Increasing value and reducing waste by optimizing the development of complex interventions: Enriching the development phase of the Medical Research Council (MRC) Framework

This is the final version of the article. Available from Elsevier via the DOI in this record.Background In recent years there has been much emphasis on ‘research waste’ caused by poor question selection, insufficient attention to previous research results, and avoidable weakness in research design, conduct and analysis. Little attention has been paid to the effect of inadequate development of interventions before proceeding to a full clinical trial. Objective We therefore propose to enrich the development phase of the MRC Framework by adding crucial elements to improve the likelihood of success and enhance the fit with clinical practice Methods Based on existing intervention development guidance and synthesis, a comprehensive iterative intervention development approach is proposed. Examples from published reports are presented to illustrate the methodology that can be applied within each element to enhance the intervention design. Results A comprehensive iterative approach is presented by combining the elements of the MRC Framework development phase with essential elements from existing guidance including: problem identification, the systematic identification of evidence, identification or development of theory, determination of needs, the examination of current practice and context, modelling the process and expected outcomes leading to final element: the intervention design. All elements are drawn from existing models to provide intervention developers with a greater chance of producing an intervention that is well adopted, effective and fitted to the context. Conclusion This comprehensive approach of developing interventions will strengthen the internal and external validity, minimize research waste and add value to health care research. In complex interventions in health care research, flaws in the development process immediately impact the chances of success. Knowledge regarding the causal mechanisms and interactions within the intended clinical context is needed to develop interventions that fit daily practice and are beneficial for the end-user

Hubungan Pengetahuan Dan Sikap Ibu Terhadap Pencegahan Penyakit Demam Berdarah Dengue (DBD) Pada Anak (6-12 Tahun) Di Wilayah Kerja Puskesmas Kawatuna.

ABSTRAK HUBUNGAN PENGETAHUAN DAN SIKAP IBU TERHADAP PENCEGAHAN PENYAKIT DEMAM BERDARAH DENGUE (DBD) PADA ANAK (6-12 Tahun) DI WILAYAH KERJA PUSKESMAS KAWATUNA Nur Amelia Sino Program Studi D-III Keperawatan Fakultas Kedokteran Universitas Tadulako Dr. Ratna Devi, SKM, M.Kes Kata kunci : Pengetahuan, Sikap, Anak, DBD Demam Berdarah Dengue (DBD) adalah suatu penyakit infeksi virus yang ditularan oleh nyamuk Aedes Aegypti sebagai vector utama dan Aedes Albopictus sebagai vector potensial. Pengetahuan dan sikap dari seorang ibu menjadi tolak ukur tentang kesadaran ibu dalam mencegah penularan. Upaya pencegahan penularan perlu dilakukan untuk mengurangi resiko terjadinya penyakit ini. Tujuan penelitian ini untuk mengetahui hubungan pengetahuan dan sikap ibu terhadap pencegahan penyakit DBD pada anak di wilayah kerja puskesmas kawatuna 2022. Metode Penelitian yang digunakan yaitu kuantitatif menggunakan pendekatan cross sectional dengan jumlah populasi 35 ibu yang mempunyai anak 6-12 tahun dan sampel yang digunakan 25 responden. Alat ukur dalam penelitian ini adalah kuesioner dan analisis yang digunakan yaitu analisis univariat dan bivariat. Hasil Penelitian menunjukkan bahwa sebagian besar tingkat pengetahuan responden dalam kategori baik yaitu 22 responden (88%), dan untuk sikap yaitu terdapat 20 responden (80%) memiliki sikap positif, serta terdapat hubungan yang signifikan antara tingkat pengetahuan dan sikap ibu terhadap pencegahan penyakit DBD pada anak 6-12 tahun di wilayah kerja puskesmas kawatuna dengan nilai p-value sebesar 0,001 < 0,05. Dapat disimpulkan bahwa ibu di wilayah kerja puskesmas kawatuna sudah dalam kategori mandiri, dan sikap yang positif, dan terdapat hubungan yang signifikan antara tingkat pengetahuan dan sikap ibu

Self-heating of bulk high temperature superconductors of finite height subjected to a large alternating magnetic field

In this work we study, both experimentally and numerically, the self-heating of a bulk, large YBCO pellet of aspect ratio (thickness / diameter) ~ 0.4 subjected to a large AC magnetic field. To ensure accurate temperature measurements, the sample was placed in an experimental vacuum chamber to achieve a small and reproducible heat transfer coefficient between the superconductor and the cryogenic fluid. The temperature was measured at several locations on the sample surface during the self-heating process. The experimentally determined temperature gradients are found to be very small in this arrangement (< 0.2 K across the radius of the superconductor). The time-dependence of the average temperature T(t) is found to agree well with a theoretical prediction based on the one-dimensional (1-D) Bean model, assuming a uniform temperature in the sample. A 2-D magneto-thermal model was also used to determine the space and time-dependent temperature distribution T(r, z, t) during the application of the AC field. The losses in the bulk pellet were determined using an algorithm based on the numerical method of Brandt, which was combined with a heat diffusion algorithm implemented using a finite-difference method. The model is shown to be able to reproduce the main trends of the observed temperature evolution of the bulk sample during a self-heating process. Finally, the 2-D model is used to study the effect of a non-uniform distribution of critical current density Jc(r, z) on the losses within the bulk superconductor

Avaliação experimental da recuperação o do íleo paralítico pós-operatório após colectomia convencional e laparoscopica

A cirurgia laparoscópica tem determinado reavaliações de muitos dogmas cirúrgicos. Dentre esses dogmas, está a aparente ausência de íleo paralítico na cirurgia laparoscópica. O objetivo do autor foi avaliar, de maneira experimental, em cães , as diferenças de recuperação da motilidade do cólon após uma colectomia tradicional e uma colectomia videolaparoscópica assistida, determinando ainda as características do íleo paralítico pós-operatório, em cães, após uma cirurgia laparoscópica. Foram utilizados dez cães mestiços, sadios, pesando de 20 a 30 kg, com idade entre 4 e 5 anos. Após uma noite de jejum, os eletrodos foram implantados, através de uma laparotomia, sob condições assépticas e anestesia geral. Cada animal teve implantado oito eletrodos bipolares. Quatro desses eletrodos foram implantados no intestino delgado, e os quatro eletrodos restantes, localizados no cólon, estando o mais distal a 20 cm da reflexão peritoneal do reto. Foi estabelecido um período de dez dias para a total recuperação do íleo paralítico pós-operatório. Após a aquisição de traçados controles, os animais foram randomizados para a realização de uma colectomia laparoscópica ou uma colectomia através de laparotomia. Após uma noite de jejum, a colectomia foi realizada sob condições assépticas e anestesia geral. Após a extubação iniciou-se a aquisição dos dados. A aquisição foi realizada até a completa recuperação do íleo paralítico, de maneira ininterrupta. Nenhum dos animais recebeu analgésicos no período pós-operatório. Não houve diferença entre o final da colectomia e o surgimento do primeiro complexo motor migrante (CMM), no intestino delgado. Com relação ao final das colectomias e o retorno à fase 11, também não houve diferença estatisticamente significativa entre os dois grupos. Os intervalos de tempo entre as ressecções colônicas e o aparecimento da primeira contração colônica migrante (CCM) não foram estatisticamente diferentes, assim como não foram os intervalos entre o final da colectomia e o surgimento da primeira contração migratória gigante do cólon. Quando relacionamos o final da cirurgia e a primeira evacuação, não houve diferença entre os grupos. O autor concluiu que a colectomia laparoscópica cursa com íleo paralítico, e que não houve diferenças entre os grupos, com relação ao período de recuperação do íleo paralítico pós-operatório, nos cães estudados