Background Anxiety conditions are debilitating and prevalent throughout the world. Acceptance and Commitment Therapy (ACT) is an effective, acceptance-based behavioral therapy for anxiety. However, there are treatment barriers (eg, financial, geographical, and attitudinal), which prevent people from accessing it. To overcome these barriers, internet-delivered ACT (iACT) interventions have been developed in recent years. These interventions use websites to deliver ACT information and skill training exercises on the Web, either as pure self-help or with therapist guidance. Objective This systematic review aimed to examine the therapeutic impact of iACT on all anxiety conditions. Methods The EMBASE, MEDLINE, ProQuest Central, PsycINFO, Scopus, and Web of Science databases were searched up to September 2018. The titles and abstracts of remaining records after deduplication were screened by 2 authors with a total of 36 full-text articles being retained for closer inspection next to eligibility criteria. Empirical studies of all designs, population types, and comparator groups were included if they appraised the impact of iACT treatment on any standardized measure of anxiety. Included studies were appraised on methodological quality and had their data extracted into a standardized coding sheet. Findings were then tabulated, and a narrative synthesis was performed because of the heterogeneity found between studies. Results A total of 20 studies met inclusion criteria. There were 11 randomized controlled trials (RCTs) and 9 uncontrolled pilot studies. Participants across all studies were adults. The anxiety conditions treated were as follows: generalized anxiety disorder (GAD), social anxiety disorder (SAD), illness anxiety disorder (IAD), and general anxiety symptoms, with or without comorbid physical and mental health problems. A total of 18 studies reported significant anxiety reduction after iACT treatment. This was observed in studies that delivered iACT with (n=13) or without (n=5) therapist guidance. The average attrition rate across all included studies during the active iACT treatment phase was 19.19%. In the 13 studies that assessed treatment satisfaction, participants on average rated their iACT experience with above average to high treatment satisfaction. Conclusions These findings indicate that iACT can be an efficacious and acceptable treatment for adults with GAD and general anxiety symptoms. More RCT studies are needed to corroborate these early iACT findings using empirical treatments in active control groups (eg, internet-delivered cognitive behavioral therapy). This would potentially validate the promising results found for SAD and IAD as well as address the full spectrum of anxiety disorders.

BackgroundThe melanoma incidence and mortality rates in rural and remote communities are exponentially higher than in urban areas. Digital health could be used to close the urban/rural gap for melanoma and improve access to posttreatment and support care services.ObjectiveThe aim of this review was to understand how digital health is currently used for melanoma posttreatment care and determine the benefits for Australian rural and remote areas.MethodsA systematic search of PubMed, Medline, PsycINFO, and Scopus was conducted in March 2018. Findings were clustered per type of intervention and related direct outcomes.ResultsFive studies met the inclusion criteria, but none investigated the benefits of digital health for melanoma posttreatment care in rural and remote areas of Australia. Some empirical studies demonstrated consumers’ acceptance of digital intervention for posttreatment care. The findings did not take into consideration individual, psychological, and socioeconomic factors, even though studies show their significant impacts on melanoma quality of aftercare.ConclusionsDigital interventions may be used as an adjunct service by clinicians during melanoma posttreatment care, especially in regions that are less-resourced by practitioners and health infrastructure, such as rural and remote Australia. Technology could be used to reduce the disparity in melanoma incidence, mortality rates, and accessibility to posttreatment care management between urban and rural/remote populations.

BACKGROUND Anxiety conditions are debilitating and prevalent throughout the world. Acceptance and Commitment Therapy (ACT) is an effective, acceptance-based behavioral therapy for anxiety. However, there are treatment barriers (eg, financial, geographical, and attitudinal), which prevent people from accessing it. To overcome these barriers, internet-delivered ACT (iACT) interventions have been developed in recent years. These interventions use websites to deliver ACT information and skill training exercises on the Web, either as pure self-help or with therapist guidance. OBJECTIVE This systematic review aimed to examine the therapeutic impact of iACT on all anxiety conditions. METHODS The EMBASE, MEDLINE, ProQuest Central, PsycINFO, Scopus, and Web of Science databases were searched up to September 2018. The titles and abstracts of remaining records after deduplication were screened by 2 authors with a total of 36 full-text articles being retained for closer inspection next to eligibility criteria. Empirical studies of all designs, population types, and comparator groups were included if they appraised the impact of iACT treatment on any standardized measure of anxiety. Included studies were appraised on methodological quality and had their data extracted into a standardized coding sheet. Findings were then tabulated, and a narrative synthesis was performed because of the heterogeneity found between studies. RESULTS A total of 20 studies met inclusion criteria. There were 11 randomized controlled trials (RCTs) and 9 uncontrolled pilot studies. Participants across all studies were adults. The anxiety conditions treated were as follows: generalized anxiety disorder (GAD), social anxiety disorder (SAD), illness anxiety disorder (IAD), and general anxiety symptoms, with or without comorbid physical and mental health problems. A total of 18 studies reported significant anxiety reduction after iACT treatment. This was observed in studies that delivered iACT with (n=13) or without (n=5) therapist guidance. The average attrition rate across all included studies during the active iACT treatment phase was 19.19%. In the 13 studies that assessed treatment satisfaction, participants on average rated their iACT experience with above average to high treatment satisfaction. CONCLUSIONS These findings indicate that iACT can be an efficacious and acceptable treatment for adults with GAD and general anxiety symptoms. More RCT studies are needed to corroborate these early iACT findings using empirical treatments in active control groups (eg, internet-delivered cognitive behavioral therapy). This would potentially validate the promising results found for SAD and IAD as well as address the full spectrum of anxiety disorders.

Background: The melanoma incidence and mortality rates in rural and remote communities are exponentially higher than in urban areas. Digital health could be used to close the urban/rural gap for melanoma and improve access to posttreatment and support care services. Objective: To understand how digital health is currently used for melanoma post-treatment care and determine its benefits for Australian rural and remote areas. Methods: A systematic search of PubMed, Medline, Google Scholar, Scopus was conducted in March 2018. Findings were clustered per type of intervention and related-direct outcomes. Results: Five studies met the inclusion criteria, but none of them investigated the benefits of digital health for melanoma post-treatment care in rural and remote areas of Australia. A number of empirical studies demonstrated consumers' acceptance toward digital intervention for post-treatment care. Findings did not take into consideration individual, psychological and socioeconomic factors, even though studies show their significant impacts on melanoma quality of aftercare. Conclusions: Digital interventions may to be used as an adjunct service by clinicians during melanoma post-treatment care, especially in regions that are lower-resourced by practitioners and health infrastructure, such as rural and remote Australia. Technology could be used to reduce the disparity in melanoma incidence, mortality rates and accessibility to post-treatment care management between urban and rural/remote populations.Keywords: Digital health; eHealth; Technology; Melanoma; Post-treatment care; Support care services; Rural areas; Remote communities; Patient centric; Oncology IntroductionAustralia remains a country with one of the highest levels of melanoma. In 2015, the worldwide average age-standardised incidence rate (ASR) for melanoma was 5 cases for 100,000, however the rates for Australia and New Zealand are over ten times that level (Table 1) , leading to a higher incidence and mortality within 5 years. The median incidence ASR for Non-Indigenous Australians with CM is 32 per 100,000 across rural and remote areas and 27 per 100,000 in major cities. In comparison, the median worldwide ARS mortality for CM is 5.4 per 100,000 across rural and remote areas and 4.6 per 100,000 in major cities [7].Melanoma treatment plans depend on (a) prognostic factors which are largely defined by the American Joint Committee on Cancer (AJCC) staging system [8], and (b) individual characteristics which will allow the clinicians to determine the type of Melanoma and the risk for recurrences. For example, patients previously treated for primary CM are at higher risk of recurrences and developing new primary melanomas and skin lesions [9]. However, early-detection can reduce mortality rates, as melanoma can be more effectively cured with simple and cheap treatments in the early stages [10]. In 1996, Berwick and colleagues reported that Total Self Skin-Examination (TSSE) may decrease melanoma mortality by 63% [11] and a 2003 study found that re...