Dr Kieran Walsh, Clinical Director, BMJ

Mr Tuan Davies, Regional Manager, BMJ Group

Professor Theodoros Kyprianou, Consultant in Respiratory and Intensive Care Medicine, eHealth and Clinical Digital Transformation, UK and Cyprus

This article reports on a webinar held on 2 February 2026 that brought together clinicians, academics, and medical publishing professionals. The discussion focused on peer review, the role of BMJ Best Practice, and the practical work involved in adapting guidance for use in Cyprus. It also drew on experience from a recent national project to review and localise BMJ Best Practice content for Cypriot healthcare professionals.

KW opened by reflecting on peer review in medical publishing. It is a familiar part of the process, yet people do not always stop to consider what it is for. It can feel like a hurdle between authors and publication, but part of its purpose is to improve the work. Reviewers look at whether research methods are sound, whether conclusions follow from the data, and whether the paper is clear and relevant. Good peer review is about gatekeeping and also about professional conversation aimed at strengthening the final article.

He outlined the main models of peer review – single blind, open, and post-publication. Each has advantages and drawbacks. Openness can promote accountability, while anonymity may allow reviewers to be more candid. But persistent problems remain. Reviewers are busy, which leads to delays. The quality of reviews can vary. Subtle methodological flaws can still be missed. Ethical issues also matter, including confidentiality and undeclared competing interests among authors and reviewers.

The group also discussed artificial intelligence. AI tools can help with tasks such as drafting and checking text, but there are risks. These include fabricated references, invented authors, and the inappropriate sharing of unpublished material with public systems. Clear journal policies, human oversight, and openness about AI use were seen as necessary to manage these risks.

The conversation moved on to clinical guidelines. Strong evidence is essential, but so is practicality. Recommendations that require long appointments, expensive tests, or highly specialised services may be evidence based yet difficult to deliver in some settings. Reviewers therefore need to consider feasibility, target users, scope, and possible conflicts of interest. Feedback should help improve guidance, not simply list faults. Clear editorial processes and records of decisions are important when disagreements arise.

TD described BMJ Best Practice as a clinical decision support resource built around real clinical consultations. It is used by a wide range of healthcare professionals, both in day-to- day care and for learning. It covers many specialties and conditions and is updated as new evidence becomes available. Its structure helps clinicians think about comorbidities, which reflects how patients present in real life.

He spoke about the pressures on health systems – more complex patients and a constant flow of new research. BMJ Best Practice aims to support clinicians in this environment by providing structured, reliable information at the point of care. It can also be used for case- based learning, to support conversations with patients, and to inform service development.

The resource was central to the Cyprus project. Local specialists reviewed the content and helped shape adaptations so that it reflected local practice. The adapted and translated material sits alongside the core content, linking international evidence with the national context.

TP then discussed how guidance was adapted. The team did not start from scratch. They used a structured approach that kept the scientific basis of the original content while adjusting it for local use.

This required balance. The underlying evidence had to remain intact, while local realities were acknowledged. All suggested changes, whether accepted or rejected, were recorded in adaptation reports to provide an audit trail. The strength or direction of recommendations was only changed if new evidence supported this. Where limits in resources affected what could be done, this was made explicit rather than quietly weakening the guidance.

Working in a small health system brings added challenges. Competing interests need careful handling. Input from different professions is important. There is a risk that informal agreement can outweigh evidence if not managed well. Common problems in adaptation projects include undocumented changes, gradual softening of recommendations due to cost concerns, and tools becoming either too simple to be useful or so detailed that they are hard to use. All of these can reduce trust in the final guidance.

The conclusion of the webinar was that strong baseline content, rigorous peer review, and a systematic approach to adaptation will result in guidelines that will be evidence based and practical in a range of different settings.

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KW and TD are employed by BMJ.