Saravana Kumar Jaganathan ¹, Aruna Priyadharshni Subramanian ¹, Agnes Aruna John ¹, Muthu Vignesh Vellayappan ¹, Arunpandian Balaji ¹, Eko Supriyanto ¹, Bakiraj Gundumalai ², Ashok Kumar Jaganathan ³

Affiliations
1 IJN-UTM Cardiovascular Engineering Centre, Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, Johor Bahru, 81310, MY
2 Research & Development Department, Bridgestone India Automotive, Mumbai, IN
3 Assistant Manager, Research and Development Wing, AVTEC Ltd, CK Birla Group, Hosur, IN

Abstract

A recent report states that more than 2,000,000 stents are used worldwide per year. Coronary artery obstruction is caused by the presence of high level of cholesterol which leads to ischemia. To prevent the elastic contraction of the artery that occurs immediately after the removal of the obstruction, typically a cardiovascular stent is placed. Structural integrity of the stent is an essential parameter determining the life span of the stent. In order to prevent the stent failure, we modelled a cardio vascular stent and subjected it to modal analysis to estimate the natural frequency of the stent. For this study three commonly used stent materials namely stainless steel (316L), cobalt-chromium alloy (CoCrMo) and titanium alloy (Ti₆Al₄V) were chosen. The natural frequencies were significantly different (P<0.05) for the three metallic stents at each corresponding modes. The vibrating modes at each frequency showed pronounced changes in their shapes for every stent material. The outcome of this work will be used by the medical product designers for designing new stents with better structural integrity by analyzing the modelled stent using ANSYS software before stent insertion, substituting in vivo experiment that is difficult and unpractical.

Keywords

Cardiovascular Stent, Coronary Artery Obstruction, Modal Shapes, Natural Frequency, Structural integrity

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Rania Hussien Al-Ashwal ¹, Eko Supriyanto ²

Affiliations
1 Clinical Science Department, Faculty of Biosciences and Engineering, University Technology Malaysia, Skudai, MY
2 IJN-UTM Cardiovascular Engineering, Clinical Science Department, Faculty of Biosciences and Medical Engineering University Technology Malaysia, Skudai, MY

Abstract

Objectives: Clinical pathway effect on improving the healthcare quality still underestimated. An overview on clinical pathway current practice overview will be presented in the context of this paper. Methods/Statistical Analysis: A search for the medical literature was conducted to screen the contemporary evidence. We focused on finding the gold standard for clinical pathway quality measures and the current status of clinical pathway in Malaysia. Various databases (MEDLINE, EMBASE, Pub Med, COHRANCE library and CINAHEL) have been screened for 2000 to 2015 studies. Checklist of the preferred reporting items for systematic reviews and meta-analyses has been used as a guide for reporting. Findings: The search has identified 720 documents, of which 315 (44%) met the inclusion criteria of this study. Twenty meta-analysis studies have been found, while only nine have completely fulfilled the search inclusion criteria. Mostly they discussed the length of stay, patient outcome and cost from RCT (Randomized Clinical Trial) or EXP (experimental design) evidence as a quality indicator for the clinical pathway which may under represent the complexity nature of clinical pathway and ignored many aspects of care. The majority of publications in Malaysia found from (UKM) with similar heterogeneous focus on the outcome measures to what have been found in the overall literature. Interestingly, we found that no meta-analysis study has been conducted in Malaysia for clinical pathway. Application/Improvements: Current research on clinical pathway still limited. More Studies on the effect of clinical pathway on quality of care still needed with emphasize on the cofounding factors.

Keywords

Clinical Pathway, Literature Review, Quality and Evidence based Medicine.

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Rania Hussien Al-Ashwal ¹, Eko Supriyanto ²

Affiliations
1 Clinical Science Department, Faculty of Biosciences and Engineering, University Technology Malaysia, Skudai, MY
2 IJN-UTM Cardiovascular Engineering, Clinical Science Department, Faculty of Biosciences and Medical Engineering University Technology Malaysia, Skudai, MY

Abstract

Objectives: Although Clinical Pathway (CP) standardizes the patient care, poor compliance remains. The consistency of the expert’s opinion on the CPs significance to the pattern of Clinical Pathway completeness was explored. Methods/Statistical Analysis: Mixed method and data triangulation were used in this study. Two types of data were collected from one hospital for STEMI (St Elevation Myocardial Infarction) patients. Primary (Survey) and secondary (CP filled documents) data were collected. Clinical Pathway content analyses with descriptive statistics were conducted using SPSS version 22. The influence of design on the completeness of the document was investigated. Findings: The content analysis revealed four main care processes in STEMI Clinical Pathway (Medical assessment and nursing, Medication therapy and treatment, Education nutrition and rehabilitation and outcome variance). We found differences in the design of the documents. Most of the experts (58%) agreed on the importance of time to treatment, while 35% of the respondents have a strong agreement on the importance of fast action to treatment and nothing should delay the intervention. CP1 was holding the highest ratio of documents completeness despite the fact that CP2 and CP3 are the improved version of CP1. Application/Improvements: The variance of the expert opinion from the real Clinical Pathway performance indicated inconsistency between the knowledge and practice. Further explanation for the phenomenon is recommended.

Keywords

Clinical Pathway, Completeness, Experts, Myocardial Infarction

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Joanne Zi En Soh ¹, Eko Supriyanto ¹

Affiliations
1 Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Johor – 81300, MY

Abstract

Background/Objectives: Due to the low Reynolds number (Re) in microfluidic domain, the predominant laminar flow might inhibit effective mixing in micro-Coiled Flow Inverter (mCFI). Fluid dynamics within the mCFI was simulated with Computational Fluid Dynamics (CFD) software to investigate the mixing profile. Methods/Statistical Analysis: Fluid flow was simulated with the software FLUENT with Species Transport (ST) setting, to replicate the mixing of two water bodies. Geometry of the mCFI was designed with a tubing diameter of 0.5 mm and curvature ratio of λ = 10. Fluid flow rate was adjusted to attain 25≤ Re ≤ 250. Findings: A mixing time of 0.59s was achieved with Re = 250. However complete mixing was still achievable even in Re = 25 albeit with a longer mixing time. Application/Improvements: Flow inversion is improved the mixing condition in micro-structured tubing, in enhancement of the diffusive mixing in microfluidics.

Keywords

Flow Inversion and Computational Fluid Dynamics (CFD), Micro-Coiled Flow Inverter (Mcfi), Reynolds Number.

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