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The purpose of this paper is to prepare a new combined method of rapid prototyping, fused deposition modeling (FDM) and electrospinning for the fabrication of coronary artery bypass graft (CABG).

A dynamically optimum design of blood vessel graft was constructed using FDM and electrospinning. Fabrication of 3‐D CABG model was constructed using pro‐engineer based on the optimum hemodynamic analysis and was converted to an stereolithography file format which was imported to the Magic software where it was edited to a high‐resolution contour. The model was then created from acrylonitrile butadiene styrene which was used as a collector for electrospinning fabrication. For the electrospinning thermoplastic polyurethane was dissolved with hexafluoroisopropanol. The voltage applied for electrospinning was 15 kV where the solid FDM model was used to collect nanofibers at fixed distance.

The properties of the fabricated vessel agreed well with those of human artery. The proposed method can be effectively used for the fabrication of an optimized graft design. This proposed method has been proved as a promising fabrication processes in fabricating a specially designed graft with the correct physical and mechanical properties.

The proposed method is novel and combines the advantages of both FDM and electrospinning techniques.

Robotic coronary artery bypass (rCABG) is a relatively novel and less invasive form of surgery. A yearlong direct-to-consumer advertising (DTCA) campaign was initiated to provide the community with information regarding rCABG, increase awareness and recruit patients. To optimize information content and ensure appropriate messaging for future campaigns, this study aims to analyze the campaign effectiveness and compared service quality perceptions and clinical outcomes, following surgery across DTCA-responder and control groups.

The institution initiated an rCABG program and one-year DTCA campaign. The authors prospectively documented all rCABG referrals prompted by these ads (DTCA-responder group) and concurrent referrals from medical providers (controls). Groups were compared according to baseline characteristics, perioperative outcomes, patient satisfaction (HCAHPS survey) and functional capacity at three weeks (Duke Activity Status Index). At six months, both groups were surveyed for patient satisfaction and unmet expectations.

There were 103 DTCA responders and 77 controls. The subset of responders that underwent rCABG (n = 54) had similar characteristics to controls, except they were younger, less likely to have lung disease or to be scheduled as an urgent case. Both groups had similar 30-day clinical outcomes, functional capacity recovery and overall satisfaction at three weeks. Follow-up interviews at six months and four years revealed that the DTCA group reported more unmet expectations regarding the “size of the skin incisions” and “recovery time” but no concern about “expertise of their surgeon”.

The DTCA campaign was effective at recruiting patients. The specific focus of the ads and narrow timeframe for decision-making about CABG lends confidence that the incremental cases seen during the campaign were prompted primarily by DTCA. However, differences in unmet expectations underscore the need to better understand the impact of message content on patients recruited via DTCA campaigns.

This is one of the first studies to provide real-world direct empirical evidence of patients’ clinical and attitudinal outcomes for DTCA campaigns. Furthermore, the findings contradict prevailing beliefs that DTCA is ineffective for prompting surgical referrals.

The paper's purpose is twofold: to provide a predictive model for estimating in‐hospital mortality rates after coronary artery bypass grafting (CABG) in Spanish autonomous regions (AR) after adjusting relevant factors; and to determine whether there is a difference between expected and observed mortality rates.

All patients registered in a minimum basic data set (MSBD) undergoing CABG between 2000 and 2004 were selected. After bivariate analysis to explore associations between in‐hospital death and other variables, a multivariate analysis using logistic regression was conducted. The predictive model was evaluated using calibration and discrimination techniques. Standardized mortality ratios by AR were calculated.

The expected Spanish in‐hospital mortality rate after CABG was 7.68 and the observed rate was 7.69 deaths per 100 operations. Discrimination obtained with the model resulted in an area under the curve of 0.70 (95 per cent CI, 0.69‐0.71). When each AR's mortality rate is calculated and compared with the observed rate, some ARs present an observed mortality rate higher or lower than the expected rate according to adjusted variables in the model.

The MSBD registry does not contain patients' critical data, such as arterial damage severity, or in which hospital procedures were performed.

There are factors related to individual patient variation, financial resources or healthcare quality in different ARs, which should be investigated in follow‐up studies.

The paper shows that, although the global expected mortality rate is almost the same as the observed Spanish mortality rate, this similarity disappears when AR rates are compared.

This paper report the effectiveness of a nursing quality assurance program over three years, which demonstrates improvement in the incidence and severity of post‐operative clean wound infections and the associated extended length of hospital stay and cost. General surgery categories included cardiovascular, orthopaedic, neurosurgery, kidney, abdominal, mammary and other. Cardiovascular categories included coronary artery bypass graft (CABG), heart transplant, and atrial valve replacement. Hip replacement and total knee replacement procedures were included in the orthopaedic category. Additional length of stay and concomitant hospital costs were calculated. Results show that early reporting of observations and implementation of appropriate treatment will decrease the incidence, severity and associated costs of post‐operative clean wound infections.

The purpose of this paper is to introduce an integrated approach using failure modes and effects analysis (FMEA), multiple-criteria decision making (MCDM), mathematical modeling and quality function deployment (QFD) techniques, for risk assessment and service quality enhancement in coronary artery bypass grafting (CABG) as a treatment for cardiovascular diseases (CVDs).

First, the disruptions in the CABG process are identified and prioritized following FMEA instructions, using two MCDM techniques, called analytic hierarchy process (AHP) and TOPSIS. Consequently, several corrective activities are identified and weighted on the basis of QFD. Finally, a mathematical model is established to determine the most cost-effective activities for implementation. The approach is developed in a fuzzy environment to reflect the uncertainty and ambiguity of human reasoning.

Regarding the CABG process disruption, a total of 30 failure modes in four main categories were identified and prioritized. Moreover, eight corrective activities were devised and ranked according to their impact on the failure modes. Finally, considering a limited amount of budget, a sensitivity analysis on the mathematical model’s objective function indicated that using 30 percent of the total budget, required to implement all corrective activities, was enough to cover more than 70 percent of the effects of corrective activities on the failure modes.

This paper contributes to the quality risk assessment knowledge by introducing an integrated approach to evaluate and improve healthcare services quality. Also, the case study conducted on the CABG process has not been done by other related studies in the literature.

Deals first, with the theoretical framework within which the Internal Market (NHSIM) is expected to operate and the particular problems which occur when a service is provided to a consumer free at the point of consumption (i.e. non‐marketed). Second, deals with some costing procedures and stresses the importance of considering costs of an episode jointly with other benefits. Both of these activities are at a relatively early stage in the NHS in general. Third and fourth, deals with two examples (internal medicine and cardiothoracic surgery) of how the NHSIM has fared during the first year at the Freeman Hospital, Newcastle upon Tyne. Shows how principles of the theory of finance may be applied to contracting for Coronary Artery Bypass Graftings.

The purpose of this paper is to review the design and fabrication of a micro‐accelerometer to be used to measure the heart wall motion of patients who have just undergone coronary artery bypass graft (CABG) surgery. The sensor will provide a means of early warning for the medical staff of associated complications with this surgery occurring.

A feasibility paper is carried out with the use of commercially available MEMS three‐axis accelerometers. The sensors are used in animal studies during which the sensor is stitched directly to the surface of a pig's heart. A need for smaller sensors is required and these are designed in‐house and fabricated using a MEMS process. The final dimensions of the sensors are 2.5×3.5×1.4 mm in width, length and height, respectively.

The results of the feasibility studies demonstrate the viability of this type of sensor for heart wall motion measurement. It is possible to detect abnormalities, which can indicate complications associated with CABG. The sensors presented here are fabricated within the tight overall size specifications deemed necessary for this application.

This paper demonstrates an application of MEMS for implantable medical sensors.

In the UK, approximately 300,000 people have a heart attack each year. One of the most common surgeries that is used to treat this is CABG. This sensor is to be used by the medical staff in post‐surgery to provide “real‐time” monitoring of the heart and give early warning of regional cardiac ischemia which can save lives and reduce hospital waiting times and costs.

This paper demonstrates an original way of measuring heart wall motion. Results from the feasibility studies have proven that this can provide an invaluable way of providing early warning of complications after heart surgery.

Procedures can be categorized as certain surgeries based on their necessity and outcomes while others are classified as uncertain surgeries based on these areas. To account for this variance, policies such as the Affordable Care Act (ACA) call for health care providers to engage in shared decision making (SDM) with patients to ensure they are informed of treatment options and asked their preferences. Yet, gender may influence the decision-making process. Thus, this project examines the decision process and how gender impacts patients’ participation in decisions to undergo certain surgeries compared to uncertain surgeries.

This research project analyzed data from the National Survey of Medical Decisions 2006–2007 which surveyed the medical decisions of US residents 40 and older.

First, the data reveals that women felt more informed having uncertain surgeries compared to men. Second, patients were less likely asked their preference for surgery when undergoing certain surgeries compared to uncertain surgeries. Third, compared to men, women having uncertain surgeries were less likely to make the final decision to have surgery, compared to sharing the final decision with health care providers.

Due to the sample size, this project could not perform three-way interactions between gender, race, and surgery type.

Gender influences the level patients feel informed having uncertain surgeries. Though policy calls for SDM, health care providers are less likely to ask patients their preference for surgery regarding certain surgeries, relative to uncertain surgeries. Gender impacts the final decision-making process regarding whether patients should have uncertain surgeries.

Statistics for the economics of health care encompasses three enormous subject areas in their own right. In order to make my task more manageable, I have decided not to say very much directly about statistics, as Dr. Alderson of the Office of Population Censuses and Surveys, and Dr John Fry, leading authorities on mortality and morbidity statistics — which are of course essential data in studying many health issues, have given papers at this seminar. Instead, I shall concentrate on the remaining two, economics and health care and in so doing divide my paper into two parts. The first will look at the evolution of health economics and then I shall turn my attention specifically to the work of my own organisation, the Office of Health Economics (OHE).

Rapid prototype models are directly integrated into non‐engineering applications such as medicine. Medical models are used to plan complex procedures prior to surgery with potential to optimise patient treatment in the operating theatre. This paper presents results following a 12 month National Health Service Executive research project to assess the feasibility of using rapid prototype medical models. A total of 16 medical models were created. Nine anatomical sites were reconstructed from patient data acquired from five London hospitals. The purpose of the models is described and the commissioning surgeons as part of a questionnaire assessed their usefulness. Future developments are discussed and conclusions about the use of medical models are made.