Farhad Peerally

Visual for newly published paper with title of paper and stock photo

NEW PAPER - BMJ Q&S
Outcome bias impacts judgements after incidents& investigations & may contribute to continued focus on individual culpability & individual focused recommendations
qualitysafety.bmj.com/content/earl...

@drwilliamlea.bsky.social @rebeccalawton.bsky.social @janekohara.bsky.social

Want to see the full roadmap? Check out our paper here:

fg.bmj.com/content/earl...

Many thanks to the MPS Foundation for funding for SCALE ENDO and to all coauthors for their brilliance. 10/10

We propose a multi-faceted approach:
🔹Journal engagement
🔹Training programs
🔹Research collaborations
🔹Dedicated funding
🔹Methodological support 9/10

Particularly exciting is the role of qualitative research alongside RCTs. From improving recruitment to identifying meaningful outcomes, these methods can enhance trial design & interpretation. We did it for the BRIDE study: bmjopen.bmj.com/content/13/1... 8/10

SCALE-ENDO | SAPPHIRE | University of Leicester SCALE-ENDO is the study of communication and adaptive capacity using in-situ learning environments based on real life risks in endoscopy.

For example, our SCALE-ENDO project shorturl.at/Xv1eN uses qualitative analysis of UKwide incident reports and video-based methods of simulated incidents to understand how endoscopy teams adapt and interact to maintain safety, informing targeted simulation training. 7/10

Or even studying safety in endoscopy: While quantitative methods tell us 'what' went wrong, qualitative approaches reveal the 'how' and 'why' - uncovering complex system interactions, team dynamics & organisational factors shaping safety. (6/10)

Take IBD care for example: Beyond measuring clinical outcomes, we need to understand how expanding therapeutic options intersect with patient agency, health inequities & structural constraints in care delivery. (5/10)

We highlight 6 key areas where qualitative approaches improves insights in GI medicine:
- Patient experiences & QoL
- Clinical decision-making
- Healthcare disparities
- Implementation of new tech
- Patient safety
- Enhancing RCTs (4/10)

Why the mismatch? Key barriers include:
- Limited familiarity with qualitative methods among editors/reviewers in clinical journals
- Misconceptions about generalisability
- Capability gaps in research teams
(3/10)

The stark reality: qualitative articles make up just 0.0008% of primary research in top-20 gastroenterology journals over 20 years. This contrasts sharply with 8% of GI studies on UK Clinical Research Network portfolio using qualitative methods. (2/10)

Excited to share our new Frontline Gastro paper calling for more qualitative research in gastroenterology! It's been gr8 collaborating with others (Shellie/ Debasish) & mentoring junior colleagues who share our passion for qual methods in GI fg.bmj.com/content/earl... (1/10)

Grateful to our international team who have pulled a gigantic effort for this piece of work to see light and to @robbrierley.bsky.social @thelancet.bsky.social Gastro Hep for publishing. Muhammad Usman, @salmanwaqar.bsky.social Nazim Ghouri Qasim Khan

Thank you for reading! We hope this guidance helps healthcare professionals better support their patients during Ramadan. For complete details and recommendations, please read the full paper in www.thelancet.com/journals/lan... (14/15)

📚 Full paper provides detailed guidance on:
- Risk stratification
- Medication adjustments
- Monitoring protocols
- Alternative arrangements
- Evidence synthesis (13/15)

⚠️ Remember:
- Individual assessment is crucial
- Shared decision making essential
- Regular monitoring important
- Safety first approach
- Respect religious beliefs while ensuring medical safety (12/15)

💡 Alternative Options:
- Winter fasting (shorter days)
- Non-consecutive fasting
- Trial fasting before Ramadan
- Religious exemptions when needed (11/15)

🏥 Pre-Ramadan Assessment Should Include:
- Disease activity
- Nutritional status
- Frailty assessment
- Medication review
- Risk stratification
- Individual counseling (10/15)

💊 Medication Management:
- Many medications can be adjusted to once/twice daily dosing
- Consider extended-release formulations
- Plan medication changes 1-3 months before Ramadan
- Regular monitoring essential (9/15)

🔵 GERD & Peptic Ulcers:
- Stable GERD: Can usually fast with medication adjustment
- Active ulcers: Should NOT fast
- Healed ulcers: Could fast with PPI coverage
- Timing of meals important (8/15)

🔴 #IBD:
- Active disease/flare: Must NOT fast
- Quiescent/mild disease: Could fast
- Regular medication still crucial
- Monitor symptoms carefully
- Calprotectin useful for monitoring (7/15)

🔵 Liver Transplant Recipients:
- Stable patients >1 year post-transplant with good graft function: Could fast
- Recent transplant (<12 months): Should NOT fast
- Need careful medication timing adjustments
- Regular monitoring essential (6/15)

🔴 Liver Cirrhosis:
- Child-Pugh B/C: Must NOT fast
- Child-Pugh A: Could fast if no malnutrition/frailty, but needs careful assessment
- Night-time fasting can be particularly problematic
- Protein supplementation crucial if fasting (5/15)

🔵 Fatty Liver Disease (MASLD):
- Patients without advanced fibrosis/cirrhosis are generally safe to fast
- Some studies show potential benefits including improved liver enzymes and metabolic parameters
- Individual assessment still needed, especially with comorbidities (4/15)

🔑 Key message: Many patients with stable GI/liver conditions can safely fast during Ramadan, but individual assessment is crucial. We developed a risk stratification system to help guide clinical decision-making. (3/15)

We reviewed the evidence on fasting during Ramadan for patients with GI & liver conditions and developed practical guidance for healthcare professionals. Here are the key points ⬇️ (2/15)

📢 Delighted to share our work in @thelancet.bsky.social Gastro Hep - Following 3+ years of int’l collaborative effort, we present our guidance on managing patients with GI & liver diseases fasting during Ramadan. www.thelancet.com/journals/lan...
Access with a free account in the Lancet
(1/15)

Gold dust view point on healthcare workforce from @alisonleary1.bsky.social in @bmj.com

> why healthcare should prioritise experience before thinking of expansion in workforce

📌

☝🏽

Congratulations Mary!