Clinical pathways have been implemented in many healthcare systems with mix results in improving the quality of care and controlling the cost. CP is a methodology used for mutual decision making and organization of care for a well-defined group of patients within a well-defined period. In developing the CPs for a medical centre, several meetings had been carried out involving expert teams which consist of physicians, nurses, pharmacists and physiotherapists. The steps used to develop the pathway were divided into 5 phases. Phase 1: the introduction and team development, Phase II: determining the cases and information gathering, Phase III: establishing the draft of CP, Phase IV: is implementing and monitoring the effectiveness of CP while Phase V: evaluating, improving and redesigning of the CP. Four CPs had been developed: Total Knee Replacement (TKR), ST Elevation Myocardial Infarction (AMI), Chronic Obstructive Airways Diseases (COAD) and elective Lower Segment Caesarean Section (LSCS). The implementation of these CPs had supported the evidence-based medicine, improved the multidisciplinary communication, teamwork and care planning. However, the rotation of posts had resulted in lack of document ownership, lack of direction and guidance from senior clinical staff, and problem of providing CPs prior to admission. The development and implementation of CPs in the medical centre improved the intra and inter departmental communication, improved patient outcomes, promote patient safety and increased patient satisfaction. However, accountability and understanding of the CPs must be given more attention.
Critical Pathways ; Quality of Health Care ; Evidence-Based Medicine ; Health Care Costs ; Interdisciplinary Communication

mortality and an important cause of morbidity in Malaysiafor several years. To reduce global cardiovascular (CV) riskin the population, primary preventive strategies need to beimplemented. Hypercholesterolaemia is one of the majorrisk factors for CVD. This paper is an expert review on themanagement of hypercholesterolemia focusing on high andvery high risk individuals. In low and Intermediate riskindividuals, therapeutic lifestyle changes (TLC) and ahealthy lifestyle alone may suffice. In high and very high riskindividuals, drug therapy in conjunction with TLC arenecessary to achieve the target LDL-C levels which havebeen shown to slow down progression and sometimes evenresult in regression of atherosclerotic plaques. Statins arefirst-line drugs because they have been shown in numerousrandomized controlled trials to be effective in reducing CVevents and to be safe. In some high risk individuals, despitemaximally tolerated statin therapy, target Low DensityLipoprotein Cholesterol (LDL-C) levels are not achieved.These include those with familial hypercholesterolaemia andstatin intolerance. This paper discusses non-statintherapies, such as ezetimibe and the newer Proproteinconvertase subtilisin/kexin type 9 Inhibitors (PCSK9-i).

The purpose of this study was to evaluate the image quality and diagnostic accuracy of coronary computed tomography angiography (CCTA) using 640-slice scanner. Advancement of multidetector computed tomography (MDCT) technology with higher spatial, temporal resolution, and increasing detector array have improved the image quality and diagnostic accuracy of CCTA. A total of 25 patients (12 men and 13 women) underwent CCTA examination was chosen and data was acquired by 640-slice scanner. All 16 segments of coronary arteries were evaluated by two reviewers using a 4-likert scale for qualitative assessment. In quantitative assessment, the evaluation of 4 main coronary arteries were analysed in terms of signal intensity (SI), image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). All 25 patients with a mean age of 52.88 ± 14.75 years old and body mass index (BMI) of 24.24 ± 3.28 kg/m2 were analysed. In qualitative assessment, from the total of 400 segments, 379 segments (95%) had diagnostic value while 21 segments did not have diagnostic value, which means 5% artefact was detected. In quantitative assessment, there was no statistical differences in gender, race, and BMI (p>0.05). Overall evaluation showed that higher SI at the left main artery (LM) at 393.7 ± 47.19. Image noise was higher at right coronary artery (RCA) at 39.01 ± 13.97. SNR and CNR showed higher at left anterior descending (LAD) with 12.73 ± 5.17 and LM 9.14 ± 4.2, respectively. In conclusion, this study indicates that 640-slice MDCT has higher diagnostic value in CCTA examination with 95% vessel visibility with 5% artefact detection.

Introduction: Heart failure (HF) prevalence is increasing in Malaysia and brings about significant poor outcomes especially on the patients’ wellbeing. Despite the devastating physical symptoms of HF experienced by patients, other social consequences on patients are often not discussed by their health care professionals. Hence, this qualitative study aims to explore and understand the quality of life (QOL) for patients in Malaysia of various ethnicity who have been diagnosed with heart failure. Methods: Nineteen (n = 19) patients with recurrent HF were recruited via purposive sampling. One-to-one semi-structured interviews were conducted after patients’ informed consent was obtained. The aforementioned sessions were audio-recorded and transcribed verbatim. Finally, the transcribed data was analysed through Braun and Clarke’s framework for thematic analysis. Results: The findings revealed that Malaysians with HF reported either positive or negative experiences related with QOL which had an effect on their well-being. Four main themes emerged included physical, psychological, social, and spirituality. Interestingly, cultural and beliefs consideration were important to understand these QOL themes of HF patients as a whole, especially in Malaysia’s multi-ethnic communities. Conclusion: Informants were able to give vivid descriptions of living with HF experiences and the way it affected their QOL due to the disruptive and uncertain nature of HF in four major themes. However, the individual themes of QOL in HF patients need to be comprehended in detail including the local cultural perspectives, particularly by health professionals who deal with HF patients of minority ethnicities, in order to improve treatment and health outcomes.