To explore stakeholder perspectives on care coordination barriers and facilitators in regionalised neuro-oncology delivery, using brain tumours as a model for examining complex care pathways serving mixed rural-urban populations.

Reflexive thematic analysis of semistructured interviews from stakeholders across the neuro-oncology care pathway was used to identify themes of care system strengths, barriers to effective service delivery and priorities for system improvement.

Regionalised Canadian health system serving one of Ontario’s largest catchment areas, characterised by predominantly rural populations and substantial geographic distances to tertiary care.

36 stakeholders purposively sampled to represent diverse roles across the care pathway, including family caregivers (n=6), healthcare providers from multiple specialties and care settings (n=28) and Indigenous community advisors (n=2).

Thematic analysis identified seven themes organised within two broad domains: care system strengths and barriers to care continuity. Care system strengths included three themes: responsive palliative care integration, provider dedication and compassionate commitment, and intra-institutional coordination infrastructure. Barriers to care continuity included four themes: insufficient pathway standardisation across settings; inadequate educational infrastructure for patients, families and providers; absent cross-institutional coordination infrastructure and limited regional clinical trial access. Participants described relatively coordinated processes within the tertiary centre, while communication and follow-up were more fragmented at interfaces with referring hospitals and community services, with participants describing patients becoming ‘lost in transitions’.

Findings reveal how regionalised cancer systems can achieve localised coordination while experiencing fragmentation at interfaces between organisations. Participants described relatively coordinated processes within the tertiary centre, alongside more fragmented communication and follow-up across interfaces with referring hospitals and community services. These stakeholder perspectives highlight potential directions for service redesign, including standardised pathways, shared information systems and clearer cross-site accountability structures, which warrant future evaluation alongside consideration of resource allocation and local feasibility. Brain tumours, requiring rapid multidisciplinary coordination, expose these interface failures with clarity, offering transferable insights for improving integrated cancer care in regionalised health systems serving geographically dispersed populations.

To explore healthcare practitioner perspectives and experiences of using strength assessment and strength training within pulmonary rehabilitation, focusing on perceived utility, barriers and impact on service delivery and patient care.

Qualitative study using semi-structured one-to-one interviews analysed through reflexive thematic analysis.

A pulmonary rehabilitation service in the South East of England, operating across three community sites.

11 female healthcare practitioners (including physiotherapists, nurses, and associate practitioners) involved in managing, delivering, or assisting in pulmonary rehabilitation programmes.

Four themes were constructed: (1) beyond lung fit: valuing strength training for functional independence; (2) mixed attitudes towards strength assessment utility in practice; (3) navigating the implementation gap: perceived challenges for pulmonary rehabilitation and strength assessment; and (4) the professional training divide: a call for further training. These findings show practitioners have positive views of strength assessment and strength training in pulmonary rehabilitation and recognise the benefits they offer services and patients. However, a number of barriers were identified, including uncertainty of strength assessment practicality in current practices, the need for staff training and education, and service-related challenges (time constraints, limited equipment and high workloads).

Healthcare practitioners perceive strength training as essential to pulmonary rehabilitation and recognise the potential benefits of assessing patient strength. However, organisational constraints, limited equipment, and insufficient staff training limit its routine implementation. Addressing these barriers through resource investment, clearer guidance, and structured training could bridge the implementation gap between evidence and everyday clinical practice, enhancing patient outcomes and the quality and consistency of pulmonary rehabilitation services across the UK.

Autistic children can experience elevated levels of emotional and behavioural problems, which adversely impact their psychosocial functioning. Positive parenting behaviours can significantly shape children’s emotional and behavioural developmental trajectories. However, for autistic children, these parenting behaviours may vary depending on their social, sensory and intellectual profiles. Literature on the association between parenting behaviours and autistic children’s internalising and externalising symptoms has been mixed. Thus, the main objective of this study will be to conduct a systematic review and meta-analysis of studies evaluating the effect of parenting behaviours on autistic children’s internalising and externalising symptoms.

Included studies have child samples between ages 6 and 17 years and a primary diagnosis of autism/Autism Spectrum Disorder (ASD), pervasive developmental disorder and/or Asperger’s syndrome as well as a measure of parenting behaviour. Primary outcomes are internalising and externalising symptoms. Substantive and methodological moderators will be examined. Searches will be conducted in MEDLINE, PsycINFO, Embase, Education Resources Information Center (ERIC) and ProQuest Dissertations and Theses Global from their inception onwards, and we will also conduct backward/forward searching of eligible studies. Published and unpublished studies will be examined. Two independent reviewers will conduct title/abstract and full-text screening as well as data extraction. Risk of bias will be assessed using the Newcastle-Ottawa Quality Assessment Scale and JBI Critical Appraisal tools. A random-effects meta-analysis model will be used, and summary effect sizes will be calculated. Moderation will be examined via Q-statistics and meta-regression to determine factors contributing to between-study variation in effect sizes.

Ethics approval is not required, as this review will use secondary data from published studies. Results will be disseminated through a peer-reviewed publication and conference presentations. The protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024528043).

PROSPERO CRD42024528043.

Pregnancy in women with pre-existing type 1 or type 2 diabetes (T1D, T2D) is associated with increased risk of complications, largely driven by maternal glucose control. Hormonal changes during pregnancy make glucose management more challenging. Physical activity (PA) may improve glucose control and reduce complications; however, little is known about PA patterns in this population and no pregnancy-specific PA guidance exists for women with pre-existing diabetes. Understanding the behaviours and experiences of both pregnant women and the healthcare professionals (HCPs) who support them is needed to inform evidence-based guidance.

This mixed-methods study comprises three sub-studies. The first will recruit 175 pregnant women (75 with T1D and 100 with T2D) who will complete three 7-day monitoring periods, one per trimester. PA will be assessed using wrist-worn accelerometers and exercise diaries, dietary intake via remote food photography, and corresponding continuous glucose monitor and diabetes-related well-being data will be collected.

The second involves a subsample of ~16 women participating in focus groups to explore experiences of being physically active during pregnancy.

The third invites ~100 HCPs involved in diabetes in pregnancy care to complete an online survey, ~10 HCPS will take part in an optional interview about their experiences of providing PA guidance.

The primary outcome is the change in PA across pregnancy. Secondary outcomes include associations between PA, glucose metrics, diet and diabetes-related well-being, and qualitative themes relating to experiences of women and HCP. Quantitative data will be analysed using multilevel modelling and regression analysis, and qualitative data using reflexive thematic analysis.

Ethical approval was granted by the East Midlands Nottingham 1 Research Ethics Committee (25/EM/0190) and University of Exeter Public Health and Sport Sciences ethics committee. Findings will be disseminated through peer-reviewed publications and conference presentations.