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BMJ Open · Jul 9, 2026

Effectiveness of ergonomic interventions in the 21st century: a protocol for an umbrella review of systematic reviews

Introduction Work-related musculoskeletal disorders (WMSDs) remain a global challenge despite technological advancements and evolving workplace practices. Ergonomic interventions—including workplace redesign, equipment modification, training and organisational strategies—have been increasingly adopted to address these challenges. However, systematic reviews assessing their effectiveness have yielded heterogeneous and sometimes contradictory findings. This protocol outlines a methodology for an umbrella review of systematic reviews aimed at synthesising high-quality evidence on ergonomic…

BMJ Open · Jul 9, 2026

Nursing managers experiences of delegation strategies and practices: a qualitative content analysis in Tehran, Iran

Objective Delegation is a key nursing management skill that enhances staff empowerment, team performance and quality of care. In complex healthcare environments, effective delegation requires structured managerial strategies that balance responsibility with staff empowerment. This study aimed to explore nursing managers’ experiences of delegation strategies and practices in clinical settings. Design A qualitative study using a conventional content analysis approach. Data were collected between 2024 and 2025 through semistructured, in-depth interviews and analysed concurrently using an…

BMJ Open · Jul 9, 2026

Impact of geographical location on ICU outcomes in adults: a scoping review

Objectives Rural populations experience poorer health outcomes than urban counterparts globally. Limited studies have examined the impact of geographical location—specifically travel distance/time and rurality—on intensive care unit (ICU) outcomes. This scoping review aimed to map literature on geographical location and ICU outcomes to better inform policy and improve ICU access in underserved communities. Design Scoping review. Data sources MEDLINE, CINAHL and Embase were searched through to 8 May 2025. Grey literature was identified through ProQuest Dissertations and Theses Global, including…

BMJ Open · Jul 9, 2026

Quality of maternal and newborn care, perinatal mental health and the emotional birth experience of women: findings of the IMAgiNE EURO study in Belgium

Objective This study explored the quality of maternal and newborn care (QMNC) in Belgium, focusing on women’s experience with care and their mental health (MH). Design We conducted a cross-sectional survey using the WHO-based IMAgiNE EURO questionnaire, updated with MH items. Setting All women who gave birth in a health facility in Belgium were included. Participants Data were collected from 621 women who gave birth between March 2022 and January 2025. Primary and secondary outcome measures Descriptive statistics summarised QMNC and MH outcomes, while logistic regression examined factors…

BMJ Open · Jul 9, 2026

Guided group reflection versus SNAPPS in enhancing clinical reasoning in final-year MBBS students at a public-sector teaching hospital in Pakistan: a quasi-experimental study

Objectives (1) To compare the effectiveness of guided group reflection (GGR) versus SNAPPS (Summarise history and physical examination, Narrow differentials, Analyse the differentials, Probe the preceptor, Plan of patient management, Self-directed learning), as a teaching intervention in improving clinical reasoning (CR) skills of final-year MBBS (Bachelor of Medicine, Bachelor of Surgery) students. (2) To determine which teaching intervention is more effective in improving specific components of CR (data acquisition, problem presentation, hypothesis generation, illness script comparison and…

BMJ Open · Jul 9, 2026

Infection prevention and control measures for Ebola and Marburg disease: a series of rapid reviews

Objectives An evidence synthesis informed the 2023 WHO infection prevention and control (IPC) guideline for Ebola disease (EBOD) and Marburg disease (MARD). Design A series of rapid reviews addressed 14 key questions (KQs) related to IPC measures for EBOD and MARD across three themes: (1) transmission/exposure, (2) personal protective equipment (PPE) and (3) decontamination/disinfection. Data sources Databases (Embase, Cochrane Database of Systematic Reviews, CENTRAL, Global Index Medicus) were searched from inception to May 2024, in addition to searches in MEDLINE and bio/medRxiv servers…

BMJ Open · Jul 9, 2026

Prevalence of suspected scoliosis based on angle of torso rotation in children and adolescents in Heqing County at different periods: a large-sample mixed-methods study

Objectives To analyse changes in the prevalence of suspected scoliosis among children and adolescents in Heqing County, South-West China, over different periods and to identify risk factors for its progression. Design A mixed-methods study, including a cross-sectional survey and longitudinal follow-up. Setting Single-centre study. An angle of torso rotation (ATR) ≥5° was defined as a positive screening result and progression was defined as an increase in ATR ≥2°. Participants In November 2021, 22 740 students aged 6–18 years were screened; in May 2023, 28 009 students aged 6–18 years…

BMJ Open · Jul 9, 2026

Healthcare professionals understanding and current practice in sarcopenia screening and diagnosis in the UK: a qualitative study

Objectives To explore healthcare professionals’ (HCPs’) understanding and current practice in the screening and diagnosis of sarcopenia to help with the development of a standardised sarcopenia screening tool that can be implemented within the National Health Service (NHS) of the UK. Design A qualitative study using semistructured interviews that were analysed using Braun and Clarke’s reflexive thematic analysis steps. Setting The interviews were conducted online. Participants Ten HCPs (consultants, physiotherapists, community matrons, dieticians and community falls specialists) within acute…

BMJ Open · Jul 9, 2026

Magnetic resonance-guided laser interstitial thermal therapy for mesial temporal lobe epilepsy (MINE): a single-centre, prospective, randomised, open-label, blinded-endpoint controlled trial protocol in China

Introduction Drug-resistant mesial temporal lobe epilepsy (mTLE) is a common and disabling focal epilepsy syndrome for which surgery offers the best chance of seizure freedom. Traditional open surgery (eg, anterior temporal lobectomy or selective amygdalohippocampectomy) is effective but may be associated with perioperative morbidity and neurocognitive sequelae. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive alternative with encouraging observational outcomes but high-quality comparative evidence versus open surgery remains limited. The MINE…

BMJ Open · Jul 9, 2026

Transanal irrigation for the management of low anterior resection syndrome (LARS): protocol for a pragmatic, multicentre, crossover randomised controlled trial

Introduction Advances in surgical techniques and neoadjuvant care for rectal cancer have increased sphincter preservation, allowing restoration of bowel continuity through low anterior resection (LAR). However, up to 75% of patients experience low anterior resection syndrome (LARS), which is bowel dysfunction characterised by faecal incontinence, frequency, urgency and clustering of bowel movements, significantly impairing quality of life (QoL). Current management is largely empirical, using lifestyle or pharmacological strategies with variable success. Transanal irrigation (TAI) is a…

BMJ Open · Jul 9, 2026

Mapping the use of interactive voice response (IVR) in healthcare in Africa: a scoping review protocol

Introduction Africa faces a substantial health burden characterised by a dual burden of communicable and non-communicable diseases compounded by persistent health system and infrastructure constraints. Digital health interventions offer scalable opportunities to strengthen healthcare delivery. Interactive voice response (IVR), an automated telephone-based technology, shows promise across African health settings; however, existing evidence is dispersed across isolated studies and demonstrates variability in outcomes and implementation approaches. This scoping review maps existing evidence on…

BMJ Open · Jul 9, 2026

Shared decision making in pain care: a systematic review study protocol of decision aids

Introduction Shared decision making (SDM) in healthcare is an ethical imperative and essential to patient-centred care. SDM is particularly useful when several preference-sensitive treatment options exist and in the setting of chronic conditions or longitudinal management. Chronic pain management embodies these characteristics, yet SDM often remains insufficient in this population. Decision aids are designed to facilitate SDM by helping patients and clinicians understand treatment options, clarify patient values, and guide collaborative decision processes. Despite their importance, the use of…

BMJ Open · Jul 9, 2026

Acute kidney injury-epidemiology in intensive care unit patients 2: study protocol for a prospective international multicentre cohort study

Introduction Reports on the epidemiology and outcomes of acute kidney injury in the critically ill provide variable estimates based on differences in populations and underlying exposures. Current and generalisable incidence data are needed along with information on long-term patient and kidney outcomes. The acute kidney injury-epidemiology in intensive care unit patients 2 (AKI-EPI 2) study aims to describe the occurrence and associated outcomes of AKI in critically ill patients worldwide. In addition, in selected centres, it aims to further describe the influence of AKI on long-term kidney…

BMJ Open · Jul 9, 2026

Pedagogical strategies for enhancing critical thinking in nursing students using large language models: a mixed-methods systematic review protocol

Introduction Large language models (LLMs) are rapidly normalising in nursing education. However, evidence regarding their impact on critical thinking—a cornerstone of safe clinical practice—remains inconsistent. Current syntheses have largely focused on student satisfaction and general utility, leaving the specific instructional mechanisms that cultivate this competency unexplored. This mixed-methods systematic review aims to identify effective pedagogical strategies for fostering critical thinking, providing evidence-based guidance to safeguard clinical competency in an artificial…

KFF Health News · Jul 9, 2026

My Search for a Psychiatric Bed in an Overburdened Health System

Over the past 70 years, the number of inpatient psychiatric beds has dropped dramatically, leaving many without critical care when they experience mental health crises. I was one of the lucky ones to get a bed — after 21 hours of waiting.

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