Search

BACKGROUND The demand for mental health care, particularly for depression and anxiety, is 3-fold greater among patients receiving oncologic and palliative care than for the general population. This population faces unique barriers, making them more susceptible to mental health challenges. Various forms of psychotherapy have been deemed effective in addressing mental health challenges in this population, including supportive psychotherapy, cognitive behavioral therapy, problem-based therapy, and mindfulness; however, their access to traditional face-to-face psychotherapy resources is limited owing to their immunocompromised status, making frequent hospital visits dangerous. Additionally, patients can face hospital fatigue from numerous appointments and investigations or may live in remote areas, which makes commutes both physically and financially challenging. Web-based psychotherapy is a promising solution to address these accessibility barriers. Moreover, web-based psychotherapy has been proven effective in addressing depression and anxiety in other populations and may be implementable among patients receiving oncologic and palliative care. OBJECTIVE The study will investigate the feasibility and effectiveness of web-based psychotherapy among patients receiving oncologic and palliative care, who have comorbid depression or anxiety. We hypothesized that this program will be a viable and efficacious treatment modality compared to current treatment modalities in addressing depression and anxiety symptoms in this population. METHODS Participants (n=60) with depression or anxiety will be recruited from oncology and palliative care settings in Kingston (Ontario, Canada). Participants will be randomly allocated to receive either 8 weeks of web-based psychotherapy plus treatment as usual (treatment arm) or treatment as usual exclusively (control arm). The web-based psychotherapy program will incorporate cognitive behavioral therapy, mindfulness, and problem-solving skills, and homework assignments with personalized feedback from a therapist. All web-based programs will be delivered through a secure platform specifically designed for web-based psychotherapy delivery. To evaluate treatment efficacy, all participants will complete standardized symptomology questionnaires at baseline, midpoint (week 4), and posttreatment. RESULTS The study received ethics approval in February 2021 and began recruiting participants in April 2021. Participant recruitment has been conducted through social media advertisements, physical advertisements, and physician referrals. To date, 11 participants (treatment, n=5; control, n=4; dropout, n=2) have been recruited. Data collection and analysis are expected to conclude by December 2021 and January 2022, respectively. Linear regression (for continuous outcomes) will be conducted with interpretive qualitative methods. CONCLUSIONS Our findings can be incorporated into clinical policy and help develop more accessible mental health treatment options for patients receiving oncologic and palliative care. Asynchronous and web-based psychotherapy delivery is a more accessible, scalable, and financially feasible treatment that could have major implications on the health care system. CLINICALTRIAL ClinicalTrials.gov NCT04664270; https://clinicaltrials.gov/ct2/show/NCT04664270 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/30735

Background The demand for mental health care, particularly for depression and anxiety, is 3-fold greater among patients receiving oncologic and palliative care than for the general population. This population faces unique barriers, making them more susceptible to mental health challenges. Various forms of psychotherapy have been deemed effective in addressing mental health challenges in this population, including supportive psychotherapy, cognitive behavioral therapy, problem-based therapy, and mindfulness; however, their access to traditional face-to-face psychotherapy resources is limited owing to their immunocompromised status, making frequent hospital visits dangerous. Additionally, patients can face hospital fatigue from numerous appointments and investigations or may live in remote areas, which makes commutes both physically and financially challenging. Web-based psychotherapy is a promising solution to address these accessibility barriers. Moreover, web-based psychotherapy has been proven effective in addressing depression and anxiety in other populations and may be implementable among patients receiving oncologic and palliative care. Objective The study will investigate the feasibility and effectiveness of web-based psychotherapy among patients receiving oncologic and palliative care, who have comorbid depression or anxiety. We hypothesized that this program will be a viable and efficacious treatment modality compared to current treatment modalities in addressing depression and anxiety symptoms in this population. Methods Participants (n=60) with depression or anxiety will be recruited from oncology and palliative care settings in Kingston (Ontario, Canada). Participants will be randomly allocated to receive either 8 weeks of web-based psychotherapy plus treatment as usual (treatment arm) or treatment as usual exclusively (control arm). The web-based psychotherapy program will incorporate cognitive behavioral therapy, mindfulness, and problem-solving skills, and homework assignments with personalized feedback from a therapist. All web-based programs will be delivered through a secure platform specifically designed for web-based psychotherapy delivery. To evaluate treatment efficacy, all participants will complete standardized symptomology questionnaires at baseline, midpoint (week 4), and posttreatment. Results The study received ethics approval in February 2021 and began recruiting participants in April 2021. Participant recruitment has been conducted through social media advertisements, physical advertisements, and physician referrals. To date, 11 participants (treatment, n=5; control, n=4; dropout, n=2) have been recruited. Data collection and analysis are expected to conclude by December 2021 and January 2022, respectively. Linear regression (for continuous outcomes) will be conducted with interpretive qualitative methods. Conclusions Our findings can be incorporated into clinical policy and help develop more accessible mental health treatment options for patients receiving oncologic and palliative care. Asynchronous and web-based psychotherapy delivery is a more accessible, scalable, and financially feasible treatment that could have major implications on the health care system. Trial Registration ClinicalTrials.gov NCT04664270; https://clinicaltrials.gov/ct2/show/NCT04664270 International Registered Report Identifier (IRRID) DERR1-10.2196/30735

Two case narratives illustrate the difficulties in resolving historical land restitution in different contexts. Cases from Canada and Kenya illustrate how different land conflicts between Indigenous land rights and registered title may be addressed. In Canada, Williams Lake involved an Indigenous community with a long settlement history in the region with a claim going back to early European settlement. In Kenya, Waitiki Farm involved a post-colonial population established by local Indigenous and migrant groups. The Williams Lake decision resulted in a First Nations land claim being settled in the form of monetary compensation in a dedicated tribunal. The Waitiki Farm decision led to a negotiated settlement in which the owner was compensated financially, and the current residents who had occupied the land were awarded long-term leases. The two cases are illustrative of historical land restitution and identify enabling conditions for the effective functioning of land restitution mechanisms in different contexts.

Land surveying is a process that is more than fieldwork. Survey-as-process includes interplay with existing surveys, with landowners (and others with rights in the land) and with regulators. Proof of concept evidence, theoretical constructs, a Specific Claims Tribunal decision and a First Nations Land Management Act boundary opinion illustrate how survey-as process fits within the larger exercise of re-establishing boundaries.

Introduction: Dysphagia occurs in roughly 30 to 67% of stroke patients and can lead to significant complications, including aspiration with subsequent pneumonia. There has been a lack of agreement on a single effective dysphagia screening tool. The tool used in our institution was developed internally based on extensive literature review, and includes dysphagia screening items followed by a water challenge. Hypothesis: We suspected this dysphagia screening tool was performing well based on low rates of aspiration pneumonia in our stroke patients. The purpose of this study was to validate the dysphagia screening tool against gold standard video fluoroscopy (VF). Methods: This was a prospective study to determine the sensitivity and specificity of the dysphagia screening tool. Our enrollment goal was 300 patients with suspected ischemic stroke between December 2016 and January 2018. The primary nurse completed the routine dysphagia screen, and the sub-investigator performed a blinded simultaneous screen, followed by VF evaluation. We used a group sequential design with interim analyses every 30 patients to allow for early stopping. The primary hypothesis was sensitivity >85%, evaluated using a one-sided test of proportion at a study alpha level of 0.025. Results: At the second interim analysis, 34/61 patients were positive for dysphagia on VF, while only 19 were positive on the screening tool. Estimated sensitivity was 55.9% (95% CI 39.5-71.1%), with a p-value below the second-stage threshold of 0.000002. Therefore, we terminated the study at this point. Estimated specificity was 51.9% (95% CI 34.0-69.3%), and the concordance between examiners for dysphagia screening as 91.8%. Conclusions: This is a routinely used screening tool across multiple hospitals within this organization. The tool did not show adequate sensitivity or specificity compared against the gold standard. Despite the results, we continue to have low rates of aspiration pneumonia. It is possible that VF may overestimate dysphagia, or that subjective interpretation of dysphagia criteria with VF may complicate the results. In conclusion, due to inadequate sensitivity and specificity of the dysphagia screening tool, we terminated the study and recommended modification of the tool.