The aims of this study were (1) to develop and validate the interactive CLAIM Test (iCLAIM Test) to measure children’s ability to assess claims about treatment effects and make informed health choices and (2) to measure this ability in Spanish primary school children using the developed test.

We followed a multistep process including (1) definition of the test scope, (2) selection of the questions, (3) translation process, (4) design and development of the online test, (5) external review with experts, (6) user-test with children and (7) cross-sectional validation study with Rasch analysis.

Spanish primary schools.

Twelve experts (75% women) participated in the review, 11 children (45% girls) participated in the user-test and 480 Spanish primary school children (46.5% girls) from fourth to sixth grades (9–12 years old) participated in the cross-sectional validation study.

The iCLAIM Test is an online, interactive and user-friendly test in Spanish that measures children’s ability to understand and apply key concepts of the informed health choices (IHC) Project when assessing claims about treatment effects and making IHCs. The test includes 30 questions: six demographic questions and 24 questions from the Claim Evaluation Tools item bank. Less than 40% of the students who participated in the cross-sectional validation study showed basic knowledge of the IHC Key Concepts and how to apply them, and less than 4% showed a clear knowledge. The test showed a good fit to the Rasch model and was acceptable to the target audience.

The iCLAIM Test is the first instrument validated for measuring children’s ability to assess treatment claims in Spain. In the future, we can tailor IHC education interventions and improve critical thinking skills about the health of Spanish children.

Children with bilateral cerebral palsy (BCP) frequently develop progressive gait impairments driven in part by muscle weakness. Although power training, which involves high-velocity loaded movements, can enhance functional capacity, its substantial physical demands often limit feasibility in this population. Blood flow restriction (BFR) training has emerged as a promising alternative, capable of eliciting comparable physiological benefits while using low-intensity exercise. This study evaluates the feasibility, safety and clinical effects of integrating BFR with treadmill training in children with BCP, an innovative approach that may deliver the advantages of intensive strengthening while reducing physical burden.

This single-centre pilot study uses a double-baseline design with 13 participants with BCP (Gross Motor Function Classification System II-III), aged 8–18. The protocol consists of a 10-week usual care period followed by a 10-week Blood Flow Restriction Treadmill Training (BFR-TT) intervention, with three sessions per week. Feasibility targets were defined as completion of at least 80% of at least 80% of sessions. Safety is monitored through pain scales and adverse events. Outcomes assess body function (strength, GAITRite), activity (walking speed, walking endurance and motor function) and participation (daily activities), comparing changes between the usual care and BFR-TT periods.

This study was approved by the French Protection of Persons Committee (2024-A00791-46). Results will be published in peer-reviewed journals and presented at international conferences.

NCT06533956.

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.

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.

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.

Many clinical practice guidelines (CPGs) claim to use Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, but its implementation varies. This suggests that CPG developers, methodologists and users would benefit from an instrument to evaluate the extent to which CPGs adhere to GRADE approach. Such a structured instrument is currently unavailable. Accordingly, this study will develop an evaluation instrument for assessing guideline adherence to the GRADE approach, which we have named ‘GRADE-Check’. The goal is to target items to which CPGs fail to adhere and that potentially have serious consequences resulting in inaccuracies in certainty of evidence and inappropriate direction or strength of recommendations, thereby discriminating across CPGs in issues of importance.

The panel will include up to 25 individuals with specific knowledge and expertise, including experienced authors, educators and methodologists on CPGs methodology and GRADE approach from relevant organisations. The instrument will focus on the key elements of GRADE, aiming for clarity for GRADE experts and non-GRADE experts to apply. The development process for GRADE-Check will consist of the following five phases: (1) recruitment of a panel of GRADE experts; (2) development of objectives and scope for the development of GRADE-Check and criteria for item selection; (3) generation of candidate items through a literature review and panel consultation; (4) panellist discussion to construct the initial draft and extended explanation manual and (5) user testing.

This study has been approved by the Medical Ethics Committee of Zhongnan Hospital of Wuhan University (no. (2025047K)). Our research findings will be published in peer-reviewed journal articles and presented at academic conferences. Additionally, the dissemination plan will include considerations for the development of implementation manuals, a dedicated project website and training tools.

In the Netherlands, approximately 2200 major amputations of the lower extremities are performed each year, the majority in vascular patients. Around 61% of these patients will develop postamputation pain (PAP). PAP is a severe, lifelong, disabling condition profoundly affecting quality of life. During amputations, the common practice is to cut the nerves without employing nerve-surgical techniques to prevent chronic pain due to neuroma formation. In recent years, targeted muscle reinnervation (TMR) has been the most frequently studied technique for treating PAP, inhibiting neuroma formation by rerouting the cut mixed nerve to a functional motor nerve. We hypothesise that a primary TMR procedure during major lower limb amputations will result in a lower prevalence of PAP.

We propose a national, multicentre, randomised, sham-controlled trial comparing TMR with traction neurectomy in major amputations of the lower extremities in patients with vascular disease. 203 patients will be recruited with an indication for a transfemoral to transtibial amputation as a primary or secondary sequela of vascular disease. The subjects are randomly assigned to the TMR group or the traction neurectomy group. PAP will be evaluated 1 year postoperatively as the primary endpoint. Secondary outcomes include quality of life, mobility, neuropathic pain, hospital anxiety and depression, cost-effectiveness and complications.

This study has been reviewed and approved by the local ethical review body, ‘The Medical Ethics Committee Leiden The Hague Delft’, under the reference: P24.073 on 28 November 2024. Results will be published in peer-reviewed journals.

NCT06719245. Dutch trial registry: NL87196.058.24

The transition from hospital to home can be challenging for parents of premature infants due to a lack of education on specific care. This may lead to both higher readmission rates and healthcare costs. Telehealth interventions can improve the quality of care specific to premature and critically ill newborns. This protocol outlines the WELCOME study and evaluates its feasibility and effectiveness of this approach.

This two-centre randomised control trial (RCT) will assign 240 families with premature and critically ill newborns to an intervention or control group. The study has a parallel group design and an exploratory framework. The control group will receive standard postdischarge care. The intervention group will additionally receive scheduled video consultations, digital assessments and 24/7 access to educational resources. Primary outcomes will focus on 30-day readmission and emergency care use. Secondary outcomes will include child development and parental health. The intervention is expected to be feasible, with high acceptance and minimal drop-out. It will aim to improve parents’ self-efficacy and health literacy. If successful, insights from this multimethod telehealth study will inform standard care.

Results will be published in anonymised and summarised form in international and national journals and symposia. The study received ethical approval from the Ethics Committee of the Ludwig-Maximilians-University Munich (No. 25-0028) and was registered in the German Clinical Trials Register on 6 March 2025 (DRKS00034422).

DRKS00034422.

Communication skills assessment (CSA) is essential for ensuring competency, guiding educational practices and safeguarding regulatory compliance in health professions education (HPE). However, there appears to be heterogeneity in the reporting of validity evidence from CSA methods across the health profession that complicates our interpretation of the quality of assessment methods. Our objective was to map reliability and validity evidence from scores of CSA methods that have been reported in HPE.

Scoping review.

MEDLINE, Embase, PsycINFO, CINAHL, ERIC, CAB Abstracts and Scopus databases were searched up to March 2024.

We included studies, available in English, that reported validity evidence (content-related, internal structure, relationship with other variables, response processes and consequences) for CSA methods in HPE. There were no restrictions related to date of publication.

Two independent reviewers completed data extraction and assessed study quality using the Medical Education Research Study Quality Instrument. Data were reported using descriptive analysis (mean, median, range).

A total of 146 eligible studies were identified, including 98 394 participants. Most studies were conducted in human medicine (124 studies) and participants were mostly undergraduate students (85 studies). Performance-based, simulated, inperson CSA was most prevalent, comprising 115 studies, of which 68 studies were objective structured clinical examination-based. Other types of methods that were reported were workplace-based assessment; asynchronous, video-based assessment; knowledge-based assessment and performance-based, simulated, virtual assessment. Included studies used a diverse range of communications skills frameworks, rating scales and raters. Internal structure was the most reported source of validity evidence (130 studies (90%), followed by content-related (108 studies (74%), relationships with other variables (86 studies (59%), response processes (15 studies (10%) and consequences (16 studies (11%).

This scoping review identified gaps in the sources of validity evidence related to assessment method that have been used to support the use of CSA methods. These gaps could be addressed by studies explicitly defining the communication skill construct(s) assessed, clarifying the validity source(s) reported and defining the intended purpose and use of the scores (ie, for learning and feedback, for decision making purposes). Our review provides a map where targeted CSA development and support are needed. Limitations of the evidence come from score interpretation being constrained by the heterogeneity of the definition of communication skills across the health professions and the reporting quality of the studies.

The UK’s medical workforce is under increasing strain, and this is compounded by increasing numbers of resident doctors diverging from specialist training pathways, instead entering non-training roles, reducing clinical hours or leaving the profession or UK workforce entirely. These decisions are shaped by both individual motivations and wider structural conditions, including unsatisfactory working conditions, limited flexibility and a perceived lack of support or autonomy. While pursuing alternative career routes offers personal and professional benefits, they can also delay progression to senior clinical roles, contributing to workforce instability. There remains limited understanding of how best to support retention, particularly given the varied contexts, settings and career trajectories of resident doctors. This realist synthesis will examine how, why and in what contexts resident doctors leave the National Health Service, and what interventions might support their retention.

This realist synthesis will follow Realist And Meta-narrative Evidence Synthesis: Evolving Standards guidance and will be conducted in five iterative steps: (1) identifying existing theories to develop an initial programme theory; (2) undertaking formal and purposive searches to identify relevant UK-based literature; (3) selecting documents based on relevance and rigour; (4) extracting and coding data to support the development of explanatory insights; and (5) synthesising findings using a realist logic of analysis to develop and refine context-mechanism-outcome configurations. An advisory group will guide the review throughout. The final programme theory will inform the development of evidence-based recommendations and design principles to support resident doctor retention.

Ethical approval is not required for this synthesis of existing literature. Findings will be disseminated through academic publications, conference presentations and accessible formats, including infographics, plain English summaries and blog posts. Target audiences include resident doctors, medical educators, workforce planners and policymakers.

PROSPERO, CRD420251004453.