Design and Development of a Film-based Intervention about Teenage Men and Unintended Pregnancy: Applying the Medical Research Council Framework in Practice

Following the UK Medical Research Council’s (MRC) guidelines for the development and evaluation of complex interventions, this study aimed to design, develop and optimise an educational intervention about young men and unintended teenage pregnancy based around an interactive film. The process involved identification of the relevant evidence base, development of a theoretical understanding of the phenomenon of unintended teenage pregnancy in relation to young men, and exploratory mixed methods research. The result was an evidence-based, theory-informed, user-endorsed intervention designed to meet the much neglected pregnancy education needs of teenage men and intended to increase both boys’ and girls’ intentions to avoid an unplanned pregnancy during adolescence. In prioritising the development phase, this paper addresses a gap in the literature on the processes of research-informed intervention design. It illustrates the application of the MRC guidelines in practice while offering a critique and additional guidance to programme developers on the MRC prescribed processes of developing interventions. Key lessons learned were: 1) know and engage the target population and engage gatekeepers in addressing contextual complexities; 2) know the targeted behaviours and model a process of change; and 3) look beyond development to evaluation and implementation.

Geometric modeling from the medical images in the CAD system to support prosthesis design

This paper presents an individual designing prosthesis for surgical use and proposes a methodology for such design through mathematical extrapolation of data from digital images obtained via tomography of individual patient's bones. Individually tailored prosthesis designed to fit particular patient requirements as accurately as possible should result in more successful reconstruction, enable better planning before surgery and consequently fewer complications during surgery. Fast and accurate design and manufacture of personalized prosthesis for surgical use in bone replacement or reconstruction is potentially feasible through the application and integration of several different existing technologies, which are each at different stages of maturity. Initial case study experiments have been undertaken to validate the research concepts by making dimensional comparisons between a bone and a virtual model produced using the proposed methodology and a future research directions are discussed.

Design and fluid dynamic analysis of a custom drip chamber in a medical disposable device

Negli ultimi anni, parallelamente allo sviluppo di calcolatori elettronici sempre più performanti, la fluidodinamica computazionale è diventata uno strumento di notevole utilità nell’analisi dei flussi e nello sviluppo di dispositivi medici. Quando impiegate nello studio di flussi di fluidi fisiologici, come il sangue, il vantaggio principale delle analisi CFD è che permettono di caratterizzare il comportamento fluidodinamico senza dover eseguire test in-vivo/in-vitro, consentendo quindi notevoli vantaggi in termini di tempo, denaro e rischio derivante da applicazioni mediche. Inoltre, simulazioni CFD offrono una precisa e dettagliata descrizione di ogni parametro di interesse permettendo, già in fase di progettazione, di prevedere quali modifiche al layout garantiranno maggiori vantaggi in termini di funzionalità. Il presente lavoro di tesi si è posto l’obiettivo di valutare, tramite simulazioni CFD, le performances fluidodinamiche del comparto sangue “camera venosa” di un dispositivo medico monouso Bellco impiegato nella realizzazione di trattamenti di emodialisi. Dopo una panoramica del contesto, è presentata una breve descrizione della disfunzione renale e dei trattamenti sostitutivi. Notevole impegno è stato in seguito rivolto allo studio della letteratura scientifica in modo da definire un modello reologico per il fluido non-Newtoniano preso in considerazione e determinarne i parametri caratteristici. Il terzo capitolo presenta lo stato dell’arte delle apparecchiature Bellco, rivolgendosi con particolare attenzione al componente “cassette” del dispositivo monouso. L’analisi fluidodinamica del compartimento “camera venosa” della cassette, che sarà presa in considerazione nei capitoli quinto e sesto, si inserisce nell’ambito della riprogettazione del dispositivo attualmente in commercio: il quarto capitolo si incentra sul suo nuovo design, ponendo specifico interesse sul layout della camera venosa di nuova generazione. Per lo studio dei flussi che si sviluppano internamente ad essa ci si è avvalsi del modulo CFD del software COMSOL multiphysics® (versione 5.0); la definizione del modello implementato e della tipologia di studio effettuato sono presi in considerazione nel quinto capitolo. Le problematiche di maggior impatto nella realizzazione di un trattamento di emodialisi sono l’emolisi e la coagulazione del sangue. Nell'evenienza che si verifichino massivamente occorre infatti interrompere il trattamento con notevoli disagi per il paziente, per questo devono essere evitate. Nel sesto capitolo i risultati ottenuti sono stati esaminati rivolgendo particolare attenzione alla verifica dell’assenza di fenomeni che possano portare alle problematiche suddette.

Randomized clinical trial comparing percutaneous closure of patent foramen ovale (PFO) using the Amplatzer PFO Occluder with medical treatment in patients with cryptogenic embolism (PC-Trial): rationale and design

Background Several studies have shown an association of cryptogenic stroke and embolism with patent foramen ovale (PFO), but the question how to prevent further events in such patients is unresolved. Options include antithrombotic treatment with warfarin or antiplatelet agents or surgical or endovascular closure of the PFO. The PC-Trial was set up to compare endovascular closure and best medical treatment for prevention of recurrent events. Methods The PC-Trial is a randomized clinical trial comparing the efficacy of percutaneous closure of the PFO using the Amplatzer PFO occluder with best medical treatment in patients with cryptogenic embolism, i.e. mostly cryptogenic stroke. Warfarin for 6 months followed by antiplatelet agents is recommended as medical treatment. Randomization is stratified according to patients age (<45 versus ≥45 years), presence of atrial septal aneurysm (ASA yes or no) and number of embolic events before randomization (one versus more than one event). Primary endpoints are death, nonfatal stroke and peripheral embolism. Discussion patients were randomized in 29 centers of Europe, Canada, and Australia. Randomization started February 2000. Enrollment of 414 patients was completed in February 2009. All patients will be followed-up longitudinally. Follow-up is maintained until the last enrolled patient is beyond 2.5 years of follow-up (expected in 2011).

A Student-Initiated Elective in Medical Ethics: Innovations in Design and Institutionalization

Introduction: This study addresses how to best approach the instruction and evaluation of clinical ethics with preclinical medical students. [See PDF for complete abstract]

Using technology to teach technology: design and evaluation of bilingual online physician education about electronic medical records.

The "EMR Tutorial" is designed to be a bilingual online physician education environment about electronic medical records. After iterative assessment and redesign, the tutorial was tested in two groups: U.S. physicians and Mexican medical students. Split-plot ANOVA revealed significantly different pre-test scores in the two groups, significant cognitive gains for the two groups overall, and no significant difference in the gains made by the two groups. Users rated the module positively on a satisfaction questionnaire.