On the surface, computer- or Internet-based cognitive behaviour therapy (CBT) appears to be a convenient and efficacious method of delivering the well-established protocols of CBT. However, caution is warranted before digitised CBT can be conceptualised as a natural extension of face-to-face CBT. The key difference in digitised CBT is its mode of delivery, but this distinction significantly influences the client's experience of CBT. The treatment settings of digitised CBT interventions are diverse and may include on-site treatment at a clinic computer station, Internet-delivered CBT at a location of the patients' choosing, or delivery of CBT through mobile technologies such as smartphones and tablet computers. To varying degrees, such settings are less controlled and could therefore introduce factors that not only deviate from well-established, manualised, in-person CBT treatments, but also introduce ethical issues for the well-meaning clinical psychologist who prescribes CBT. This article reviews the core features of digitised CBT interventions and examines potential ethical concerns of digitised CBT as they relate to the principles of the Canadian Code of Ethics for Psychologists. Issues related to accessibility, cost, confidentiality, record keeping, risk assessment, and the role of the therapist are explored. Areas in need of further consideration are suggested, and recommendations that align with the Code of Ethics are provided for Canadian clinicians.Keywords: cognitive behaviour therapy, iCBT, digital CBT, e-therapy, code of ethics, electronic record-keeping, access to therapyResumeEn surface, la therapie cognitivo-comportementale (TCC) assistee par ordinateur ou par l'Internet semble etre une methode pratique et efficace de delivrer les protocoles bien etablis de TCC. Il convient toutefois de faire preuve de prudence avant de conceptualiser la TCC numerisee en tant qu'extension naturelle de la TCC en personne. La difference cle dans la TCC numerisee reside dans son mode de transmission. Or, cette distinction influence significativement l'experience du client face a la TCC. Les contextes de traitement des interventions de TCC numerisees sont varies, pouvant comprendre le traitement sur place a un poste d'ordinateur dans une clinique, la TCC assistee par Internet dans un heu determine par le patient, ou la TCC prodiguee par des technologies mobiles telles que les telephones intelligents et les tablettes electroniques. A des degres divers, de tels contextes sont moins controles et donc susceptibles d'introduire des facteurs qui peuvent non seulement devier des TCC en personne, manuelles et bien etablies mais aussi introduire des problemes ethiques pour le psychologue clinique bien intentionne qui a prescrit la TCC. Cet article examine les caracteristiques principales des interventions par TCC numerisee et evalue les preoccupations potentielles d'ordre ethique de la TCC numerisee par rapport aux principes du Code canadien d'ethique pour les psychologues. Les questions liees a l'accessibilite, aux couts, a la confidentialite, a la tenue des registres, a l'evaluation des risques ainsi qu'au role du therapeute y sont explorees. Les domaines necessitant une consideration plus approfondie sont suggeres et les recommandations en lien avec le Code d'ethique sont fournies aux cliniciens canadiens.Mots-cles : therapie cognitivo-comportementale, TCC individuelle, TCC numerisee, therapie electronique, code d'ethique, tenue de registres electronique, acces a la therapie.With the continued increase of smartphones, tablets, and general Internet use over the last decade, psychology as a discipline has begun to embrace the advantages of computerised communication technologies to offer clients therapeutic interventions within this digital milieu. However, due to the rapidly changing nature of technology, it is difficult for formal ethical guidelines to keep pace with the realities of advancing research and clinical methodologies. …
Attention-deficit/hyperactivity disorder (ADHD) in adulthood and dementia with Lewy bodies (DLB) share many cognitive and noncognitive similarities. The overlapping features between both disorders complicate differential diagnosis. The aim of the current systematic review was to compare patterns of neuropsychological profiles in older adults with ADHD and DLB.Of the 1989 ADHD-related articles and 1332 DLB-related articles screened, 3 ADHD and 25 DLB articles were retained for qualitative synthesis and review.A synthesis of individual study findings revealed isolated working memory deficits for late-life ADHD, and performance deficits in areas of attention, memory, language, and visuoperceptual abilities for DLB. Results were limited by small samples and absence of data in some cognitive domains.These initial findings support potentially unique neurocognitive profiles for ADHD in later life and DLB that would enable practitioners to differentially diagnose and appropriately treat older adults presenting with these phenotypically similar disorders.
The rapid expansion of mobile phone applications is increasingly relevant to the field of professional psychology. This article highlights the ethical challenges related to the development and integration of mobile phone technologies into clinical practice with clients who suffer from a diagnosable mental illness, with an emphasis on the relevant ethical principles included in the Canadian Code of Ethics for Psychologists. The benefits and risks associated with mobile phone application interventions are reviewed, to provide psychologists with the information necessary to guide ethical decision-making. Preliminary guidelines for the ethical practice of mobile technology in psychology are proposed throughout the article (e.g., mobile applications that deliver treatment should be used to support an evidence-based intervention facilitated by a mental health professional), and areas for future research are recommended.Keywords: professional practice, ethics, technology, decision-making, mobile phone applicationsResumeL'expansion rapide des applications de telephonie mobile con- cerne de plus en plus le domaine de la psychologie professionnelle. Cet article met en relief les defis ethiques relies a l'expansion et a l'integration des technologies du telephone cellulaire dans la pra- tique clinique avec des clients presentant des troubles de sante mentale diagnosticables, en particulier les principes de deontologie qui sont inclus dans le Code canadien de deontologie profession- nelle des psychologues. Les avantages et les risques associes aux interventions realisees au moyen d'applications de telephonie mo- bile sont presentes afin de fournir aux psychologues de l'information qui les guidera dans la prise de decisions ethiques. Au fil de l'article sont proposees des lignes directrices prelimi- naires pour l'utilisation ethique de la technologie mobile en psy- chologie, par ex., les applications pour le traitement devraient etre utilisees en appui a une intervention fondee sur des donnees probantes mise en oeuvre par un professionnel de la sante mentale. L'article propose divers domaines pouvant faire l'objet d'etudes futures.Mots-cles : pratique professionnelle, deontologie, technologie, prise de decision, applications pour telephone mobile.There are a myriad of technologies available in the Western world, and their presence is ubiquitous. Technologies like the World Wide Web, smart mobile phones, computers, and smaller personal computing tablets such as the iPad are increasingly pop- ular. The advent of technological advances has revolutionized the ways in which people interact with one another. For example, personal communications can occur through cyberspace, and meet- ings that once required face-to-face contact are increasingly being conducted as virtual meetings, with people connecting through a Web-based platform, but from various physical locations.Advances in technology are progressively more relevant to the clinical practice of psychology and mental health services gener- ally. The rapid advances in technologies have profoundly influ- enced the mediums and methods of the delivery of mental health services. Psychology has incorporated new technologies to meet the demand for effective low-cost alternatives to traditional or face-to-face therapy. From early experience with telephone thera- pies (Mohr et al., 2012), online therapy is now available for individuals to seek treatment for a variety of ailments and disor- ders in the comfort of their homes, albeit these programs are currently limited in Canada (Andersson, Carlbring, Ljotsson, & Hedman, 2013). Recent developments in computer bandwidth, and the widespread availability of such computer applications as Skype, FaceTime and qq, now permit the easy transmission ofbotli voice and live video across space and time zones.In addition to telephone and online therapy, psychologists must now consider the impact of smart mobile phone technology on psychological assessment and intervention. …
To characterize the presence of Clostridium sordellii and Clostridium perfringens in the vagina and rectum, identify correlates of presence, and describe strain diversity and presence of key toxins.We conducted an observational cohort study in which we screened a diverse cohort of reproductive-aged women in the United States up to three times using vaginal and rectal swabs analyzed by molecular and culture methods. We used multivariate regression models to explore predictors of presence. Strains were characterized by pulsed-field gel electrophoresis and tested for known virulence factors by polymerase chain reaction assays.Of 4,152 participants enrolled between 2010 and 2013, 3.4% (95% confidence interval [CI] 2.9-4.0) were positive for C sordellii and 10.4% (95% CI 9.5-11.3) were positive for C perfringens at baseline. Among the 66% with follow-up data, 94.7% (95% CI 88.0-98.3) of those positive for C sordellii and 74.4% (95% CI 69.0-79.3) of those positive for C perfringens at baseline were negative at follow-up. At baseline, recent gynecologic surgery was associated with C sordellii presence, whereas a high body mass index was associated with C perfringens presence in adjusted models. Two of 238 C sordellii isolates contained the lethal toxin gene, and none contained the hemorrhagic toxin gene. Substantial strain diversity was observed in both species with few clusters and no dominant clones identified.The relatively rare and transient nature of C sordellii and C perfringens presence in the vagina and rectum makes it inadvisable to use any screening or prophylactic approach to try to prevent clostridial infection.ClinicalTrials.gov, www.clinicaltrials.gov, NCT01283828.
The management of infective endocarditis (IE) is very challenging in patients with blood cultures negative for a microorganism. Unfortunately, this situation is not uncommon, occurring in up to 30% of cases of IE. Precise microbiological diagnosis, however, is critical to optimize the antibiotic regimen, and thus, non-culture-based molecular techniques are playing a growing role in the care of these patients. We present a patient with culture-negative IE due to Haemophilus parainfluenzae, with the pathogen identified only via molecular techniques.
Chronic wounds cost the Australian health system at least US$2·85 billion per year. Wound care services in Australia involve a complex mix of treatment options, health care sectors and funding mechanisms. It is clear that implementation of evidence-based wound care coincides with large health improvements and cost savings, yet the majority of Australians with chronic wounds do not receive evidence-based treatment. High initial treatment costs, inadequate reimbursement, poor financial incentives to invest in optimal care and limitations in clinical skills are major barriers to the adoption of evidence-based wound care. Enhanced education and appropriate financial incentives in primary care will improve uptake of evidence-based practice. Secondary-level wound specialty clinics to fill referral gaps in the community, boosted by appropriate credentialing, will improve access to specialist care. In order to secure funding for better services in a competitive environment, evidence of cost-effectiveness is required. Future effort to generate evidence on the cost-effectiveness of wound management interventions should provide evidence that decision makers find easy to interpret. If this happens, and it will require a large effort of health services research, it could be used to inform future policy and decision-making activities, reduce health care costs and improve patient outcomes.
ABSTRACT Actinomycetes are increasingly recognized as pathogenic in the immunocompromised host. We isolated an asporogenous, nonmotile, aerobic gram-positive rod from a transplant recipient with a fatal pulmonary infection. The pathology was similar to that associated with Rhodococcus equi , including intrahistiocytic localization. The organism was relatively inert in standard biochemical tests. 16S rRNA gene sequencing indicated a potentially unique organism most closely related to the genus Streptomyces , for which we propose the name “ Parastreptomyces abscessus .”
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