A Scoping Review Examining Governance, Co-Creation, and Social and Ecological Justice in Living Labs Literature

Living Labs (LLs) are increasingly being used as an approach to address complex sustainability-related challenges. Inspired by existing knowledge and practice gaps, calls for further examination of governance and co-creation in relation to LLs work, and our experiences in the Lake Superior Living Labs Network, we conducted a scoping review of the recent (2015–2019) LLs literature. This review focused on peer-reviewed LLs literature aimed at addressing sustainability-related challenges and involving universities as key collaborators specifically. This scoping review addressed the research questions: how are LLs conceptualized, described, and applied? how are LLs governed? How is co-creation supported in LLs work? and, are social and/or environmental justice considered in LLs work? From the 729 citations gathered in the electronic database searches, 48 papers were identified as relevant through the screening and eligibility assessment. We found that this literature is growing rapidly, highly interdisciplinary, and predominantly taking place within European urban centres. We summarize the findings in relation to our research questions and outline implications for interrogating governance, unpacking co-creation, and working towards social and ecological justice in LLs research and practice. We conclude by outlining four key research directions to advance LLs work, including, (1) expanding research across a greater diversity of settings; (2) examining and analyzing governance and power dynamics; (3) exploring how learning evolves via co-creation; and (4) examining how universities are impeding and/or supporting advances in relation to governance, co-creation, and justice in LLs work.

Healthcare Providers Face Numerous Challenges in Treating Patients with Psoriasis: Results from a Mixed-Methods Study

Background The paradigm shift toward biologic medications in psoriasis care requires healthcare providers (HCPs) to become acquainted with mechanisms of action and safety profiles of these new treatments to confidently use them in practice. A better understanding of this paradigm shift is necessary to provide adequate education for HCPs in psoriasis care. Objectives This study assessed clinical practice gaps and challenges experienced by HCPs caring for patients with psoriasis. Methods A mixed-methods approach was used to identify practice gaps and clinical challenges of dermatologists, rheumatologists, primary care physicians, physician assistants, and nurse practitioners with various levels of clinical experience in academic and community-based settings. Qualitative and quantitative data were collected sequentially. Interviews were transcribed and thematically analyzed. Results A total of 380 psoriasis care providers in Canada and the US participated in this study. Analysis revealed challenges in establishing an accurate diagnosis of psoriasis (including screening for sub-type and distinguishing psoriasis from other skin conditions), selecting treatment (particularly regarding recently approved treatments), monitoring side effects, and collaborating with other HCPs involved in psoriasis care. Conclusion These findings highlight educational needs of HCPs involved in psoriasis care that could have repercussions on accurate and timely diagnosis of the condition, treatment initiation, side effect monitoring, and continuity of care. Findings provide a starting point for clinicians to reflect on their practice and for the improvement of continuing professional development interventions that would bridge these gaps.

Practice Gaps and Barriers in Optimal Care Among Healthcare Providers Treating Patients with Myelodysplastic Syndrome (MDS) and Acute Myeloid Leukemia (AML): Results of a Two-Phase Qualitative/Quantitative Study

Background: Rapid advances in the understanding of the biology of MDS and AML have led to novel therapeutic interventions that have increased the clinical complexity of decision making in patient care. This study sought to quantify professional practice gaps and barriers to optimal care among healthcare providers treating patients with MDS and AML at academic medical centers and/or community cancer centers and clinics globally, with the goal of informing the design of evidence-based education interventions aiming at addressing these gaps. Methods: In February-May 2021, 329 physicians (n = 190), physician assistants (n = 16) and advanced practice providers [nurse practitioners (n = 51) and pharmacists (n = 72)] were recruited to participate in a two-phase national educational study focused on MDS and AML. Eligible participants had to be active practitioners who treat patients with MDS and AML (n = 263 US; 66 ex-US). In the exploratory qualitative phase of this study, 30 US participants completed a 45-minute telephone interview focusing on the personal, contextual, and behavioral factors that influence a provider's clinical reasoning process in diagnosis and treatment. These participants completed a brief online case-based survey before the interview. Interviews were transcribed and analyzed through thematic analysis. The quantitative phase of this study consisted of an online survey composed of specific multiple-choice questions, semantic differential rating scales, and case vignettes. Respondents' answers to each of the questions in the quantitative survey were compared with optimal answers as identified by treatment guidelines and faculty experts. Results: A group of 6 core practice gaps were identified through combined analysis of data from the online surveys and in-depth interviews. Of note, just 10% of US and 3% of ex-US participants agreed with expert opinion and would consider patients over 75 years with high-risk MDS or AML as possible candidates for stem cell transplant. For newly diagnosed high-risk MDS, 20% to 35% of participants are incorporating venetoclax/azacitidine into practice off-label, even for patients with TP53 mutations. About half (52%) of participants agreed with expert recommendation of venetoclax + HMA for elderly patients (>75 y) with newly diagnosed AML. A minority of participants' practice (18%) matched expert recommendations of venetoclax + HMA for a 68 yo patient with newly diagnosed AML and ECOG PS 2 with a FLT3 mutation with many participants (33%) recommending intensive chemotherapy with midostaurin. Similarly, for secondary AML progression from MDS with previous HMA therapy, a minority of participants (24%) agreed with the expert recommendation of CPX-351. Finally, a minority of study participants knew the mechanisms of action or targets of promising agents in clinical trials for patients with TP53 mutations, including eprenetapopt/APR-246 (31%) and magrolimab (36%). Detailed results of analysis will be presented, including group-specific analyses and investigation of the causalities of each of the practice gaps identified. Conclusions: Many hematology/oncology professionals are not applying optimal care in patients with MDS and AML. Most notably, study participants may not adequately consider stem cell transplant for older patients with high-risk MDS or AML potentially impacting outcomes. At the same time, the overuse of intensive chemotherapy regimens by healthcare providers could have multiple consequences for older patients with AML including poorer outcomes and reduced quality of life. Finally, a lack of familiarity with promising agents under clinical investigation in MDS and AML with TP53 mutations may lead to missed opportunities to enroll eligible patients on clinical trials and potentially delay integration of emerging data and agents with new indications into clinical practice. Results of this study provide evidence to support the design of clinical tools, educational programs, and performance improvement interventions. Disclosures Daver: Bristol Myers Squibb: Consultancy, Research Funding; Genentech: Consultancy, Research Funding; Daiichi Sankyo: Consultancy, Research Funding; Glycomimetics: Research Funding; Gilead Sciences, Inc.: Consultancy, Research Funding; Sevier: Consultancy, Research Funding; Abbvie: Consultancy, Research Funding; Novimmune: Research Funding; FATE Therapeutics: Research Funding; Astellas: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding; Amgen: Consultancy, Research Funding; ImmunoGen: Consultancy, Research Funding; Trillium: Consultancy, Research Funding; Trovagene: Consultancy, Research Funding; Hanmi: Research Funding; Novartis: Consultancy; Jazz Pharmaceuticals: Consultancy, Other: Data Monitoring Committee member; Dava Oncology (Arog): Consultancy; Celgene: Consultancy; Syndax: Consultancy; Shattuck Labs: Consultancy; Agios: Consultancy; Kite Pharmaceuticals: Consultancy; SOBI: Consultancy; STAR Therapeutics: Consultancy; Karyopharm: Research Funding; Newave: Research Funding. Stein: Janssen Pharmaceuticals: Consultancy; Genentech: Consultancy; Astellas: Consultancy; Syndax Pharmaceuticals: Consultancy; Daiichi Sankyo: Consultancy; Syros Pharmaceuticals, Inc.: Consultancy; PinotBio: Consultancy; Celgene: Consultancy; Bristol Myers Squibb: Consultancy; Foghorn Therapeutics: Consultancy; Jazz Pharmaceuticals: Consultancy; Gilead Sciences, Inc.: Consultancy; Blueprint Medicines: Consultancy; Abbvie: Consultancy; Agios Pharmaceuticals, Inc: Consultancy; Novartis: Consultancy.

Implementation of a Cellulitis Management Plan in Three Australian Regional Health Services to Address an Evidence–Practice Gap in Antibiotic Prescribing

Despite the availability of evidence-based guidelines, antibiotics for cellulitis remain inappropriately prescribed. This evidence–practice gap is more evident in low-resource settings, such as rural hospitals. This implementation study developed and introduced a cellulitis management plan to improve antibiotic prescribing for cellulitis in three health services in regional Australia. Appropriateness of antibiotic prescribing for cellulitis at Day 1 was the primary outcome measure. Adults with ICD-10-AM codes for lower-limb cellulitis admitted as inpatients of the three health services between May and November 2019 (baseline, n = 165) and March and October 2020 (post-implementation, n = 127) were included in the assessment. The uptake of the cellulitis management plan was 29.1% (37/127). The appropriateness of antibiotic prescribing for cellulitis at Day 1 was similar at baseline (78.7%, 144/183) and in the intention-to-treat post-implementation group (81.8%, 126/154) [95% CI −5.6% to 11.3%, p = 0.50]. Commencement of the cellulitis management plan resulted in a non-statistically significant increase in antibiotic appropriateness at Day 1 compared to when a cellulitis management plan was not commenced (88.1% vs. 79.5%; 95% CI −5.6% to 19.8%; p = 0.20) Evaluation of more real-world strategies to address evidence–practice gaps, such as the appropriateness of antibiotic prescribing for cellulitis, is required.

Rural community-based nurses’ self-reported knowledge and skills in the provision of psychosocial care to palliative and end-of-life clients and carers

Objective This study examined rural community-based nurses' self-reported knowledge and skills in the provision of psychosocial care to rural residing palliative and end-of-life clients and carers. We further sought to determine correlates of knowledge gaps to inform workforce education and planning. Method Nurses from a rural area of Victoria, Australia, were invited to complete an electronic questionnaire rating their knowledge against 6 national palliative care standards and 10 screening and assessment tools. A 5-point scale of (1) No experience to (5) Can teach others was used to rate knowledge. Results were classified into three categories: practice gaps, areas of consolidation, and strengths. Descriptive and logistical regression was used to analyze data. Results A total of 122 of 165 nurses (response rate = 74%) completed the survey. Of these nurses, 87% were Registered Nurses, 43% had ≥10 years' experience in palliative care, and 40% had palliative care training. The majority of practices across the standards and screening and assessment tools were rated as knowledge strengths (N = 55/67, 82%). Gaps and areas of consolidation were in the use of client and carer assessment tools, the care of specific populations such as children, supporting carers with appropriate referrals, resources, and grief, and facilitating the processes of reporting a death to the coroner. Lack of formal training and lower years of experience were found to be associated with practice gaps. Significance of results Our study found rural nurses were confident in their knowledge and skills in the majority of psychosocial care. As generalist nurses make up the majority of the rural nursing workforce, further research should be undertaken on what educational strategies are needed to support and upskill rural community-based nurses to undertake formal training in palliative care.