Suárez, Nataly R. Espinoza

Introduction Despite the increasingly evidenced positive impacts of green space on human physical and mental health, green spaces remain inequitably distributed across different socioeconomic groups. Urban planning and design should prioritise the development and maintenance of urban green spaces, especially for vulnerable and marginalised populations while thinking about protecting them from the effects of green gentrification. This scoping review will explore how the concepts of equity, diversity and inclusion are integrated into the design, the planning and policy development of urban green spaces. Also, we will explore what are the efforts made to incorporate equity, diversity, and inclusion concepts into the planning, design and policy development of urban green spaces to make them equitable for vulnerable and marginalised populations. Methods and analysis This protocol is based on the methodology developed by Arksey and O’Malley and improved by Levac et al . The search will be done in conjunction with a professional librarian, to include studies in all languages. The review will include multidisciplinary databases: Ovid MEDLINE, Ovid EMBASE, CINAHL, Web of Science and GeoBase. The search will be done from each database’s inception to February 2024. We will present our results narratively and will conduct a thematic analysis using the urban green equity framework. This framework will guide our understanding of the interplay between the spatial distribution of urban green spaces and the recognition of diverse voices in urban greening decision-making. Ethics and dissemination This scoping review will not require ethical approval since it will be collected from publicly available documents. The results of this scoping review will be presented as a scientific article, social media and public health or environmental conferences organised by environmental organisations or academic institutions.

Background The objective is to examine and synthesise the best available experimental evidence about the effect of ambulatory consultation duration on quality of healthcare. Methods We included experimental studies manipulating the length of outpatient clinical encounters between adult patients and clinicians (ie, therapists, pharmacists, nurses, physicians) to determine their effect on quality of care (ie, effectiveness, efficiency, timeliness, safety, equity, patient-centredness and patient satisfaction). Information sources Using controlled vocabulary and keywords, without restriction by language or year of publication, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews and Scopus from inception until 15 May 2023. Risk of bias Cochrane Risk of Bias instrument. Data synthesis Narrative synthesis. Results 11 publications of 10 studies explored the relationship between encounter duration and quality. Most took place in the UK’s general practice over two decades ago. Study findings based on very sparse and outdated evidence—which suggested that longer consultations improved indicators of patient-centred care, education about prevention and clinical referrals; and that consultation duration was inconsistently related to patient satisfaction and clinical outcomes—warrant low confidence due to limited protections against bias and indirect applicability to current practice. Conclusion Experimental evidence for a minimal or optimal duration of an outpatient consultation is sparse and outdated. To develop evidence-based policies and practices about encounter length, randomised trials of different consultation lengths—in person and virtually, and with electronic health records—are needed. Trial registration number OSF Registration DOI:10.17605/OSF.IO/EUDK8.

Abstract Background Venous thromboembolism (VTE) in pregnancy is a major cause of maternal morbidity and death. The use of low-molecular-weight heparin (LMWH), despite being the standard of care to prevent VTE, comes with some challenges. Shared decision-making (SDM) interventions are recommended to support patients and clinicians in making preference-sensitive decisions. The quality of the SDM process has been widely assessed with the decisional conflict scale (DCS). Our aim is to report participants’ perspectives of each of the components of an SDM intervention (DASH-TOP) in relation to the different subscales of the DCS. Methods Design: A convergent, parallel, mixed-methods design. Participants: The sample consisted of 22 health care professionals, students of an Applied Clinical Research in Health Sciences (ICACS) master program. Intervention: We randomly divided the participants in three groups: Group 1 received one component (evidence -based information), Group 2 received two components (first component and value elicitation exercises), and Group 3 received all three components (the first two and a decision analysis recommendation) of the SDM intervention. Analysis: For the quantitative strand, we used a non-parametric test to analyze the differences in the DCS subscales between the three groups. For the qualitative strand, we conducted a content analysis using the decisional conflict domains to deductively categorize the responses. Results Groups that received more intervention components experienced less conflict and better decision-making quality, although the differences between groups were not statistically significant. The decision analysis recommendation improved the efficacy with the decision-making process, however there are some challenges when implementing it in clinical practice. The uncertainty subscale showed a high decisional conflict for all three groups; contributing factors included low certainty of the evidence-based information provided and a perceived small effect of the drug to reduce the risk of a VTE event. Conclusions The DASH-TOP intervention reduced decisional conflict in the decision -making process, with decision analysis being the most effective component to improve the quality of the decision. There is a need for more implementation research to improve the delivery of SDM interventions in the clinical encounter.

Abstract Background Peripherally inserted central catheters (PICCs) and midlines are commonly used devices for reliable vascular access. Infection and thrombosis are the main adverse effects of these catheters. We aimed to evaluate the relative risk of complications from midlines and PICCs. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies. The primary outcomes were catheter-related bloodstream infection (CRBSI) and thrombosis. Secondary outcomes evaluated included mortality, failure to complete therapy, catheter occlusion, phlebitis, and catheter fracture. The certainty of evidence was assessed using the GRADE approach. Results Of 8368 citations identified, 20 studies met the eligibility criteria, including 1 RCT and 19 observational studies. Midline use was associated with fewer patients with CRBSI compared with PICCs (odds ratio [OR], 0.24; 95% CI, 0.15–0.38). This association was not observed when we evaluated risk per catheter. No significant association was found between catheters when evaluating risk of localized thrombosis and pulmonary embolism. A subgroup analysis based on location of thrombosis showed higher rates of superficial venous thrombosis in patients using midlines (OR, 2.30; 95% CI, 1.48–3.57). We did not identify any significant difference between midlines and PICCs for the secondary outcomes. Conclusions Our findings suggest that patients who use midlines might experience fewer CRBSIs than those who use PICCs. However, the use of midline catheters was associated with greater risk of superficial vein thrombosis. These findings can help guide future cost-benefit analyses and direct comparative RCTs to further characterize the efficacy and risks of PICCs vs midline catheters.

CSCW has previously investigated the "information work" that patients do in relation to their health, illnesses, and treatments. Our study contributes to this ongoing stream of work by investigating the information work that chronically ill patients do in relation to their physical bodily experiences. We use an interpretivist approach and qualitative methods (semi-structured interviews and observations) to examine how patients in a midwestern U.S. city carry out information work related to their bodily experiences of Chronic Kidney Disease (CKD). Our findings highlight four themes related to such work: bodily experiences of CKD; making meaning of bodily experiences through experiential learning; communicating bodily experiences; and attuning daily life around bodily experiences. In so doing, we show how patients continuously engage in information work in relation to their bodily experiences. For example, we found participants experienced physical sensations such as pain, cramping, and extreme fatigue, which elicited complex labor, yet most patients received little education from health care professionals about what bodily sensations they might have and what these physical experiences might mean. While patients and clinicians worked collaboratively to adjust treatment based on bodily information, such collaborative adjustment often did not occur until patients learned to interpret and communicate bodily experiences through a difficult and physically painful "trial and error" learning process. Our empirical insights extend on the literature of information work that chronically ill patients do and inform design of information technologies and care processes for patients with chronic disease.

Objective Shared decision making (SDM) tools can help implement guideline recommendations for patients with atrial fibrillation (AF) considering stroke prevention strategies. We sought to characterize all available SDM tools for this purpose and examine their quality and clinical impact. Methods We searched through multiple bibliographic databases, social media, and an SDM tool repository from inception to May 2020 and contacted authors of identified SDM tools. Eligible tools had to offer information about warfarin and ≥1 direct oral anticoagulant. We extracted tool characteristics, assessed their adherence to the International Patient Decision Aids Standards, and obtained information about their efficacy in promoting SDM. Results We found 14 SDM tools. Most tools provided up-to-date information about the options, but very few included practical considerations (e.g., out-of-pocket cost). Five of these SDM tools, all used by patients prior to the encounter, were tested in trials at high risk of bias and were found to produce small improvements in patient knowledge and reductions in decisional conflict. Conclusion Several SDM tools for stroke prevention in AF are available, but whether they promote high-quality SDM is yet to be known. The implementation of guidelines for SDM in this context requires user-centered development and evaluation of SDM tools that can effectively promote high-quality SDM and improve stroke prevention in patients with AF.

Abstract Background: It is estimated that 10-25% of patients with hypothyroidism use desiccated thyroid extract (DTE) as their primary thyroid hormone replacement medication, despite concerns about the risk of thyrotoxicosis associated with DTE use. It is unclear why many patients prefer the use of DTE as a thyroid hormone replacement formulation over guideline-concordant therapies such as levothyroxine (LT4). Methods: We conducted a mixed-methods study by analyzing patient-reported information from patient online forums to better understand patient preferences for and attitudes toward the use of DTE to treat hypothyroidism. We searched the 10 most popular patient forums based on number of users (WebMD, Topix, Health questions, Patients like me, Drugs.com, Endocrine Web, Everyday Health, Talk Health Partnership, Spark People and Patients.info) using the key terms: desiccated thyroid extract, desiccated thyroid treatment, thyroid USP, commercial names of DTE (Armour Thyroid® or Natural Thyroid®), thyroid extract, AND hypothyroidism. Unique posts were retrieved from those websites between each forum’s inception to March 2018. From these posts, we extracted descriptive information on patient demographics and clinical characteristics and qualitatively analyzed posts’ content to further explore patient perceptions on DTE and other thyroid hormone replacement therapies. Results: Unique 1,235 posts were initially retrieved from the included patient forums. After the initial screening, we selected data from three of these forums (WebMD, Patients Like Me, and Drugs.com) based on the completeness of the available information (673 posts). Nearly half (45%) of patients reported that a clinician initially drove their interest in trying DTE. Patients described many reasons for switching from a previous therapeutic approach to DTE, including lack of improvement in symptoms (58%) and the development of side effects (22%). Among a majority of patients, DTE was described as moderately-to-majorly effective overall (81%) and more effective than the previous therapy (77%). The most frequently described benefits associated with DTE use were an improvement in clinical symptoms (56%) as well as a change in overall well-being (34%). One-fifth of patients described side effects related to the use of DTE. Qualitative analysis of posts’ content supported these findings and raised additional issues around the need for individualizing therapy approaches for hypothyroidism as well as difficulties obtaining DTE. Conclusions: Among patients with hypothyroidism, a subset may prefer DTE over guideline-concordant therapies for many reasons, including perceived effectiveness, despite the risks associated with DTE. Future work should incorporate patient-reported outcomes to better elucidate the mechanisms responsible for therapy preferences in this subset of patients.