the structure of social networks and support systems globally. In a matter of weeks, the global community saw an incredible uptake in telemedicine, which brought benefits and pitfalls. As PWP adapted to virtual platforms and the changing architecture of care delivery, the pandemic amplified many preexisting inequities amongst populations and countries, exposing a new 'digital divide'.

Psychologists are in a position to respond to the COVID-19 pandemic through research, practice, education, and advocacy. However, concerns exist about the ethical implications associated with transitioning from face-to-face to online or virtual formats as necessitated by stay-at-home orders designed to enforce the social distancing required to flatten the curve of new COVID-19 cases. The purpose of this article is to review potential ethical issues and to provide guidance to psychologists for ethical conduct in the midst of the current crisis and its aftermath. In addition to contextualizing relevant ethical considerations according to the principles and standards of the current American Psychological Association’s ethics code, vignettes are presented to exemplify the ethical dilemmas psychologists in various roles may face when responding to COVID-19 and to offer suggestions and resources for resolving potential conflicts.

The coronavirus-2019 pandemic was declared a national emergency in the United States on March 13, 2020. The disruptions resulting from subsequent unprecedented mitigation efforts have limited and, in some cases, eliminated the ability of psychologists to meet in person with their patients, clients, and examinees. This has led to a broad and sudden reliance on synchronous (live) videoconferencing (also commonly referred to as telehealth, telepsychological practice, and telepractice) to deliver clinical services. A vital component of psychological practice involves the administration of psychological testing, particularly in clinical settings and specialties that rely heavily on the use of assessment instruments. Remote administration of psychological testing presents challenges that cannot be ignored, even in a crisis, without risking the violation of ethical standards and without compromising the reliability and interpretability of test results and the security of test instruments. With these considerations in mind, we provide practical guidance for remote test administration, using the Minnesota Multiphasic Personality Inventory instruments.

Social distancing practices resulting from the Covid-19 pandemic have accelerated the
use of telehealth and virtual team meetings. Until recently, telehealth was embraced
mainly as a way to enable remote patient care and specialist consultations and to provide
convenience for patients. Covid-19 has changed that, and the health care community
has clamored to adapt. This article offers a set of evidence-based tips for enhancing the
personal quality of one’s virtual communications by video or phone – be “present,” identify
needs, listen, respond with empathy, and share information – and some strategies for
applying them with both patients and colleagues.

As coronavirus disease 2019 cases increase throughout the country and health care systems grapple with the need to decrease provider exposure and minimize personal protective equipment use while maintaining high-quality patient care, our specialty is called on to consider new methods of delivering inpatient palliative care (PC). Telepalliative medicine has been used to great effect in outpatient and home-based PC but has had fewer applications in the inpatient setting. As we plan for decreased provider availability because of quarantine and redeployment and seek to reach increasingly isolated hospitalized patients in the face of coronavirus disease 2019, the need for telepalliative medicine in the inpatient setting is now clear. We describe our rapid and ongoing implementation of telepalliative medicine consultation for our inpatient PC teams and discuss lessons learned and recommendations for programs considering similar care models.