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☐ ☆ ✇ BMJ Open

Barriers and facilitators to implementing the living guideline development framework in oncology: a mixed methods study

Por: Ismaila · N. · Harvey · B. E. · Einhaus · K. · Mbuagbaw · L. · Ma · J. · Thabane · L. — Enero 16th 2026 at 18:44
Objective

To explore stakeholder experiences with implementing the living guideline (LG) development framework in oncology, and to identify barriers, facilitators and solutions to support its uptake and sustainability.

Design

An exploratory sequential mixed methods design was used, beginning with qualitative semi-structured interviews with guideline development stakeholders, analysed thematically; and followed by a cross-sectional survey to quantitatively rate the importance of factors identified in phase one.

Setting

National and international oncology guideline development programmes using the LG development framework.

Participants

Stakeholders involved in LG development, including expert panel co-chairs, panel members, patient representatives, methodologists and administrative staff.

Results

Nine stakeholders participated in qualitative interviews, and 45 completed the survey. Most participants were male (5/9:56% qualitative; 26/45:58% quantitative) and based in the US (7/9:78% and 29/45:64%, respectively). Overall, the results from both the qualitative and quantitative strand revealed seven themes (34 subthemes) as barriers and six themes (21 subthemes) as facilitators. Additionally, 9 themes were proposed as solutions. The most frequently reported barriers included evidence timeliness, interpretation and publication delays. Prominent facilitators included effective management, resource optimisation and panel engagement. Participants strongly endorsed investment in artificial intelligence enhanced tools to improve the speed and efficiency of evidence acquisition and review.

Conclusion

While the LG framework provides strong methodological guidance, its practical application presents notable challenges, particularly in resource demands and implementation logistics. Successful adoption requires adequate infrastructure, expertise and oversight. These findings highlight critical considerations for developers aiming to implement sustainable LG models in oncology and beyond.

☐ ☆ ✇ BMJ Open

Determinants of treatment decisions in advanced dementia: a protocol for a cross-cultural mixed-methods study

Por: Lima · J. P. · Mbuagbaw · L. · Prasad · M. · Kumar · A. · Wafeu · G. S. · Bonnet · R. · Agoritsas · T. · Li · S. · Liu · Z. · Alonso-Coello · P. · Akio Nishijuka · F. · Mirza · R. · Matos Silva · C. · Alshanketi · R. · Alsahafi · I. · Alnuaimi · A. · Heen · A. F. · Schwartz · L. · Guyatt — Diciembre 31st 2025 at 11:30
Introduction

Values and preferences are key determinants of optimal care, and variability in patient values and preferences often dictates differences in patient management. Clinicians’ views of patients’ values and preferences may differ across cultural aspects and stage of training, but the extent to which this is the case remains uncertain. One key value and preference issue is the trade-off between quantity and quality of life, and this issue is particularly prominent among patients with dementia. We therefore propose to investigate the extent to which physicians’ perceptions of optimal management for patients living with advanced dementia may differ due to cross-cultural factors and stage of medical training.

Methods and analysis

We will conduct a sequential explanatory mixed-methods study (QUAN -> qual). First, we will administer paper-based or electronic surveys during educational sessions, conferences and rounds to medical students, residents and physicians in ten countries, either in person or online. Following that, a qualitative inquiry, guided by the findings of the quantitative study and the principles of the interpretive description design, will inform an in-depth exploration of the predictive factors identified in the quantitative data analysis.

Ethics and dissemination

The Hamilton Integrated Research Ethics Board at McMaster University has approved this study (approval number 2024-17651). We will disseminate our findings in peer-reviewed publications and present results at conferences as oral and poster presentations.

☐ ☆ ✇ PLOS ONE Medicine&Health

Assessment of allergy knowledge among the Palestinian community: A cross-sectional study

Por: Maha Rabayaa · Mustafa Ghanim · Malik Alqub · Mohammad Abuawad · Majdi Dwikat · Samar Alkhaldi · Haneen Badawi · Johnny Amer — Diciembre 17th 2025 at 15:00

by Maha Rabayaa, Mustafa Ghanim, Malik Alqub, Mohammad Abuawad, Majdi Dwikat, Samar Alkhaldi, Haneen Badawi, Johnny Amer

Introduction

Allergy is a form of chronic illness with an increasing prevalence globally. Adequate knowledge among the community about the causes, symptoms, and treatment of allergy is crucial in preventing the associated life-threatening complications. Limited research has been conducted in Palestine regarding this health priority. The current study aimed to assess the Palestinian community’s level of knowledge regarding allergy.

Methods

An observational cross-sectional study was conducted using an online questionnaire targeting Palestinians aged 18 years and older between 1 June 2024 and 26 January 2025. The questionnaire gathered demographic information about the participants and assessed their knowledge level concerning allergy.

Results

A total of 1002 participants were included in the study. The mean age of the participants was 30.33 years. 66.1% of the participants were females, 60.2% were unmarried, 60.1% had possessed a bachelor’s degree, 63.1% had a personal history of allergy, and 82% reported knowing of someone with allergies. The mean knowledge score about allergies was 5.4 out of 10, with over half of the participants having an average level of knowledge (4–6). The knowledge score about allergies was significantly different based on the participants’ sex, marital status, place of residence, educational level, and occupation (p-value Conclusion

The Palestinians’ knowledge of allergy is considered good regarding its common causes and symptoms. However, there is still inadequate knowledge about the treatment of allergy and its less common causes. The community awareness of allergy should be improved through targeted campaigns and brochures aimed at achieving earlier diagnosis and proper management to prevent the development of life-threatening complications.

☐ ☆ ✇ PLOS ONE Medicine&Health

Retrospective analysis of the BariClip procedure: Clinical outcomes and complication profile

by Saleh Abualhaj, Anas Alyazouri, Mosleh M. Abualhaj, Lina Alshadfan, Shadi Hamouri, Obada Alaraishy, Eman Alkhawaja, Amro Mureb, Ali Aloun, Abdallah Arabyat

Background

Bariclip is an emerging non- resective bariatric device designed to restrict gastric capacity while preserving anatomical integrity. Unlike traditional sleeve gastrectomy, Bariclip implantation does not involve gastric resection, potentially minimizing surgical risk and allowing reversibility. However, data on its early efficacy and safety remain limited.

Objective

To evaluate short-term surgical outcomes, weight loss metrics, and comorbidity resolution among patients undergoing Bariclip implantation.

Methods

This retrospective observational study included 82 patients who underwent Bariclip placement at a single tertiary care center. Data were extracted from electronic medical records, operative logs, and follow-up notes. Outcomes assessed included total weight loss (TWL%) and excess weight loss (EWL%) at 2 weeks, 1, 2, 3, and 6 months postoperatively. Additional variables included operative time, hospital stay, early postoperative complications (within 30 days), reintervention rates, and changes in obesity-related comorbidities.

Results

The cohort had a mean age of 37.6 ± 9.9 years, with the majority being female (76.8%) and obese (mean BMI = 36.6 ± 4.7 kg/m²). Most patients (91.5%) underwent surgery for obesity management. Postoperatively, patients reported low pain scores (mean = 5.2), with no need for opioid analgesia and early mobilization in 62.2%. Complication rates were low (3.6%). Repeated measures ANOVA revealed a significant reduction in BMI over time (p  Conclusion

Bariclip surgery demonstrated favorable short-term safety and efficacy, with substantial weight loss and low complications rate observed within six months. These findings support Bariclip as a promising minimally invasive option for weight management in select patient populations.

☐ ☆ ✇ BMJ Open

Frequency of reported abuse, stigma and discrimination during facility-based childbirth among migrant mothers and their suggestions for improvement: a mixed method WHO standards-based multicentre study in Italy

Por: Mariani · I. · Covi · B. · Valente · E. P. · Lazzara · G. · Not · S. · Casetta · G. · Manfrida · M. M. · Bua · J. · Piazza · M. · Zanetti · A. · Moretti · V. · Giornelli · R. · Battistin · S. · Miani · M. P. · Pecci · L. · Pizzocchero · E. · Fabiani · C. · Michelutti · A. · Pertner · V. · Sa — Octubre 21st 2025 at 08:30
Objectives

This study aims at documenting the frequency of reported abuse, stigma and discrimination and exploring the perspectives for improving the quality of maternal-newborn care (QMNC) of migrant mothers’ reporting abuse, stigma or discrimination.

Design

Mixed methods multicentre cross-sectional study.

Setting

All maternal facilities (tertiary and secondary levels of care, n=9) from Friuli-Venezia Giulia region, Northeast Italy, between November 2019 and January 2022 in Northeast Italy.

Participants

874 migrant and 3968 non-migrant women answering a validated WHO Standard-based questionnaire after birth.

Outcome measures

Frequency of reported abuse, stigma and discrimination during facility-based childbirth was calculated and compared with those of non-migrant mothers. Thematic analysis was conducted on eight open questions, using WHO Standards as a framework for the analysis.

Results

Among migrant women, 84 (9.6%) reported some type of abuse, stigma and discrimination, a frequency similar to non-migrant women (9.8%, p=0.880). The most frequently reported was verbal abuse (87.7%), followed by stigma and discrimination (15.1%). Most women (86.9%) provided at least one comment, with a frequency comparable to non-migrant women (p=0.076). Among a total of 327 comments, 104 (31.8%) were practical suggestions for improving QMNC. Experience of care was the domain with the highest frequency both of negative (64.9% of negative comments) and positive comments (51.7% of positive comments) and with the highest frequency of suggestions for improving QMNC (52.9% of suggestions). Overall, suggestions mainly focused on strengthening healthcare professionals’ communication skills, allowing companionship during childbirth, increasing healthcare professionals’ availability and timely support.

Discussions

This study shows that both migrant and non-migrant mothers are exposed to abuse, stigma and discrimination during childbirth, and that both are willing to provide practical suggestions, which should be used for planning actions to improve QMNC.

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