Background: Telemedicine includes the delivery of health-care services and sharing of health information across distances. Past research has found that telemedicine can play a role in enhancing complementary, alternative, and integrative medicine (CAIM) while allowing the maintenance of cultural values and ancestral knowledge. This scoping review synthesized evidence regarding the use of telemedicine in the context of CAIM. Methods: Following Arksey and O’Malley’s scoping review framework, CINAHL, PsycINFO, MEDLINE, EMBASE and AMED databases were searched systematically. The CADTH website was also searched for grey literature. Eligible articles included a CAIM practice or therapy offered through telemedicine, with no restrictions placed on the type of telemedicine technology used. Inductive thematic analysis was conducted to synthesise common themes among the included studies. Results: Sixty-two articles were included in this synthesis. The following themes emerged: 1) the practitioner view of CAIM delivered through telemedicine, 2) the patient view of CAIM delivered through telemedicine, and 3) the technological impacts of telemedicine delivery of CAIM. Conclusions: Studies have shown that telemedicine delivery of CAIM is feasible, acceptable, and results in positive health outcomes. Some barriers remain such as existing illness and morbidity, inability to form strong patient-provider relationships relative to face-to-face approaches, and technological difficulties. Future intervention research should focus on reducing such barriers, as well as explore which patient population would realize the greatest benefit from CAIM delivered via telemedicine, and the impact of interventions on providers and caregivers.

Introduction: Functional heterogeneity in cancer may result in the metastasis of various types of tumour cells throughout the body. Attempting to explain functional heterogeneity in cancer cells has given rise to two models. The Cancer Stem Cell model proposes that a subset of tumour cells self-replicate and that heterogeneity is a progeny of various cancer stem cells (CSCs). The Clonal Evolution Model proposes heterogeneity as a product of mutations across tumour cells that accumulate and metastasize linearly or branching. Methods: Research was conducted through open-access journals and information was compiled surrounding CSC models using the Google Scholar and McMaster Library database search engines. Inclusions were sources that detailed the relationship between both models of functional heterogeneity and microenvironments and treatments. Literature that did not center around tumour microenvironments was not included in this literature review. Results: The two main models of tumour proliferation were explored and related to hypoxic tumour microenvironments. Various markers, etiologic agents and toxins were identified that contribute to tumour progression. Cell signalling and pathways that contribute to major cellular functions were identified, along with possible disruptions and epigenetic changes that lead to tumour and CSC proliferation. Discussion: This study reveals that the tumour microenvironment plays a large role in the proliferation of CSCs. Although the therapies targeting microenvironments are in early stages of development, focusing on these CSC targeted-therapies may lead to better treatments for cancer or more effective combination therapies. Strengths of the paper include the compilation of major contributing areas to CSC proliferation, whereas limitations encompass the high variability of tumour cells that are not all covered in this review. Conclusion:While no definitively eradicating treatment for CSCs currently exist, the recent developments in cancer research indicate promising new techniques for its management. Implications: By further studying malignant CSCs, highly effective cancer treatments may result, leading to the advancement of CSC recognition and combination therapy.

Background Telemedicine includes the delivery of health-care services and sharing of health information across distances. Past research has found that telemedicine can play a role in enhancing complementary, alternative, and integrative medicine (CAIM) while allowing the maintenance of cultural values and ancestral knowledge. This scoping review synthesized evidence regarding the use of telemedicine in the context of CAIM. Methods Following Arksey and O’Malley’s scoping review framework, CINAHL, PsycINFO, MEDLINE, EMBASE and AMED databases were searched systematically. The CADTH website was also searched for grey literature. Eligible articles included a CAIM practice or therapy offered through telemedicine, with no restrictions placed on the type of telemedicine technology used. Inductive thematic analysis was conducted to synthesise common themes among the included studies. Results Sixty-two articles were included in this synthesis. The following themes emerged: 1) the practitioner view of CAIM delivered through telemedicine, 2) the patient view of CAIM delivered through telemedicine, and 3) the technological impacts of telemedicine delivery of CAIM. Conclusions Studies have shown that telemedicine delivery of CAIM is feasible, acceptable, and results in positive health outcomes. Some barriers remain such as the presence of chronic illness and morbidity, inability to form strong patient-provider relationships relative to face-to-face approaches, and technological difficulties. Future intervention research should focus on reducing such barriers, as well as explore which patient population would realize the greatest benefit from CAIM delivered via telemedicine, and the impact of interventions on providers and caregivers.