Malaysian Statistics On MEDICAL DEVICES 2007 · Malaysian Statistics On MEDICAL DEVICES A...

Malaysian Statistics OnMEDICAL DEVICES

A publication of the

Engineering Services Division, Medical Device Bureau and the Clinical Research CentreMinistry of Health Malaysia

Subramani V; Mohammad Ali K; Mohd. Roslan H; Jahizah H; Zakaria Z; Ramanathan R; Katijjahbe M.A;Muralitharan G; Suganthi C; Suarn Singh; Aizai A; Abdul Razak M; Rosemi S; Zaki Morad; Murali S; Rohna R;

Rahmat O; Mariam I.

Ariza ZakariaFaridah Aryani Md. Yusof

Lim T.O.

2007



2007





Rahmat O; Mariam I.


Lim T.O.

Malaysian Statistics On Medical Devices 2007August 2008© Ministry of Health Malaysia

Published by:The National Medical Device SurveyLevel 3, MMA House 124, Jalan Pahang53000 Kuala LumpurMalaysia

Tel. : (603) 4043 9300Fax : (603) 4043 9500e-mail : [email protected] site: http://www.crc.gov.my/nmds

This report is copyrighted. However it may be freely reproduced without the permission of the National Medical Device Survey. Acknowledgement would be appreciated. Suggested citation is Ariza Z, Faridah A, Lim T.O. (Eds). Malaysian Statistics On Medical Devices 2007. Kuala Lumpur 2008

This report is also published electronically on the website of the National Medical Device Survey at: http://www.crc.gov.my/nmds

Funding:The National Medical Device Survey is funded by a grant from the Ministry of Health Malaysia (MRG Grant Number MRG-CRC-2008-02)

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FOREWORD

The Ministry of Health Malaysia has embarked on a landmark project, the National Medical Device Survey (NMDS), to capture data on the availability and use of medical devices in both the government and private sectors in Malaysia and this report is an output of the project.

This NMDS report is very relevant in the present environment of ever increasing healthcare costs in both the government and private sectors. We are almost completely lacking in data on the availability and use of medical devices in the country. This publication will help in some ways to rectify the situation.

I am confident this publication will be a very useful reference to the government, the industry and the public and I must congratulate those who are involved in the survey for successfully completing the project. I am looking forward to see that the data are regularly updated through follow-up surveys.

Y. BHG. DATUK IR. M.S. PILLAYDeputy Director General of Health, Research & Technical Support,Ministry of Health Malaysia

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PREFACE

Data on the availability and use of medical devices is important to better understand healthcare provision in a country. Availability and access to medical technologies are likely to differ among countries and almost certainly unevenly distributed within a country. These differences could be because of several factors, such as demographic differences, differences in epidemiology of disease, differences in medical approaches or differences in economic conditions. This type of information allows for better decision-making in the allocation of resources and procurement of medical technologies. The use of this information can help to ensure access to and appropriate use of medical technology for better health outcomes.

To our knowledge, there has not been any published survey on the availability and utilization of medical devices in Malaysia and this aptly called National Medical Device Survey (NMDS) is, we believe, the first of its kind. However in carrying out this survey, in a country like Malaysia that does not have single central database on the procurement or reimbursement for medical devices, the task of compiling data on devices are fraught with problems. Data needed to be collected from multiple sources and some of these sources were less than forthcoming in providing data due to apprehension on the actual or possible use of the data or possibly, some sources were too busy to be able or want to provide the data needed.

After the hurdle of data collection was surmounted, the next problem was data analysis. There was a need for intelligent and expert analysis to distill credible information out of all these data as the data from various sources were not always complete or clean or in the format or depth that was wanted. We therefore regard this first report from the NMDS as a proof of concept; it demonstrates such project is indeed feasible. These initial efforts and experiences in conducting NMDS will stand us in good stead. NMDS is a work in progress, and as it improves its coverage and secure better cooperation from all relevant source data providers over time, we expect to publish more comprehensive reports in future.

We would like to thank all staff that has worked so hard in this survey. We would also like to thank all agencies and institutions who have helped in providing data and who have helped in one way or another.

Dr. Lim Teck Onn Mr. Zamane Abd. Rahman Mr. Chin Goo ChaiChairperson Co-Chairperson Co-Chairperson

National Medical Device Survey,Ministry of Health, Malaysia

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ACKNOWLEDGEMENTS

The National Medical Device Survey would like to thank the following :

• All the medical doctors, medical assistants and nurses who participated in NMDS survey

• Participating private hospitals for cooperating with the survey

• The Faber Mediserve Sdn. Bhd., Radicare Sdn. Bhd. and Tongkah Medivest Sdn. Bhd., for their valuable assistance

• All who have in one way or another supported and/or contributed to the success of the NMDS and to this report

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1. Hospital Alor Gajah 2. Hospital Ampang 3. Hospital Bahagia 4. Hospital Balik Pulau 5. Hospital Baling 6. Hospital Banting 7. Hospital Batu Gajah 8. Hospital Batu Pahat 9. Hospital Bau 10. Hospital Beaufort 11. Hospital Beluran 12. Hospital Bentong 13. Hospital Besut 14. Hospital Betong 15. Hospital Bintulu 16. Hospital Bukit Mertajam 17. Hospital Changkat Melintang 18. Hospital Daro 19. Hospital Duchess of Kent 20. Hospital Dungun 21. Hospital Gerik 22. Hospital Gua Musang 23. Hospital Hulu Terengganu 24. Institute of Respiratory Medicine25. Hospital Ipoh 26. Hospital Jasin 27. Hospital Jelebu 28. Hospital Jeli 29. Hospital Jempol 30. Hospital Jengka 31. Hospital Jerantut 32. Hospital Jitra 33. Hospital Kajang 34. Hospital Kampar 35. Hospital Kanowit 36. Hospital Kapit 37. Hospital Kemaman 38. Hospital Keningau 39. Hospital Kepala Batas 40. Hospital Kinabatangan 41. Hospital Kluang 42. Hospital Kota Belud 43. Hospital Kota Marudu 44. Hospital Kota Tinggi 45. Hospital Kuala Kangsar46. Hospital Kuala Krai 47. Hospital Kuala Kubu Bharu48. Hospital Kuala Lipis49. Hospital Kuala Lumpur 50. Hospital Kuala Nerang 51. Hospital Kudat 52. Hospital Kulim 53. Hospital Kunak 54. Hospital Labuan 55. Hospital Lahad Datu 56. Hospital Langkawi 57. Hospital Daerah Lawas 58. Hospital Likas 59. Hospital Limbang 60. Hospital Daerah Lundu 61. Hospital Machang 62. Hospital Marudi 63. Hospital Melaka 64. Hospital Mersing 65. Hospital Mesra Bukit Padang 66. Hospital Miri

67. Hospital Muadzam Shah 68. Hospital Mukah 69. Hospital Papar 70. Hospital Parit Buntar 71. Hospital Pasir Mas 72. Hospital Pekan 73. Hospital Permai 74. Hospital Pontian 75. Hospital Port Dickson 76. Hospital Pulau Pinang 77. Hospital Putrajaya 78. Hospital Queen Elizabeth 79. Hospital Raja Perempuan Zainab II 80. Hospital Rajah Charles Brooke Memorial81. Hospital Ranau82. Hospital Raub 83. Hospital Saratok 84. Hospital Umum Sarawak 85. Hospital Sarikei 86. Hospital Seberang Jaya 87. Hospital Segamat 88. Hospital Selama 89. Hospital Selayang 90. Hospital Semporna 91. Hospital Sentosa 92. Hospital Serdang 93. Hospital Seri Manjung 94. Hospital Serian 95. Hospital Setiu 96. Hospital Sibu 97. Hospital Sik 98. Hospital Simunjan99. Hospital Sipitang100. Hospital Slim River101. Hospital Sri Aman 102. Hospital Sultan Abdul Halim 103. Hospital Sultan Haji Ahmad Shah 104. Hospital Sultan Ismail 105. Hospital Besar Sultanah Aminah 106. Hospital Sultanah Bahiyah107. Hospital Pakar Sultanah Fatimah 108. Hospital Sultanah Nur Zahirah 109. Hospital Sungai Bakap 110. Hospital Sungai Buloh 111. Hospital Sungai Siput 112. Hospital Taiping 113. Hospital Tambunan 114. Hospital Tampin 115. Hospital Tanah Merah 116. Hospital Tangkak 117. Hospital Tanjong Karang 118. Hospital Tapah 119. Hospital Tawau 120. Hospital Teluk Intan 121. Hospital Temenggung Seri Maharaja Tun Ibrahim 122. Hospital Tengku Ampuan Afzan 123. Hospital Tengku Ampuan Jemaah 124. Hospital Tengku Ampuan Rahimah 125. Hospital Tengku Anis 126. Hospital Tenom 127. Hospital Tuanku Ampuan Najihah 128. Hospital Tuanku Fauziah 129. Hospital Tuanku Ja’afar 130. Hospital Tuaran 131. Hospital Tumpat 132. Hospital Yan

PARTICIPANTS OF THE NATIONAL MEDICAL DEVICE SURVEYMOH Hospitals

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University & Armed Forces Hospitals1. Pusat Perubatan Universiti Kebangsaan Malaysia 2. Pusat Perubatan Universiti Malaya 3. Hospital Universiti Sains Malaysia4. Hospital Angkatan Tentera Lumut5. Hospital Angkatan Tentera Terendak

Private Hospitals1. Amanjaya Specialist Centre2. Arunamari Specialist Medical Centre3. Assunta Hospital4. Az-Zahrah Islamic Medical Centre5. Bukit Mertajam Specialist Hospital 6. Columbia Asia Medical Centre, Sarawak7. Columbia Asia Medical Centre, Seremban8. Columbia Asia Nursing and Rehabilitation Centre9. Damai Medical and Heart Clinic Sdn. Bhd10. Damai Service Hospital (Head Quarters)11. Damai Specialist Centre Sdn. Bhd 12. Damansara Specialist Hospital13. Darul Ehsan Medical Centre14. Gleneagles Medical Centre, Penang15. Hope Children Hospital, Farlim16. Hope Children Hospital, Jln Gottlieb17. Hope Children Hospital, Sg. Ara18. INS Specialist Centre 19. Ipoh Specialist Hospital20. Island Hospital21. Johor Specialist Hospital22. Kajang Medical Centre23. Kajang Plaza Medical Centre24. Kampung Baru Medical Centre25. KCDC Hospital Sdn. Bhd26. Kedah Medical Centre27. Kempas Medical Centre28. Kinta Medical Centre29. Kota Bharu Medical Centre30. Kuantan Medical Centre31. Lam Wah Ee Hospital 32. Landmark Medical Centre Sdn. Bhd33. Larut Medical Centre34. Loh Guan Lye Specialist Centre35. Mahkota Medical Centre36. Medical Specialist Centre (JB) Sdn. Bhd37. Metro Specialist Hospital38. Miri City Medical Centre39. Mount Miriam Hospital Cancer Centre40. Multimedic Specialist & Maternity Centre41. N. S. Chinese Maternity Hospital and Medical Centre

42. National Heart Institute43. NCI Cancer Hospital44. Normah Medical Specialist Centre45. Pantai Ayer Keroh Hospital Sdn. Bhd46. Pantai Cheras Medical Centre47. Pantai Indah Hospital48. Pantai Mutiara Hospital 49. Peace Medical Centre50. Pelangi Medical Centre51. Penang Adventist Hospital52. Penawar Hospital53. Perak Community Specialist Hospital54. Perdana Specialist Hospital55. Pusat Pakar Tawakal56. Pusat Rawatan Islam Medical Centre57. PUSRAWI Hospital Sdn. Bhd58. PUSRAWI SMC Hospital Sdn. Bhd59. Puteri Specialist Hospital60. Putra Medical Centre, Alor Setar61. Putra Medical Centre, Sungai Buloh62. Putra Specialist Hospital (Melaka) Sdn. Bhd 63. Rafflesia Medical Centre Sdn. Bhd64. Rejang Medical Centre65. Sabah Medical Centre66. Sambhi Clinic Sdn. Bhd67. Sentosa Medical Centre (KPJ Kajang Specialist Hosp.)68. Siow Specialist Hospital69. Sri Kota Specialist Medical Centre70. Sri Manjung Specialist Centre Sdn. Bhd71. Srigim Specialist Women and Children’s Hospital72. Subang Jaya Medical Centre73. Sunway Medical Centre74. Taiping Medical Centre75. Taj Hospital 76. Taman Desa Medical Centre77. Tanjung Medical Centre78. Timberland Medical Centre79. Tun Hussein Onn National Eye Hospital

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AbOUT THE NATIONAL MEDICAL DEVICE SURVEY The National Medical Device Survey (NMDS) is a service initiated and supported by the Ministry of Health (MOH) to collect information on the supply, procurement and utilization of medical devices in Malaysia. It is designed to quantify the current trends of availability and utilization of medical devices, as well as support the implementation of the proposed regulatory system for medical devices in Malaysia. In supporting this, the NMDS shall provide the functional capacity for the collection, analysis, reporting and dissemination of data on medical devices in Malaysia.

Sponsors and Organization of the NMDSThe NMDS is jointly sponsored by:

• The Engineering Services Division and the Medical Device Bureau of the MOH

• The Clinical Research Centre, National Institute of Health MOH.

The Pharmaceutical Research Unit of the Clinical Research Centre MOH undertakes the daily operation of NMDS. To ensure that the NMDS meets the needs and expectations of all interested parties, a Governance Board has been established to oversee the operations of the NMDS. All major groups involved in medical device issues in Malaysia such as the MOH, professional bodies, private healthcare providers and the medical device industries are represented on this board. The board, therefore works as a consultative forum and provide advice on issues pertaining to the NMDS and other aspects of quality use of medical devices in Malaysia.

Premise of the NMDSEfficient functioning of device market depends in part on buyers’ access to information on suppliers, products and prices. Safe and effective use of device depends in part on users’ access to information on technical performance and users’ instructions.The objective of the NMDS is therefore to quantify the present state and time trends of medical device procurement and utilization at various level of our health care system, whether national, regional, local or institutional. It will provide a public information service to ensure that high quality, reliable and timely information on medical devices are available for promoting equitable access to, and safe and effective use of such devices in Malaysia.

Routinely compiled statistics on availability and use of medical devices have many applications, such as to:

1. Describe the demographic patterns of device availability and utilization to better understand device use in its natural clinical environment.

2. Estimate expenditure on medical devices, which constitutes a significant proportion of our public and private healthcare costs.

3. Monitor and evaluate the cost-effectiveness of device-based treatments with respect to device productivity and equity in provision, which may have significant impact on resource management within our healthcare system.

4. Monitor users’ device-experience and evaluate the clinical effectiveness of medical devices, and their associated health outcomes as well as factors influencing those outcomes.

5. Support reporting of adverse events or product problems by suppliers or user facilities.

6. Relate the number of adverse device effects reported to our device vigilance system to the number of people exposed to the device in order to assess the magnitude of the problem, or to estimate the degree of under-reporting of adverse events.

7. Stimulate and facilitate applied clinical and epidemiologic research on the economics, utilization, safety and effective use of medical devices.

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NMDS GOVERNANCE bOARD CHAIRPERSON: Dr. Lim Teck Onn,

Director, Clinical Research Center MOH.

CO-CHAIRPERSON: Mr. Zamane Abdul Rahman,Director, Medical Device Bureau MOH.

CO-CHAIRPERSON: Mr. Chin Goo Chai.Director, Engineering Services Division MOH

MEMbERSClinical Research Centre MOH Dr. Faridah Aryani Md. Yusof

Medical Device Bureau MOH Mr. Ahmad Sharif Hambali

Engineering Services Division MOH Pn. T. Sasikala Devi

Procurement Division MOH Pn. Hamidah Bidin

Malaysian Medical Association -

Malaysian Dental Association (MDA) -

Malaysian Private Dental Practitioner’s Association (MPDPA)

-

Association of Private Hospitals Malaysia (APHM)

Dr. Hooshmana M Palany

Malaysian Medical Device Association Mr. Yong Tuan Heng

Association of Malaysian Medical Industries

Mr. Peter Ring

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MEMbERS OF NMDS EXPERT PANELSExpert Panel Institution

1. Imaging and Diagnostic Facilities And DevicesDr. Subramani A/L Venugopal (Chairperson) Hospital Tuanku Ja’afar Dr. Nik Fatimah Salwati Hospital Sultanah BahiyahDr. Hjh Salwah Hashim Hospital Pulau PinangDr. Zaharah Musa Hospital Selayang.Dr. Harikrishna A/L Sivaganabalan Hospital Tengku Ampuan RahimahDr. Che Zubaidah Che Daud Institut Pediatrik, HKL.Ir. Dr. Syed Mustafa Kamal Engineering Services Div, MOH

2. Nuclear Medicine Facilities And DevicesDato’ Dr. Mohammad Ali Kadir (Chairperson) Hospital Pulau PinangDr. Lee Boon Nang Hospital Kuala Lumpur.

3. Oncology Facilities And DevicesDr. Mohd. Roslan Bin Haron (Chairperson) Hospital Sultan IsmailAss. Prof. Dr. Fuad Ismail Pusat Perubatan Universiti Kebangsaan MalaysiaDr. Ahmad Kamal Mohamed Subang Jaya Medical CentreDr. Vincent Phua Hospital Kuala LumpurEn. Mohd Farihan Jaffar Hospital Kuala LumpurPuan Rubiah Mohd Pakah Hospital Kuala LumpurPn Mahzom Pawanchek Hospital Kuala Lumpur

4. Anaesthesiology and Intensive Care Facilities And DevicesDato’ Dr. Jahizah Hj. Hassan (Chairperson) Hospital Pulau PinangProf. Dr. Mazidar Mansor. Pusat Perubatan Universiti MalayaClinical Ass. Prof. Dr. Choy Yin Choy. Pusat Perubatan Universiti Kebangsaan MalaysiaDato’ Dr. Teh Keng Hwang Hospital Sultanah BahiyahDr. Irene Cheah Hospital Kuala LumpurDr. Neoh Siew Hong Hospital Taiping

5. General Surgery Facilities And DevicesDato’ Dr. Zakaria Bin Zahari (Chairperson) Hospital Kuala LumpurDr. Mohammed Saffari Mohammed Haspani Hospital Kuala LumpurDr. Mohd Mazri Yahya Hospital Kuala Lumpur

6. Orthopedic & Traumatology Facilities And Devices Dato’ Dr. Ramanathan Ramiah (Chairperson) Hospital IpohDr. Mohammad Anwar Hau Abdullah Hospital Raja Perempuan Zainab IIDr. Kamariah Nor Mohd Daud Hospital Kuala LumpurDr. Ng Yue Onn Hospital AmpangDr. Lee Joon Kiong Pantai Medical Centre Bangsar Dr. Mahathar Abd Wahab Hospital Kuala Lumpur

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7. Physiotherapy and Occupational Therapy Facilities And DevicesCik Katijjahbe Mohd Ali (Chairperson) Pusat Perubatan Universiti Kebangsaan MalaysiaDatin Hjh Asiah Bt Hashim Hospital Kuala LumpurPn. Misnah Roslam Hospital SerdangPn. Tan Wai Choo Hospital Sungai BulohPn. Wong Swee Fong Hospital Tengku Ampuan RahimahPn. Lim Khee Li Hospital Kuala LumpurPn. Hjh. Hamidah Hj. Ariffin Hospital SelayangPn. Khuzaimah Abd. Aziz Hospital Kuala LumpurPn. Jamaliah Musa, Hospital Kuala LumpurPn. Zalila Kashim Hospital Kuala LumpurPn Aqilah Leela T. Narayanan Hospital Sultanah AminahPn. Zunaidah Abu Samah Hospital Kuala LumpurPn. Tan Foo Lan Hospital Kuala LumpurPn Anil Kalsom Bte Musa Hospital Tengku Ampuan RahimahPn. Rohana Mukahar Pusat Perubatan Universiti Kebangsaan MalaysiaDr. Julia Patrick Engkasan Pusat Perubatan Universiti Kebangsaan MalaysiaPn. Noormah Mohd Darus Health Technology Assesment Div., MOH

8. Obstetrics & Gynecology Facilities And DevicesDr. Muralitharan Ganesalingam (Chairperson) Hospital Kuala LumpurDr. Zaridah Shaffie Hospital Tuanku FauziahDr. Krishnakumar A/L Harikrishnan Hospital Tuanku Ja’afarDr. R.P Japaraj Hospital Ipoh

9. Neurology Facilities And Devices Dr. Suganthi Chinnasami Hospital Kuala LumpurY. Bhg. Dato’ Dr. Md. Hanip Bin Rafia Hospital Kuala LumpurDr. Santhi Datuk Puvanarajah Hospital Kuala LumpurDr. Mooi Chin Leong Hospital Kuala Lumpur

10 Psychiatry Facilities And DevicesDato’ Dr. Suarn Singh Hospital Bahagia Ulu Kinta Dr. Hj. Mohd Daud Dalip Hospital Mesra Bukit Padang Dr. Siti Nor Aizah Ahmad Hospital Kuala Lumpur.Prof Dr. Mohd Fadzillah Bin Abdul Razak Universiti Malaysia SarawakEn Rosdi Bin Zainol Hospital Kuala LumpurDr. Hj. Mohd Rasidi M. Saring Hospital Sultanah Bahiyah

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11. Cardiology And Cardiothoracic Surgery Facilities And DevicesDr. Aizai Azan (Chairperson) Institut Jantung NegaraDr. Surinder Kaur Institut Jantung NegaraDr. Alan Yean Yip Fong Hospital Umum SarawakDr. Chong Wei Peng Pusat Perubatan Universiti MalayaDr. Faisal Bin Ismail Hospital SerdangDr. Ernest Ng Hospital SerdangProf Dr. Sim Kui Hian Hospital Umum SarawakDr. Ong Tiong Kiam Hospital Umum Sarawak

12. Respiratory Medicine Facilities And DevicesDato’ Dr. Abdul Razak Abdul Mutalif Hospital Pulau PinangAssoc. Prof. Dr. Roslina Abdul Manap Pusat Perubatan Universiti Kebangsaan MalaysiaDr. Tengku Saifudin Tengku Ismail Hospital SelayangDr. Noor Aliza Md Tarekh Hospital Sultanah AminahDr. George Kutty Simon Hospital Sultanah BahiyahDr. Ashari Yunus Institut Perubatan RespiratoriDr. Jamalul Azizi Abdul Rahman Hospital Queen ElizabethDr. Norhaya Mohd Razali Hospital Sultanah Nur Zahirah Assoc. Prof. Dr. Pang Yong Kek Pusat Perubatan Universiti Malaya Assoc. Prof. Dr. How Soon Hin Universiti Islam Antarabangsa Malaysia /

Hospital Tengku Ampuan Afzan Professor Dr. Liam Chong-Kin Pusat Perubatan Universiti MalayaDr. Mat Zuki Bin Mat Jaeb Hospital Raja Perempuan Zainab IIDr. Zalwani Bt Zainuddin Hospital Tuanku FauziahBgd Gen Dr. Mohd Ello Mohd Sued Hospital Angkatan Tentera Lumut

13. Gastroenterology Facilities And DevicesDr. Hj. Rosemi Salleh (Chairperson) Hospital Raja Perempuan Zainab IIDato’ Dr. Muhammad Radzi Abu Hassan Hospital Sultanah BahiyahDr. Hjh Rosaida Hj Md Saudi Hospital Kuala LumpurDr. Sheikh Anwar Abdullah Pusat Perubatan Universiti Kebangsaan Malaysia

14. Nephrology Facility And DevicesProf. Dato’ Dr. Zaki Morad (Chairperson) Ampang Puteri Specialist Hospital Dr. Ong Loke Meng Hospital Pulau PinangDato’ Dr. Rozina Ghazalli Hospital Pulau PinangDr. Hooi Lai Seong Hospital Sultanah AminahDr. Goh Bak Leong Hospital SerdangDr. Lim Yan Ngo Hospital Kuala LumpurTn. Hj. Mohd Sulaiman Bin Dalimi Hospital SerdangEn. A. Suhaili Bin Shahri Hospital Kuala LumpurSr Lee Day Guat National Renal Registry

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15. Urology Facilities And DevicesDr. Murali Sundram Abdullah (Chairperson) Hospital Kuala LumpurDr. Clarence Lei Chang Moh Normah Medical Centre

16. Dermatology Facilities And DevicesDr. Rohna Ridzwan (Chairperson) Hospital SelayangPuan Sri Datin Dr. Suraiya Hani Tun Hussein. Hospital Kuala LumpurDr. Asmah Johar Hospital Kuala LumpurDr. Choon Siew Eng Hospital Sultanah Aminah, Johor BahruDr. Najeeb Bin Mohd. Safdar Hospital Tuanku Jaafar

17. Otorhinolaryngology And Audiology Facilities And DevicesProf. Madya Dr. Rahmat Omar (Chairperson) Pusat Perubatan Universiti MalayaDato’ Dr. Abd. Majid Md. Nasir Hospital Kuala LumpurDr. Junainah Sabirin Health Technology Assesment Div., MOHEn. Mahamad Almyzan Awang Pusat Perubatan Universiti Kebangsaan MalaysiaCik Nor Shahrina Mohd Zawawi Pusat Perubatan Universiti Kebangsaan Malaysia

18. Ophthalmology And Optometry Facilities And DevicesDatin Dr. Mariam Ismail (Chairperson) Hospital SelayangDr. Goh Pik Pin Hospital SelayangDato’ Dr. Balaravi Pillai Hospital IpohDato’ Dr. Vasantha Kumar S. Thangasamy Hospital Tengku Ampuan RahimahDr. Hj. Abdul Mutalib Bin Othman Hospital Queen ElizabethDr. Jamalia Rahmat Hospital Kuala Lumpur

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NMDS PROjECT STAFFProject Leader Dr. Faridah Aryani Md. Yusof

Clinical Research Manager Dr. Ariza Zakaria.

Clinical Research Coordinator -

Research Assistants -

Economist Mr. Adrian Goh

Statistician Dr. Hoo Ling Ping

IT Manager Ms. Celine Tsai Pao Chien

Database Developer/ Administrator Ms Tang Roh YuMr. Patrick Lum See Kai

Network Administrator Mr. Kevin Ng Hong HengMr. Adlan Abd. Rahman

Desktop Publisher & Webmaster Ms. Azizah Alimat

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CONTENTS

FOREWORD . i

PREFACE . iii

ACKNOWLEDGEMENTS . iv

PARTICIPANTS OF THE NATIONAL MEDICAL DEVICE SURVEY . v

AbOUT THE NATIONAL MEDICAL DEVICE SURVEY . vii

NMDS GOVERNANCE bOARD . viii

MEMbERS OF NMDS EXPERT PANELS . ix

NMDS PROjECT STAFF . xiii

CONTENTS . xv

AbbREVIATIONS . xvi

METHODS . xvii

Chapter 1: Imaging And Diagnostic Facilities And Devices . 1

Chapter 2: Nuclear Medicine Facilities And Devices . 5

Chapter 3: Oncology Facilities And Devices . 9

Chapter 4: Anaesthesiology And Intensive Care Facilities And Devices . 11

Chapter 5: General Surgery Facilities And Devices . 15

Chapter 6: Orthopaedic And Traumatology Facilities And Devices . 21

Chapter 7: Physiotherapy And Occupational Therapy Facilities And Devices . 23

Chapter 8: Obstetrics & Gynaecology Facilities And Devices . 27

Chapter 9: Neurology Facilities And Devices . 31

Chapter 10: Psychiatry Facilities And Devices . 35

Chapter 11: Cardiology And Cardiothoracic Surgery Facilities And Devices . 39

Chapter 12: Respiratory Facilities And Devices . 43

Chapter 13: Gastroenterology Facilities And Devices . 47

Chapter 14: Nephrology Facilities And Devices . 53

Chapter 15: Urology Facilities And Devices . 57

Chapter 16: Dermatology Facilities And Devices . 63

Chapter 17: Otorhinolaryngology And Audiology Facilities And Devices . 69

Chapter 18: Ophthalmology And Optometry Facilities And Devices . 73

Chapter 19: Gaps In Medical Technology In Malaysia . 79

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AbbREVIATIONS

AbbI Advanced Breast Biopsy InstrumentationAPC Argon Plasma CoagulationbAER Brainstem Auditory Evoked ResponsebER Beyond Economic RepairbiPAP Bilevel Positive Airway PressureCathlab Cardiac Catheterization LaboratoryCCU Coronary Care UnitCOPD Chronic Obstructive Pulmonary Disease CPAP Continuous Positive Airway PressureCPM Continuous Passive MotionCRC Clinical Research CentreCRRT Continuous Renal Replacement TherapyCT Computed TomographyCTG CardiotocographyCUSA Cavitron Ultrasonic Surgical AspiratorDbE Double Balloon EnteroscopeDG Director General of Health, Ministry of Health,

Malaysia ECG ElectrocardiographyECMO Extra-Corporeal Membrane OxygenatorECT Electroconvulsive TherapyEEG ElectroencephalographyEMG ElectromyographyEOG ElectrooculographyEP Evoked PotentialESWL Extracorporeal Shockwave LithotripterEUS Endoscopic UltrasoundFESS Functional Endoscopic Sinus SurgeryGb Governance BoardHAL Haemorrhoid Artery LigationHD HaemodialysisHDU Haemodialysis UnitHFOV High Frequency Oscillatory VentilatorHKL Kuala Lumpur HospitalHDR High Dose-RateIAbP Intra-Aortic Balloon PumpICU Intensive Care UnitIMRT Intensity Modulated RadiotherapyIVUS Intra Vascular UltrasoundKKM Kementerian Kesihatan MalaysiaLINAC Linear AcceleratorLDR Low Dose-Rate LVAD Left Ventricular Assist DeviceMDb Medical Device BureauMMHD Malaysian Medical Health DirectoryMOH Ministry of HealthMRI Magnetic Resonance ImagingNC Not Classified (cannot be classified between

public and private sectors)

NCV Nerve Conduction VelocityNCS Nerve Conduction StudyND No DataNd:YAG Neodymium-Doped Yttrium Aluminium GarnetNMDS National Medical Device SurveyOAE Otoacoustic EmissionORL OtorhinolaryngologyPCA Patient Controlled AnalgesiaPD Peritoneal DialysisPET Positron Emission TomographyPICU Paediatric Intensive Care UnitPSG PolysomnographyPUVA Psoralen combined with exposure to ultraviolet

light A (UVA)SDP Source Data ProvidersSSEP SomatoSensory Evoked PotentialSWD Short Wave DiathermyTCD Transcranial DopplerTEE Trans-Oesophageal EchocardiographyTENS Transcutaneous Electrical Nerve StimulationUVA Ultraviolet light AUVb Ultraviolet light BVACS Vacuum Assisted Closure SystemVEP Visual Evoked PotentialVT Video-TelemetryWHO World Health Organization

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METHODSIntroductionThe NMDS is designed, broadly speaking, to estimate the quantity and pattern of use of medical devices in Malaysia, as well as to estimate our expenditure on devices. This is an ambitious project, which requires multiple surveys targeting the various levels of the medical device supply chain and utilization in healthcare facilities in the country in order to capture all the required data to meet its purpose. For this first effort, we had therefore realistically targeted data sources that are absolutely critical and accessible.

Hence, the statistics on the availability of medical device in this report are estimated based on data from only a limited number of surveys. In particular, the scope of the survey was limited to:

• Hospitals only, though for certain therapy areas (Nephrology, Cardiology), we were able to supplement the data from more specialized surveys conducted by the National Renal Registry (NRR) and National Cardiovascular Disease Database (NCVD)

• Asset device only. Data on disposable devices will have to await future survey.

Survey Population, Sampling And Response (Coverage) Rate

The survey conducted by NMDS and supplemented by those by NRR and NCVD, its survey population, its sampling unit and sample size, and the survey response or coverage rates are summarized in the table below.

# Site Classification Survey population MaximumResponse Rate (%)

Minimum Response Rate (%)

1. Public sector 137 71 43

2 Private sector 79 55 37

* Note: 1. Public sector consists of 132 MOH, 3 University and 2 Armed Forces hospitals.2. Response rates vary between specialties.

The survey conducted by NMDS and supplemental surveys by NRR and NCVD were entirely by primary data collection. For MOH data, available database on device asset was also used to cross-check the data.

Data Management

The collected data, whether in databases, on paper or electronic data collection form, is compiled into a single database, appropriately processed and coded prior to statistical analysis.

The database server is running on a Windows 2000 Server. The server environment is Intel Xeon 2.4 Mhz, with a total of 2GB RAM memory and 67.8GP Raid5 Hard disk. The NMDS database was created in Ms SQL Server 2000. The application has 3 modules: Contact Management, Data Entry and Data Processing.

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The data processing steps for this initial version of NMDS data are presented as follows, in 2 phases:

Phase 1 Survey/Database Development and Data Collection

1. On the basis of the NMDS project’s Terms of Reference (ToR), some initial discussions were held within CRC, supplemented with research on literature to develop the first drafts of NMDS survey forms.

2. Various existing databases were obtained and studied to extract learnings for application on the NMDS. Where relevant, these learnings were used to enhance/edit the structure and content of survey forms.

3. On the basis of the said information in 1 & 2, the first draft of the survey forms were produced and presented for challenge of adequacy in the required data fields/ variables for each specialty.

4. Draft survey forms were shared with internal and external referees and the feedback was collated for the finalization of the survey forms.

In most cases, the project team had to consult with the experts in various disciplines to get a better understanding of the variables of significance.

5. The survey forms were then finalized for approval, with the final versions being made up of 28 medical specialties and 5 supportive specialties.

The variables required were divided into 3 sections: Section 1: Establishment Details.Section 2: Diagnostic and Therapeutic Facility.Section 3: Associated Equipment of Interest.

6. Approval of the NMDS survey was granted by the Chairperson of the NMDS, allowing the team to proceed with actualizing the survey activities.

7. The approved survey forms were shared with the IT department for them to use as the basis for creating the NMDS Database. The intention was for the Database to be ready for populating by the time the completed survey forms had been returned by the SDPs.

8. Upon approval, survey forms were sent out to the Directors of relevant identified SDPs to seek voluntary participation into the survey. SDPs were identified from the Malaysian Medical Health Directory (MMHD) and counter-checked by staff making the calls.

9. The project team was dependent on the SDP sites to ensure the survey forms were appropriately distributed within their institutions. The project team then followed up with each individual specialty. The follow up was dependent on the availability of the specialty at the site with the MMHD used as reference. Where there are uncertainties, the NMDS project team contacts the SDP directly to ascertain the availability of specialties.

A “service provider” of a particular specialty was defined as any participating site that provides specialists services respective to the discipline and includes sites that only provide visiting specialist services. It does not require a resident specialist to be available at the site.

10. SDPs are meant to respond within a set deadline. Feedback is received either by fax or post prior to Data processing. The NMDS project team also takes the initiative to pursue timely feedback from the respondents.

xix

Data Processing of Survey Data

1. Survey data was entered into the NMDS Database that had been created by the IT department based on the finalized survey forms (refer to Phase 1: 7 above). Drop down options similar to that in the survey form of each specialty was part of the database design to minimize data entry errors.Prior to data entry, personnel were fully briefed on how to use the database and enter the data via a training event which included a demonstration.

Personnel were supervised whilst doing the first few entries to make sure sufficient competency had been developed to minimize if not eliminate errors.

A standard document on steps and precautions on Data entry was mailed to each personnel. Those who were unable to decipher the feedback were advised to enquire from senior staff.

Each entry is recorded for quality assurance purposes.

2. Visual review and manual assessment of entries are performed to capture erroneous, inconsistent or inaccurate entries in the survey forms. These typically occur when information is entered under the “Others” or “Shared Equipment” section. Follow-up with the SDP is performed where required.

Where data was provided using brand names, online searches or follow-up with the SDP was conducted to guide any required editing of the survey form data.

3. The populated Database then underwent Edit Checks, with the database entries being meticulously crosschecked against the original survey forms.

4. It was then decided to exclude further data processing of a subset of devices reported by the SDPs due to limitations in resources. The criteria for selection of devices to be reported per specialty were outlined by priority for treatment and quality of survey data available. Selection was done by the NMDS project team with support from the Chairperson.

Only data on functioning medical devices were processed and reported. Functioning medical devices were defined as medical equipment that were used in daily procedures at the participating site and excludes:

• equipment deemed as in Beyond Economic Repair as well as • equipment which, although were still in working condition, were non-operational (not used)

at the site.

5. Data is then exported to Datamed Bio-Statistics for further data processing.

This included a specific focus on estimation of missing data from poorly populated survey forms or non-responsiveness.

Datamed personnel were tasked with grouping and collating the NMDS data into forms and reports that would allow further study by the project team. These forms and reports were used by the team to assess the quality of the NMDS data internally as well as with assistance from the expert panel.

xx

Statistical Methods

In this report, the quantity of the availability of a device is expressed as in absolute count as well as in number per million inhabitants. The latter statistics are calculated as follows:

Where T is an estimate of the total quantity of the device available in the country in the year under considerationP is the mid-year population of Malaysia or the relevant geographic region where the survey was conducted

T the total is estimated from the sample of relevant health care facilities as follows:

The total is estimated by T = Σ Wi Ti

Where;Ti is the value of the quantity of device available in the ith facility in the year

Wi is the sampling weight of the ith facility

Wi = (B/b) * (bi/ Ь)

Where B is total number of beds in the population, b is number of beds of the responding hospitals (sample), bi is number of beds in the ith facility, and Ь the mean number of beds in the population.The sampling weight for each sampling unit or unit of analysis therefore has the following components:

1. Probability of selection. The basic weight is obtained by multiplying the reciprocals of the probability of selection at each step of sampling design.

2. Adjustment for non-response.The response rate was less than 100% for hospital surveys; an adjustment to the sampling weight is required. The non-response adjustment weight is a ratio with the number of units in the population as the numerator and the number of responding sampling units as the denominator. The adjustment reduces the bias in an estimate to the extent that non-responding units have same characteristics as responding units. Where this is unlikely, some adjustments took into account differences in some relevant characteristics between responding and non-responding units that may influence drug utilization, such as bed strength, staff strength, scope of services for hospitals etc.

Finally, adjustments are also made to the statistical estimates to approximate known values from existing device asset database and from key informants, where these are available.

TNumber of device/million population = P

TNumber of device/million population = P

1

CHAPTER 1IMAGING AND DIAGNOSTIC FACILITIES AND DEVICES

Edited by :Dr. Subramani a/l Venugopal1

With contributions from :Dr. Che Zubaidah Che Daud2, Dr. Harikrishna a/l Sivaganabalan3, Dr. Hjh. Salwah Hashim4, Dr. Nik Fatimah Salwati5, Dr. Zaharah Musa6

1 Hospital Tuanku Ja’afar, 2 Hospital Kuala Lumpur, 3 Hospital Tengku Ampuan Rahimah, 4 Hospital Pulau Pinang, 5 Hospital Sultanah Bahiyah, 6 Hospital Selayang

REPORTThe National Medical Devices Survey (NMDS), a service initiated and supported by the Ministry of Health, and coordinated by the CRC, gives complete information on the availability of devices and services in all states in Malaysia. This information is crucial for future planning and financing of equipment and manpower.

The current survey can be considered a good starting point, but some minor changes will be made for future data collection, in order to better reflect the Imaging and Diagnostic facilities, equipment and services that are available. Accurate compilation of data in this NMDS survey will greatly facilitate the planners to buy the right thing for the right place at the right time.

With capital expenditure for Imaging and Diagnostic being very high, coupled with rapid advances in technology, it is imperative that we have accurate records of the devices available, so that they can be optimally utilized, with minimal or no duplication of services, for a given population.

Almost all larger hospitals (both public and private) in the country are now fairly well equipped with general radiography, fluoroscopy, ultrasound, mammography, computed tomography (CT) and magnetic resonance scanners. Angiography services are available in most tertiary centers. Basic and vascular interventional radiology is fast developing into a necessity. Smaller or primary hospitals and health facilities are also fairly well equipped with radiological services commensurate with the clinical services provided.

However, the rapid explosion of technology has thrown so many new machines and techniques, which need careful evaluation, before being adopted in Malaysia.

This report is done with the data provided by the contributors from all states. Some of the states cannot obtain accurate data from all hospitals, especially in the private hospitals.

2

Table 1: Available Therapeutic and Diagnostic Facilities in Imaging and Diagnostic MedicinePopulation Radiology Centre

No in million No % pmpMalaysia 26.64 108 100 4

SectorPublic - 66 61Private - 42 39

StateJohor 3.17 9 8 3Kedah & Perlis 2.11 7 6 3Kelantan 1.53 7 6 5Melaka 0.73 5 5 7Negeri Sembilan 0.96 2 2 2Pahang 1.45 7 6 5Perak 2.28 11 10 5Terengganu 1.04 3 3 3Pulau Pinang 1.49 11 10 7Sabah 3 13 12 4Sarawak 2.36 12 11 5Selangor & W.P. Kuala Lumpur 6.43 21 19 3

Table 2: Available Medical Devices in Imaging and Diagnostic Medicine

PopulationComputed

Tomography (CT) Scanner

Magnetic Resonance

Imaging (MRI) Unit

Angiographic Unit

Mobile C-Arm Unit

No in million No % pmp No % pmp No % pmp No % pmp

Malaysia 26.64 100 100 4 63 100 2 42 100 2 250 100 9

SectorPublic - 51 51 31 49 17 40 152 61Private - 49 49 32 51 25 60 98 39

StateJohor 3.17 7 7 2 5 8 2 3 7 1 16 6 5Kedah & Perlis 2.11 7 7 3 6 9 3 3 7 1 18 8 9

Kelantan 1.53 3 3 2 2 3 1 2 5 1 11 4 7Melaka 0.73 5 5 7 4 6 5 3 7 4 9 4 12Negeri Sembilan 0.96 3 3 3 2 3 2 2 5 2 8 3 8

Pahang 1.45 4 4 3 2 3 1 1 2 1 11 4 8Perak 2.28 6 6 3 4 6 2 2 5 1 22 9 10Terengganu 1.04 1 1 1 1 2 1 0 0 0 8 3 8

Pulau Pinang 1.49 14 14 9 8 13 5 7 16 5 28 12 19

Sabah 3 7 7 2 3 5 1 2 5 1 11 4 4Sarawak 2.36 11 11 5 5 8 2 3 7 1 21 8 9

Selangor & W.P Kuala Lumpur 6.43 32 32 5 21 33 3 14 33 2 87 35 14

3

Population Total Mammography

Conventional Mammography

Digital Mammography

Mammography with Stereotactic biopsy System


Malaysia 26.64 95 100 4 37 100 1 9 100 0 37 100 1


StateJohor 3.17 9 9 3 3 8 1 0 0 0 5 13 2

Kedah & Perlis 2.11 7 7 3 1 3 0 1 11 0 4 11 2

Kelantan 1.53 2 2 1 1 3 1 0 0 0 1 3 1Melaka 0.73 4 4 5 4 11 5 0 0 0 0 0 0

Negeri Sembilan 0.96 4 4 4 2 5 2 0 0 0 1 3 1


Pulau Pinang 1.49 12 13 8 5 14 3 1 11 1 5 13 3

Sabah 3 6 6 2 2 5 1 1 11 0 3 8 1Sarawak 2.36 8 8 3 5 14 2 1 11 0 2 5 1


Population Ultrasound with Doppler

No in million No % pmp

Malaysia 26.64 387 100 15


StateJohor 3.17 31 8 10Kedah & Perlis 2.11 31 8 15Kelantan 1.53 21 5 14Melaka 0.73 12 3 16Negeri Sembilan 0.96 11 3 11Pahang 1.45 13 4 9Perak 2.28 25 6 11Terengganu 1.04 6 2 6Pulau Pinang 1.49 37 10 25Sabah 3 31 8 10Sarawak 2.36 29 7 12Selangor & W.P Kuala Lumpur 6.43 140 36 22

*Note: 1. Counts for “Ultrasound with Doppler” units mentioned above exclude Echocardiocardiography units, which are mentioned under Chapter 11: Cardiology and Cardiothoracic Surgery Facilities and Devices.

5

CHAPTER 2 NUCLEAR MEDICINE FACILITIES AND DEVICES

EXPERT PANEL MEMbERSChairperson: Dato’ Dr. Mohamed Ali Abdul Khader1

Members : Dr. Lee Boon Nang2, Dr. Ng Chen Siew 3, Dr. Felix Sundram4, Assoc. Prof Sazilah A. Sarji 5

1 Hospital Pulau Pinang, 2 Hospital Kuala Lumpur, 3 Hospital Sultanah Aminah, 4 Subang Jaya Medical Centre, 5 University Malaya Medical Centre

INTRODUCTIONSince the early 1960’s, when nuclear medicine services first started in Malaysia, its scope has expanded from just providing diagnostic services to the present therapeutic and also interventional nuclear medicine. With the introduction of Positron Emission Tomography (PET), the setting up of cyclotron facility and the use of targeted delivery agents for imaging and therapy, the possibility of achieving earlier, more accurate and more specific diagnosis, it promises significant improvements in clinical outcomes. This increasing insight into the molecular origins of disease, the visualization of pathological changes at the cellular and biochemical level, before their anatomical changes occur shall without doubt reshape the whole pattern of healthcare.

Worldwide, the field of nuclear medicine has developed tremendously and has become an established medical specialty and has expanded to various fields of subspecialisations and also integration with other medical specialties to provide more comprehensive patient management.

Nuclear Medicine involves the use of radioactive isotopes (radioisotopes) to prevent, diagnose, and treat disease.

Scope of Nuclear MedicineNuclear Medicine Service has 3 major sections: a) Clinical Nuclear Medicine

b) Nuclear Pharmacy

c) Nuclear Medicine Physics

a) Clinical Nuclear Medicine

The Clinical Nuclear Medicine section is the mainstay of the department providing the diagnostic and therapeutic aspect of nuclear medicine. This section incorporates the nuclear medicine physicians, medical officers, nurses and the technologists.

b) Section of Nuclear Pharmacy

The nuclear pharmacy section is managed by a pharmacist trained in nuclear medicine and handles the quality control, and the preparation of radiopharmaceuticals for nuclear medicine procedure.

c) Nuclear Medicine Physics Section

The Nuclear Medicine Physics section is managed by the nuclear medicine physicist who is also a key member of the nuclear medicine team. The responsibilities revolve around the safety issues in relation to patients, staff and the public, quality assurance relating to both the performance of key equipment as well as procedural factors contributing to the quality of service.

6

REPORTThe nuclear medicine service in the Ministry of Health is to be setup as nuclear medicine department on a regional basis. These centres will play a bigger role as training centres and also develop a chosen subspecialty area to focus on at a tertiary level later on.

In Malaysia, the nuclear medicine services began its operation as a unit in the department of Radiotherapy in Kuala Lumpur Hospital and between in the next 30 years only 3 additional centres began its operation all within the Klang valley. It is only in the 1990’s that more centres were setup due to the advancement of nuclear medicine technologies both in the hardware and computerization. In the year 2007 there are a total of 12 nuclear medicine centers providing various degrees of services ranging from purely diagnostic to therapy and the more recent sophisticated Positron Emission Tomography.

However the provision of nuclear medicine services are provided by nuclear medicine setup under various jurisdictions like in the department of Radiology, Department of Internal Medicine, Department of Oncology and in one center under the department of Biomedical Imaging. Until 2005 there was no independent nuclear medicine department in the Ministry of Health.

To facilitate planned expansion, a National Nuclear Medicine Meeting was held on 2nd to 5th May 2002 in Johor Bahru, officiated by the Director General of Health, Malaysia. During this meeting, the major stakeholders involving nuclear medicine attended where various issues, problems, weaknesses were identified and extensively discussed. Recommendations and target for achievement were prioritized.All regional nuclear medicine centres would be equipped in phases with:

• Hot lab providing dispensing of radioisotopes • Diagnostic nuclear medicine services• Therapeutic nuclear medicine services• Therapeutic nuclear medicine wards

• Positron Emission Tomography (PET) servicesThe nuclear medicine facilities and devices data collated are as below :

Table 1: Available Therapeutic and Diagnostic Facilities in Nuclear Medicine

Population Hospital with Radionuclide Isolation Ward Nuclear Medicine Centre

No in million No % pmp No % pmp

Malaysia 26.64 5 100 0 12 100 0

SectorPublic - 3 60 8 66Private - 2 40 4 34

StateJohor 3.17 0 0 0 1 8 0Kedah & Perlis 2.11 0 0 0 0 0 0Kelantan 1.53 1 20 1 1 8 1Melaka 0.73 0 0 0 0 0 0Negeri Sembilan 0.96 1 20 1 0 0 0Pahang 1.45 0 0 0 0 0 0Perak 2.28 0 0 0 0 0 0Terengganu 1.04 0 0 0 0 0 0Pulau Pinang 1.49 0 0 0 1 8 1Sabah 3 0 0 0 0 0 0Sarawak 2.36 0 0 0 1 8 0Selangor & W.P. Kuala Lumpur 6.43 3 60 0 8 67 1

7

Table 2: Available Medical Devices in Nuclear Medicine

Population Total Gamma Camera Units

Single head Gamma Camera

2-head Gamma Camera

3-head Gamma Camera

No in million No % pmp No % pmp No % pmp No % pmpMalaysia 26.64 12 100 0 2 100 0 9 100 0 1 100 0


StateJohor 3.17 1 8 0 0 0 0 1 11 0 0 0 0

Kedah & Perlis 2.11 0 0 0 0 0 0 0 0 0 0 0 0

Kelantan 1.53 2 17 1 1 50 1 1 11 1 0 0 0Melaka 0.73 0 0 0 0 0 0 0 0 0 0 0 0N. Sembilan 0.96 0 0 0 0 0 0 0 0 0 0 0 0Pahang 1.45 0 0 0 0 0 0 0 0 0 0 0 0Perak 2.28 0 0 0 0 0 0 0 0 0 0 0 0Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0

Pulau Pinang 1.49 3 25 2 1 50 1 2 22 1 0 0 0

Sabah 3 0 0 0 0 0 0 0 0 0 0 0 0Sarawak 2.36 2 17 1 0 0 0 2 22 1 0 0 0


References :1. Nuclear Medicine in the 21st Century: Contributing To Better Health Care, MOH DG Technical Report2. 2006 Annual Report, Ministry of Health, Malaysia 3. Malaysian Statistics on Medicine, 2005

9

CHAPTER 3 ONCOLOGY FACILITIES AND DEVICES

Edited by:Ass. Prof. Dr. Fuad Ismail1

With contributions from:Dr. Ahmad Kamal Mohamed2, Dr. Mohd Roslan B. Haron3, Dr. Vincent Phua4, En. Mohd Farihan Jaffar4, Puan Rubiah Pakah4, Pn. Mahzom Pawanchek4

1 Pusat Perubatan Universiti Kebangsaan Malaysia, 2 Pusat Perubatan Subang Jaya, 3 Hospital Sultan Ismail,4 Hospital Kuala Lumpur.

REPORTRadiotherapy is one of the cornerstones of cancer therapy, both for cure and palliation. Radiotherapy services are equipment based with 2 distinct modalities, teletherapy and brachytherapy.

Teletherapy is currently based on Linear Accelerators (LINAC) with older cobalt units available in a few hospitals. There are 5 cobalt units in the country. These are technically still working but are not used as they are being phased out to be replaced by linacs. The only working unit is in a private centre in Selangor.

Linacs form the backbone of radiotherapy with the capability to deliver 2-D & 3-D treatment as standard. There are a total of 30 linacs in Malaysia with a ratio of 1.17 per million population (pmp). This is far lower than the recommended ratio in UK of 4 PMP. Apart from the lack of equipment, there is also a great imbalance in the distribution of linacs in Malaysia with almost half concentrated in the Klang Valley (Selangor & Wilayah Persekutuan). Large states such as Kedah, Perak, Pahang and Terengganu still lack radiotherapy centres hence have no available equipment. As radiotherapy is given over several weeks, the lack of facilities results in patients having to move to another state for a protracted period of time for treatment. The other states have between 1-4 linacs each.

Improvements in technology have resulted in improved treatment delivery by improved radiation dosimetry. Five (5) radiotherapy centres are able to offer more sophisticated radiotherapy using Intensity Modulated Radiotherapy (IMRT). Other specialized equipment includes one (1) cyberknife device and linac based stereotactic devices (4), all in Klang Valley except one.

Brachytherapy is an important modality in radiotherapy especially in gynaecological malignancies. Both High Dose-Rate (HDR) and Low Dose-Rate (LDR) are equally effective. The overall capacity in the country is adequate for gynaecological treatment but due to unequal distribution, there is no services in some states namely Kedah, Pahang & Terengganu. Klang Valley has overcapacity with about half the available brachytherapy devices.

Radiotherapy may be given for palliation or for cure. Treatment time may be between 1 – 7 weeks. The current recommendation states that 50% of patient with cancer require radiotherapy treatment at some point. The incidence rate of cancer in Australia is over 4000 PMP compared to 1400 PMP in Malaysia. The required number of machines in Australia is estimated to be 6.5 per million population. Given that our incidence is about 3 times lower, the number of linacs required in our country should be about 60 machines in total. Equitable distribution of equipment is equally important.

10

Table 1: Available Therapeutic and Diagnostic Facilities in Oncology

No Data to Date

Table 2: Available Medical Devices in Oncology

Population Linear Accelerator High dose brachytherapy

Low dose brachytherapy IMRT


Malaysia 26.64 28 100 1 8 100 0 10 100 0 7 100 0



Kelantan 1.53 2 7 1 1 13 1 0 0 0 1 14 1Melaka 0.73 2 7 3 0 0 0 2 20 3 0 0 0Negeri Sembilan 0.96 2 7 2 0 0 0 1 10 1 1 14 1

Pahang 1.45 0 0 0 0 0 0 0 0 0 0 0 0Perak 2.28 0 0 0 0 0 0 1 10 0 0 0 0Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0Pulau Pinang 1.49 4 14 3 1 13 1 0 0 0 1 14 1Sabah 3 1 4 0 0 0 0 1 10 0 0 0 0Sarawak 2.36 3 11 1 1 13 0 0 0 0 1 14 0Selangor & W.P Kuala Lumpur

6.43 11 39 2 4 50 1 4 40 1 2 29 0

Population Co 60* Equipment on phase out CyberKnife


Malaysia 26.64 1 100 0 1 100 0

Sector

Public - 0 0 0 0

Private - 1 100 1 100

State

Johor 3.17 0 0 0 0 0 0

Kedah & Perlis 2.11 0 0 0 0 0 0

Kelantan 1.53 0 0 0 0 0 0

Melaka 0.73 0 0 0 0 0 0

Negeri Sembilan 0.96 0 0 0 0 0 0

Pahang 1.45 0 0 0 0 0 0

Perak 2.28 0 0 0 0 0 0

Terengganu 1.04 0 0 0 0 0 0

Pulau Pinang 1.49 0 0 0 0 0 0

Sabah 3 0 0 0 0 0 0

Sarawak 2.36 0 0 0 0 0 0

Selangor & W.P Kuala Lumpur 6.43 1 100 0 1 100 0

11

CHAPTER 4ANAESTHESIOLOGY AND INTENSIVE CARE FACILITIES AND DEVICES

Edited by:Dato’ Dr. Jahizah Hassan1, Professor Marzida Mansor2, Associate Professor Choy Yin Choy3, Dr. Mary Suma Cardosa4, Dr. Irene Cheah5, Dr. Neoh Siew Hong6, Dato’ Dr. KH Teh 7.

1 Hospital Pulau Pinang, 2 Pusat Perubatan Universiti Malaya, 3 Pusat Perubatan Universiti Kebangsaan Malaysia, 4 Hospital Selayang, 5 Hospital Kuala Lumpur, 6 Hospital Ipoh, 7 Hospital Sultanah Bahiyah.

INTRODUCTIONThe data on medical devices for Anaesthesiology and Intensive Care was collected over duration of one-year using survey forms that were sent to both public and private hospitals in Malaysia. The availability of the therapeutic and diagnostic facilities in anaesthesia was based on the number of Intensive Care Units (ICU), High Dependency Units, Anaesthetic Clinics and Acute Pain Services in Malaysia.

Table 1: Available Therapeutic and Diagnostic Facilities in Anaesthesiology

Population Adult Intensive Care Unit (ICU)

Paediatric Intensive Care Unit (PICU)

Adults burns Intensive Care

Unit

Paediatric burns Intensive Care

Unit


Malaysia 26.64 103 100 4 32 100 1 12 100 0 3 100 0

Sector

Public - 65 55 12 38 10 83 2 67

Private - 38 45 20 62 2 17 1 33

State

Johor 3.17 13 13 4 3 10 1 0 0 0 0 0 0

Kedah & Perlis 2.11 9 9 4 1 3 0 2 17 1 1 33 0

Kelantan 1.53 4 4 3 3 9 2 1 8 1 0 0 0

Melaka 0.73 5 5 7 1 3 1 1 8 1 0 0 0

N. Sembilan 0.96 5 5 5 1 3 1 0 0 0 0 0 0

Pahang 1.45 4 4 3 1 3 1 1 8 1 0 0 0

Perak 2.28 10 10 4 3 9 1 0 0 0 0 0 0

Terengganu 1.04 2 2 2 1 3 0 0 0 0 0 0 0

Pulau Pinang 1.49 13 13 9 4 12 3 0 0 0 1 33 1

Sabah 3 5 5 2 3 9 1 0 0 0 0 0 0

Sarawak 2.36 7 7 3 2 6 1 1 8 0 0 0 0


12

Population High Dependency Unit Anaesthetic Clinic Acute Pain Service

No in million No % pmp No % pmp No % pmp

Malaysia 26.64 55 100 2 30 100 1 38 100 1

SectorPublic - 21 38 15 50 38 100Private - 34 62 15 50 0 0

StateJohor 3.17 8 15 3 4 13 1 5 13 2Kedah & Perlis 2.11 4 7 2 2 7 1 4 11 2Kelantan 1.53 2 4 1 1 3 1 2 5 1Melaka 0.73 3 5 4 2 7 3 2 5 3Negeri Sembilan 0.96 3 5 3 1 3 1 2 5 2Pahang 1.45 3 5 2 2 7 1 2 5 1Perak 2.28 5 9 2 2 7 1 3 8 1Terengganu 1.04 2 4 2 0 0 0 1 3 1Pulau Pinang 1.49 4 7 3 5 17 3 2 5 1Sabah 3 2 4 1 3 10 1 1 3 0Sarawak 2.36 6 11 3 3 10 1 4 11 2Selangor & W.P. Kuala Lumpur 6.43 13 24 2 5 17 1 10 26 2

The data showed that Malaysia has 4 adult, 1 paediatric and 0 adult and paediatric burns ICU per million population (pmp) as shown in Table 1. The distribution of the adult intensive care is almost equal between the private and public hospitals; however there are more paediatric intensive care units available in the private sector. In the case of adult and paediatric ICUs, majorities are in the public sectors. With regards to distribution of ICU throughout Malaysia it is not surprising to find that majority of the intensive care services are located in places where there are major public or private hospitals. The availability of adult ICU for instance varies from 26% in Selangor and W.P Kuala Lumpur to 2% in Terengganu. This is probably due to maldistribution of human resources and availability of private hospitals, which is probably influenced by population’s income, geographical demarcation and urbanization. The paediatric ICU availability follows the similar trend as the adult ICU and in fact, their services are even more deficient as compared to adult ICU. We have 1 paediatric ICU pmp. Their availability ranges from as low as 0% in Terengganu to 20% in Selangor& WP Kuala Lumpur. Adult and paediatric burns ICU are the most deficient of all the intensive care facilities. More of these services should be made available in the near future.

High dependency unit is available in most of the states as a step down unit. It is encouraging to note that the anaesthetic clinic services have taken off in Malaysia, both in the public and private sectors. This reflects that a proportion of patients schedule for elective surgery were seen prior to surgery for optimization. This anaesthetic clinic services will certainly reduce cancellation rate of elective surgery and improves patient care and safety. In terms of medical devices, there are not many devices are needed in the anaesthetic clinic. Perhaps in future when more anaesthetists are trained to do specific echocardiography to assess the cardiovascular status of patients preoperatively, then, this statistic on anaesthetic clinic may be more relevant.

The data showed that Acute Pain Services are well establish in most major public hospitals but not available in private hospitals. We are fully aware that such services are available in majority of the private hospitals using similar devices. The data is not being captured probably due to the fact that acute pain services are being provided by individual practitioner / anaesthetist rather than by the acute pain team.

13

Table 2: Available Medical Devices in Anaesthesiology

Population Anaesthesia Ventilator

Adult Portable Ventilator

Intensive Care Ventilator

High Frequency Adult Intensive Care Ventilator


Malaysia 26.64 655 100 25 236 100 9 793 100 30 26 100 1

SectorPublic - 451 69 184 78 555 70 21 81Private - 204 31 w 52 22 238 30 5 19


Kelantan 1.53 19 3 12 15 6 10 50 6 33 0 0 0Melaka 0.73 21 3 29 12 5 16 41 5 56 0 0 0N. Sembilan 0.96 11 2 11 4 2 4 14 2 15 0 0 0Pahang 1.45 18 3 12 10 4 7 32 4 22 1 4 1Perak 2.28 49 7 21 18 8 8 46 6 20 0 0 0Terengganu 1.04 21 3 20 4 2 4 25 3 24 0 0 0P. Pinang 1.49 79 12 53 31 13 21 134 17 90 0 0 0Sabah 3 48 7 16 21 9 7 29 4 10 1 4 0Sarawak 2.36 65 10 28 18 8 8 64 8 27 0 0 0Selangor & W.P Kuala Lumpur 6.43 228 35 35 68 29 11 243 31 38 23 88 4

Population

Neonatal / Paediatric

Intensive Care Ventilator

Paediatric High Frequency Oscillatory Ventilator (HFOV)

Flexible Fiber Optic Intubation

Scope

Patient Controlled

Analgesia (PCA) Infusion Pump


Malaysia 26.64 379 100 14 41 100 2 121 100 5 387 100 15


StateJohor 3.17 36 9 11 5 12 2 8 7 3 15 4 4

Kedah & Perlis 2.11 32 8 15 7 17 3 6 5 3 15 4 7

Kelantan 1.53 20 5 13 6 15 4 7 6 5 16 4 10Melaka 0.73 9 2 12 1 2 1 2 2 3 11 3 15N. Sembilan 0.96 20 5 21 1 2 1 7 6 7 6 2 6Pahang 1.45 18 5 12 1 2 1 4 3 3 24 6 17Perak 2.28 27 7 12 2 5 1 8 7 4 36 9 16Terengganu 1.04 15 4 14 1 2 1 5 4 5 7 2 7P. Pinang 1.49 35 9 23 2 5 1 10 8 7 43 11 29Sabah 3 44 12 15 6 15 2 7 6 2 12 3 4Sarawak 2.36 18 5 8 2 5 1 8 7 3 30 8 13


14

Population Level 1 Infusion Pump With or Without Hotline


Malaysia 26.64 491 100 18


StateJohor 3.17 46 9 15Kedah & Perlis 2.11 42 9 20Kelantan 1.53 29 6 19Melaka 0.73 12 2 16Negeri Sembilan 0.96 22 5 23Pahang 1.45 19 4 13Perak 2.28 77 16 34Terengganu 1.04 35 7 34Pulau Pinang 1.49 41 8 27Sabah 3 23 5 8Sarawak 2.36 7 1 3

Selangor & W.P Kuala Lumpur 6.43 138 28 21

The data in Table 2 concentrate on ventilators, which comprise of anaesthesia ventilator, adult portable ventilator, ICU ventilator, high frequency adult ICU ventilator and paediatric and neonatal high frequency oscillatory. These equipment are the common items available in the facilities in Table 1 but the figures may not be a true reflection of the services rendered to the population as some of these equipment may not being used due to shortage of anaesthetists and nurses. Similarly, the same reasoning applies to the data on anaesthesia ventilators (anaesthetic machines) and flexible fibre optic intubation scopes. In future, it may be more useful to have a statistics on the number of operation theatres in each hospitals surveyed as these two devices are mostly available in the operating theatre (OT) rather than in the intensive care. With regards to the anaesthesia ventilators, we are assuming that these ventilators are the ones that are attached to the anaesthetic machines.

The main data collection on the device used for acute pain service is patient controlled analgesia (PCA) infusion pump. The pumps are widely available in both private and public hospitals in a reasonable numbers, indicating that the services are being provided in both sectors. The last equipment in Table 2 is level 1 infusion pump with or without hotline. The figures combined the generic and specific for rapid infusion. The hotline is widely available in most hospital. However Level 1infusion pumps are not widely available.

This is our first effort in trying to compile our own data on medical devices for our fraternity; therefore the data may not reflect the actual numbers, as many of the private hospitals are not included. The range of equipment covered is also inadequate and more detailed definitions and information should be made available in the future.

15

CHAPTER 5GENERAL SURGERY FACILITIES AND DEVICES

EXPERT PANEL MEMbERSChairperson : Dato’ Dr. Dato’ Dr. Zakaria Bin Zahari 1

Members : Dr. Mohammed Saffari Mohammed Haspani1, Dr. Mohd Mazri Yahya1

1 Hospital Kuala Lumpur

Table 1: Available Therapeutic and Diagnostic Facilities in General Surgery

PopulationDay Case Surgery

Unit High Dependency (Surgical) Unit

Surgical Neonatal Intensive Care Unit (SNICU)

Anorectal Physiology Laboratory


Malaysia 26.64 63 100 2 41 100 2 9 100 0 1 100 0

Sector

Public - 27 43 17 41 7 78 1 100

Private - 36 57 24 59 2 22 0 0

State

Johor 3.17 4 6 1 2 5 1 1 11 0 0 0 0

Kedah & Perlis 2.11 6 10 3 5 12 2 1 11 0 0 0 0

Kelantan 1.53 3 5 2 3 7 2 1 11 1 0 0 0

Melaka 0.73 2 3 3 3 7 4 1 11 1 0 0 0

N. Sembilan 0.96 1 2 1 2 5 2 1 11 1 0 0 0

Pahang 1.45 4 6 3 3 7 2 0 0 0 0 0 0

Perak 2.28 7 11 3 4 10 2 0 0 0 0 0 0

Terengganu 1.04 0 0 0 1 3 1 0 0 0 0 0 0

P. Pinang 1.49 5 8 3 5 12 3 1 11 1 0 0 0

Sabah 3 5 8 2 2 5 1 1 11 0 0 0 0

Sarawak 2.36 7 11 3 3 7 1 0 0 0 0 0 0

Selangor & W.P. Kuala Lumpur 6.43 19 30 3 8 20 1 2 22 0 1 100 0

16

Population Liver Transplant Unit Robotic Surgical Suite


Malaysia 26.64 1 100 0 0 0 0


StateJohor 3.17 0 0 0 0 0 0Kedah & Perlis 2.11 0 0 0 0 0 0Kelantan 1.53 0 0 0 0 0 0Melaka 0.73 0 0 0 0 0 0Negeri Sembilan 0.96 0 0 0 0 0 0Pahang 1.45 0 0 0 0 0 0Perak 2.28 0 0 0 0 0 0Terengganu 1.04 0 0 0 0 0 0Pulau Pinang 1.49 0 0 0 0 0 0Sabah 3 0 0 0 0 0 0Sarawak 2.36 0 0 0 0 0 0

Selangor & W.P. Kuala Lumpur 6.43 1 100 0 0 0 0

Table 2: Available Medical Devices in General Surgery

PopulationAutomated

breast Tissue Core biopsy Gun

Vacuum Assisted breast biopsy

GunAbbI System

Gamma Probe For Sentinel Node And Parathyroid

SurgeryNo in

million No % pmp No % pmp No % pmp No % pmp

Malaysia 26.64 31 100 1 4 100 0 0 0 0 1 100 0


StateJohor 3.17 1 3 0 0 0 0 0 0 0 0 0 0Kedah & Perlis 2.11 3 10 1 1 25 0 0 0 0 0 0 0Kelantan 1.53 4 13 3 0 0 0 0 0 0 0 0 0Melaka 0.73 2 6 3 0 0 0 0 0 0 0 0 0N. Sembilan 0.96 0 0 0 0 0 0 0 0 0 0 0 0Pahang 1.45 2 6 1 1 25 1 0 0 0 0 0 0Perak 2.28 3 10 1 0 0 0 0 0 0 0 0 0Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0Pulau Pinang 1.49 3 10 2 1 25 1 0 0 0 1 100 1Sabah 3 1 3 0 0 0 0 0 0 0 0 0 0Sarawak 2.36 2 6 1 0 0 0 0 0 0 0 0 0Selangor & W.P. Kuala Lumpur 6.43 10 33 2 1 25 0 0 0 0 0 0 0

17

Population

Operating Table With Yellow-Fin

boots And jacknife Positioning Capability

Harmonic Scalpel

Argon Plasma Coagulation

System

Ultrasonic Dissector and

Aspirator (CUSA)


Malaysia 26.64 123 100 5 45 100 2 40 100 2 33 100 1


StateJohor 3.17 18 15 6 2 4 1 2 5 1 2 6 1Kedah & Perlis 2.11 5 4 2 5 11 2 5 12 2 0 0 0Kelantan 1.53 4 3 3 3 7 2 3 8 2 0 0 0Melaka 0.73 6 5 8 1 2 1 0 0 0 6 18 8Negeri Sembilan 0.96 7 6 7 1 2 1 0 0 0 0 0 0Pahang 1.45 3 2 2 2 4 1 6 15 4 4 12 3Perak 2.28 18 15 8 5 11 2 3 8 1 3 9 1Terengganu 1.04 1 1 1 0 0 0 0 0 0 0 0 0Pulau Pinang 1.49 20 16 13 10 22 7 5 12 3 3 9 2Sabah 3 12 10 4 1 2 0 1 3 0 1 3 0Sarawak 2.36 11 9 5 3 7 1 2 5 1 4 12 2Selangor & W.P. Kuala Lumpur 6.43 18 15 3 12 27 2 13 32 2 10 31 2

PopulationTransrectal Ultrasound

Anorectal Manometer

Pudendal Nerve Latency Test Equipment

Haemorrhoid Artery Ligation (HAL) Doppler

Equipment No in

million No % pmp No % pmp No % pmp No % pmp

Malaysia 26.64 4 100 0 0 0 0 1 100 0 3 100 0



18

Population Radiofrequency Ablation Unit

Liver Dialysis Unit (MARS)

Endovenous Laser Unit Craniotome




Population

Paediatric Upper Gastrointestinal Diagnostic And

Therapeutic Endoscope Set

Paediatric Lower

Gastrointestinal Diagnostic And

Therapeutic Endoscope Set

Cystoscopy Set For Urology

And Complex Intersex Surgery

Paediatric Thoracoscopy

And Abdominal Laparoscopy Set For Minimally

Invasive Laparoscopic

SurgeryNo in million No % pmp No % pmp No % pmp No % pmp

Malaysia 26.64 14 100 1 12 100 0 15 100 1 13 100 0



19

PopulationVacuum Assisted Closure System

(VACS)Dermatome Robotic Surgery

System


Malaysia 26.64 22 100 1 51 100 2 2 100 0



21

CHAPTER 6 ORTHOPAEDIC AND TRAUMATOLOGY FACILITIES AND DEVICES

Edited by:Dr. Kamariah Nor MD1., Dr. Mohammad Anuar H.A2., Dr. Ng YO3, Dato’ Dr. Ramanathan R4, Dr. Lee JK 5 and Dr. Mahathar AW.1.

1 Hospital Kuala Lumpur, 2 Hospital Raja Perempuan Zainab II, 3 Hospital Ampang, 4 Hospital Ipoh, 5 Pusat Perubatan Pantai Bangsar.

REPORTExternal fixation is the commonest mode of treatment for open fractures. Generally all hospitals with orthopedic services will have at least one external fixator set. So, generally in Malaysia there are 333 sets of external fixators, which equate roughly to 13 sets per million population. However, in Sabah, there are only 15 sets of external fixators that are generally inadequate for the 3 million population. The distribution of external fixators is balanced between the public and private sector. However in the public sector, the distributions were high in urban areas and Wilayah Persekutuan.

Overall, there is some mal-distribution of external fixators, with higher concentration in Penang (22 PMP) but low concentration in Sabah. As for Ilizarov set, there are higher numbers in Sarawak (5PMP) as compared to other states (1-2 PMP). The panel recommends that each hospital which provides orthopaedic and trauma services should have at least one set of external fixators (each for upper limb, lower limb and mini set).

Currently there are only 116 sets of upper limb external fixators (4 set PMP), which is not enough to deal with the increasing number of upper limb injuries.

The Panel also suggests a more proper definition and clarification of external fixator sets. The specification can be varies from different companies with different capacities. In addition, data on trained personnel available to operate the devices in that particular hospital may be useful. This will indicate whether the devices are being used optimally or if they can be mobilized to other hospitals if trained personnel are not available or have been transferred.

Table 1: Available Therapeutic and Diagnostic Facilities in Orthopedic & Traumatology

No Data To Date

22

Table 2: Available Medical Devices in Orthopedics & Traumatology

Population Total External Fixator Unit

External Fixator Lower Limb Unit

External Fixator Upper Limb Unit

External Fixator Mini Unit


Malaysia 26.64 333 100 13 151 100 6 116 100 4 67 100 3




Population Illizarov Unit


Malaysia 26.64 47 100 2



23

CHAPTER 7PHYSIOTHERAPY AND OCCUPATIONAL THERAPY FACILITIES AND DEVICES

Contributors:Datin Hjh Asiah Bt Hashim1, Cik Katijjah Be Mohd Ali2, Pn. Misnah Roslam3, Pn. Tan Wai Choo4, Pn. Wong Swee Fong5, Pn. Lim Khee Li1, Pn. Hjh. Hamidah Hj. Ariffin6, Pn. Khuzaimah Abd. Aziz1, Pn. Jamaliah Musa1, Pn. Zalila Kashim1

1 Hospital Kuala Lumpur, 2 Pusat Perubatan Universiti Kebangsaan Malaysia, 3 Hospital Serdang, 4 Hospital Sungai Buloh, 5 Hospital Tengku Ampuan Rahimah, 6 Hospital Selayang

REPORTThe data portrayed in this report are data from the NMDS (2007) as well as data collated by the expert panel of this discipline (2008 data). Whilst the data collected in 2007 includes input from the private sector institutions, those of 2008 below are all from the public hospitals and health clinics in Malaysia. Figures from the private sectors, University Hospitals and Arm Forces Hospitals in 2008 were not obtained.

The findings are as follows:-There is an increase of number of device per million population (PMP) from year 2007 to 2008.

MEDICAL DEVICE PMPTranscutaneous Electrical Nerve Stimulation (TENS) From 13 to 14Short wave Diathermy (SWD) From 6-9Pressure Feedback* From 2-3

*Note :The pressure feedback survey done in 2008 refers to a simple device that is commonly used to measure the core muscle work of cervical and lumbar region.

There is decrease of number of device per million population (PMP) from year 2007 to 2008 :

MEDICAL DEVICE PMPUltrasound* From 11-7Laser From 3-2Continuous Passive Motion Exerciser From 2-0

*Note:There is a doubt whether the Neuromuscular Ultrasound Therapy stimulation system is referred to just an ultrasound machine which is commonly used in the physiotherapy department and Klinik Kesihatan in Malaysia.

The number of devices shown is not proportionate to the population of the respective states. It is most likely based on the demand of the cases seen and the services provided by the hospitals. The Klang valley is the most populated but does not have the most number of devices such as SWD, TENS, Ultrasound, laser, pressure feedback and CPM.

Conclusion:The figures obtained for devices compared with the population (PMP) are very far from desirable stage. Even though with addition of devices from the private sectors, it still makes no difference in number of devices in per million population as demonstrated in 2007.

24

Table 1: Available Therapeutic and Diagnostic Facilities in Physiotherapy and Occupational TherapyNo Data To Date

Table 2: Available Medical Devices in Physiotherapy and Occupational Therapy

Population Transcutaneous Electrical Nerve Stimulation (TENS)

Short wave Diathermy(SWD)


Year ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08

Malaysia 26.64 333 - 100 - 13 - 163 - 100 - 6 -

Sector -Public - 268 374 80 - 123 173 75 -Private 65 ND 20 - 40 ND 25 -

StateJohor 3.17 31 22 9 6 10 7 8 13 5 7 3 4Kedah & Perlis 2.11 11 39 3 10 5 18 7 15 4 8 3 7Kelantan 1.53 11 17 3 5 7 11 10 9 6 5 7 6Melaka 0.73 17 8 5 2 23 11 6 3 4 2 8 4N. Sembilan 0.96 8 16 2 5 8 17 6 9 4 5 6 9Pahang 1.45 16 39 5 10 11 27 12 17 7 10 8 12Perak 2.28 17 35 5 9 7 15 14 16 9 10 6 7Terengganu 1.04 12 12 4 3 12 12 11 16 7 10 11 15Pulau Pinang 1.49 35 20 11 5 23 13 14 9 9 5 9 6Sarawak 2.36 31 34 9 9 13 14 18 17 11 10 8 7Sabah 3 18 28 6 8 6 9 9 19 6 11 3 6Selangor & W.P Kuala Lumpur 6.43 126 104 38 28 20 16 48 30 29 17 7 5

25

Population Ultrasound Therapy Continuous Passive Motion Exerciser (CPM)

No in million No % pmp No % pmpYear ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08

Malaysia 26.64 287 - 100 - 11 - 48 - 100 - 2 -


StateJohor 3.17 14 15 5 8 4 5 3 1 6 9 1 0Kedah & Perlis 2.11 10 18 3 9 5 9 0 3 0 27 0 1Kelantan 1.53 7 10 2 5 5 7 0 0 0 0 0 0Melaka 0.73 12 5 4 3 16 7 0 0 0 0 0 0Negeri Sembilan 0.96 5 7 2 4 5 7 1 0 2 0 1 0Pahang 1.45 12 17 4 9 8 12 2 0 4 0 1 0Perak 2.28 10 21 3 11 4 9 9 0 19 0 4 0Terengganu 1.04 4 13 1 7 4 13 0 0 0 0 0 0Pulau Pinang 1.49 22 11 8 6 15 7 6 4 13 2 4 3Sarawak 2.36 17 22 8 11 7 9 2 1 4 9 1 0Sabah 3 16 24 8 123 5 8 2 1 4 9 1 0Selangor & W.P Kuala Lumpur 6.43 158 29 56 15 25 5 23 1 48 9 3 0

Population Laser Therapy Pressure biofeedback System


Year ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08

Malaysia 26.64 74 - 100 - 3 - 44 - 100 - 2 -


StateJohor 3.17 3 2 4 3 1 1 6 1 14 1 2 0

Kedah & Perlis 2.11 2 3 3 5 1 1 1 14 2 17 0 7

Kelantan 1.53 3 4 4 7 2 5 2 7 5 8 1 5Melaka 0.73 2 0 3 3 1 7 2 8 1 10

Negeri Sembilan 0.96 3 3 4 5 3 3 2 4 5 5 2 4


Pulau Pinang 1.49 8 3 11 5 5 2 2 5 5 6 1 3

Sarawak 2.36 3 3 4 5 1 2 7 8 15 10 3 3Sabah 3 3 7 4 12 1 2 6 4 14 5 2 1


27

CHAPTER 8 ObSTETRICS & GYNAECOLOGY FACILITIES AND DEVICES

Edited by :Dr. Murali Ganesalingam1

With contributions from : Dr. Krishnakumar a/l Harikrishnan2, Dr. R.P Japaraj3, Dr. Zaridah Shaffie4

1 Hospital Kuala Lumpur, 2 Hospital Tuanku Ja’afar, 3 Hospital Ipoh, 4 Hospital Tuanku Fauziah

INTRODUCTIONThere are various types of equipment being used within the obstetrics and gynaecology discipline. What would improve our ability to determine the best equipment to purchase would be a pre-survey questionnaire on the equipment and their make and the benefits and disadvantages of a particular brand that is currently in use.

Equipment such as suction pumps are equipment that are currently part of any operating theatre set up and there is no need to purchase such equipment specifically for suction curettage as we used to previously when suction pumps were not part of standard operating theatre equipment. Such items must be identified and deleted from future surveys.

Hospitals are currently built as turnkey projects and come fully equipped. There must be a system to capture the equipment that is in place and a system to ensure that future projects need to secure appropriate approvals before furnishing equipment to hospitals.

We are now using more disposable equipment. Vacuum extractors for delivering babies for example are now available in disposable form. A study should be done on these to assess the quality of the products and their effectiveness in clinical use.

Postal studies do not work, as the response rate and response time are not under the control of the agency carrying out the study. Small groups of investigators should be formed to represent the various disciplines and perhaps work out a method whereby these groups can visit hospitals in a staggered manner and obtain information first hand.

Other equipment that needs to be assessed from obstetrics and gynaecology would be:

1. Equipment for urodynamic studies2. Equipment used in assisted reproduction3. Laparoscopic equipment4. Hysteroscopic equipment5. Colposcopic equipment6. The various stirrups used during gynaecological surgery7. Gynaecological examination couches for office examination

28

Table 1: Available Therapeutic and Diagnostic Facilities in Obstetrics & Gynaecology

Population Labour Suite Gynaecology Oncology Unit

Assisted Reproductive Centre (Fertility Center)

No in million No % pmp No % pmp No % pmpMalaysia 26.64 198 100 5 10 100 0 16 100 1

SectorPublic - NC - 5 50 NC -Private - NC - 5 50 NC -

StateJohor 3.17 32 16 10 1 10 0 3 19 1

Kedah & Perlis 2.11 23 12 11 0 0 0 0 0 0

Kelantan 1.53 12 6 8 0 0 0 0 0 0Melaka 0.73 8 4 11 3 30 4 1 6 1Negeri Sembilan 0.96 15 8 15 1 10 1 0 0 0

Pahang 1.45 8 4 6 0 0 0 0 0 0Perak 2.28 12 6 5 0 0 0 1 6 0Terengganu 1.04 6 3 6 0 0 0 0 0 0

Pulau Pinang 1.49 15 8 10 1 10 1 3 19 2

Sabah 3 20 10 7 1 10 0 2 12 0Sarawak 2.36 20 10 8 0 0 0 1 6 0Selangor & W.P Kuala Lumpur 6.43 27 14 4 3 30 0 5 31 1

Table 2: Available Medical Devices in Obstetrics & Gynaecology

Population

Total Cardiotocograph

(assume each CTG has internal and

external CTG functions)

External Cardiotocograph

Internal Cardiotocograph

Combined Internal and

External CTG

No in million No % pmp No % pmp No % pmp No % pmpMalaysia 26.64 789 100 30 581 100 22 196 100 7 76 - -

SectorPublic - NC - 419 72 166 85 NC -Private - NC - 163 28 30 15 NC -

StateJohor 3.17 100 13 31 38 7 12 7 4 2 ND - -Kedah & Perlis 2.11 44 5 21 43 7 20 16 8 8 6 - 3Kelantan 1.53 38 5 25 29 5 19 21 11 14 5 - 3Melaka 0.73 40 5 55 13 2 18 3 2 4 15 - 21N. Sembilan 0.96 40 5 42 31 5 32 6 3 6 5 - 5Pahang 1.45 25 3 17 20 3 14 8 4 6 7 - 5Perak 2.28 54 7 24 45 8 20 19 10 8 32 - 14Terengganu 1.04 23 3 22 23 4 22 4 2 4 2 - 2P. Pinang 1.49 55 7 37 48 8 32 14 7 9 4 - 3Sabah 3 69 9 23 58 10 19 25 13 8 ND - -Sarawak 2.36 107 14 45 47 8 20 14 7 6 ND - -Selangor & W.P Kuala Lumpur 6.43 194 25 30 187 33 29 59 29 9 ND - -

29

Population Colposcope system

Hysteroscope system

Transabdominal Transducer Ultrasound

Transvaginal Transducer Ultrasound


Malaysia 26.64 91 100 3 87 100 3 279 100 10 195 100 8

SectorPublic - NC - NC - NC - NC -Private - NC - NC - NC - NC -

StateJohor 3.17 18 20 5 17 20 5 60 21 19 55 27 17Kedah & Perlis 2.11 7 8 3 2 2 1 21 8 10 14 7 7Kelantan 1.53 4 4 3 4 5 3 10 4 7 8 4 5Melaka 0.73 4 4 5 3 3 4 20 7 27 15 7 21N. Sembilan 0.96 6 7 6 5 6 5 25 9 26 15 7 16Pahang 1.45 2 2 1 3 3 2 6 2 4 3 1 2Perak 2.28 4 4 2 12 14 5 15 5 7 12 6 5Terengganu 1.04 1 1 1 3 3 3 3 1 3 3 1 3P. Pinang 1.49 8 9 5 5 6 3 14 5 9 13 6 9Sabah 3 8 9 3 3 3 1 22 8 7 12 6 4Sarawak 2.36 7 8 3 6 7 3 14 5 6 6 3 3Selangor & W.P Kuala Lumpur 6.43 22 24 3 24 28 4 69 25 11 47 23 7

Population Suction and Curettage System

Amnioscope system

blood gas machine for fetal

sampling

Laparoscope system


Malaysia 26.64 314 100 12 160 100 6 107 100 4 78 100 3


StateJohor 3.17 37 12 12 20 13 6 15 14 5 18 23 6

Kedah & Perlis 2.11 17 5 8 0 0 0 0 0 0 2 3 1

Kelantan 1.53 12 4 8 0 0 0 1 1 1 2 3 1Melaka 0.73 8 3 11 4 3 5 3 3 4 4 5 5N. Sembilan 0.96 30 10 31 7 4 7 5 5 5 5 6 5Pahang 1.45 7 2 5 6 3 4 3 3 2 2 3 1Perak 2.28 32 10 14 15 9 7 12 11 5 4 5 2Terengganu 1.04 2 1 2 3 2 3 3 3 3 1 1 1P. Pinang 1.49 20 6 13 0 0 0 0 0 0 3 4 2Sabah 3 28 9 9 22 14 7 12 11 4 8 10 3Sarawak 2.36 22 7 9 14 9 6 6 6 3 7 9 3


31

CHAPTER 9 NEUROLOGY FACILITIES AND DEVICESEdited by : Dr.Suganthi Chinnasami1 , Dr. Mooi Chin Leong1, Dr. Santhi Datuk Puvanarajah1, Dato’ Dr. Hj. Md. Hanip Rafia1.

With contributions from : Neurophysiology Unit HKL

1 Hospital Kuala Lumpur.

NEUROPHYSIOLOGY SERVICES IN PUbLIC SECTOR IN MALAYSIAThe first Neurophysiology unit in Malaysia was set up in 1964 at Kuala Lumpur Hospital with only one staff in charge of the unit. Over the years there has been a gradual increase in the total number of neurophysiology units in various states in Malaysia. Currently, there are about 19 units with 67 trained Medical Assistants. The Clinical Neurophysiology Unit provides standard electroencephalography (EEG) and video-telemetry (VT); nerve conduction studies (NCS) and electromyography (EMG); evoked potentials (EP) which include visual, somatosensory and brainstem auditory evoked response; Transcranial Doppler (TCD); and sleep studies. The unit in HKL also runs a 6 months training programme every year for technologists working in the various neurophysiology units in other major hospitals nationwide since.

Epilepsy is one of the most common neurological conditions affecting at any given time between 0.5% and 1% of the general population in developed country. Most studies of the prevalence of active epilepsy have estimated the figure to be 4 and 10 per 1000. The diagnosis of epilepsy is clinical and rests on the description of the seizure provided by the patient and eyewitnesses. Electroencephalogram (EEG) is the study used to record the electrical activity of the brain and should only be carried out in those patients in whom the symptoms suspicious of epilepsy. In such patients the findings of epileptic abnormalities in the EEG lends weight to the diagnosis and the seizure type may also be clarified. EEGs are often insensitive as more than 50% of patients with epilepsy will have a normal tracing.

Portable EEG recording is done in cases where better detection of the interictal and ictal events may be achieved with prolonged recording using portable equipment and this allows recording to take place in the patient’s usual environment.

Behavioral correlation can be achieved in inpatients by video monitoring during EEG and this is called as Video-EEG telemetry. This investigation is mandatory in the evaluation for Epilepsy Surgery and may be the only way to distinguish epileptic seizures from the nonepileptic events.

Electrodiagnostic (EDX) studies play a key role in the evaluation of patients with neuromuscular disorders. Nerve conduction study and needle electromyography form the core of the EDX study and are often used to diagnose disorders of the nerve and muscles. Performed and interpreted correctly, EDX studies yield critical information about the underlying neuromuscular disorder and allow use of other laboratory tests in an appropriate and efficient manner. The principal goals of every EDX study are to localize the disorder and assess its severity. If the disorder localizes the peripheral nerves (i.e. neuropathic), EDX studies often yield further key information, including the fiber types involving the underlying pathophysiology and the temporal course of the disorder.

Polysomnography (PSG) is a diagnostic test during which a number of physiological variables are measured and recorded during sleep. Information is gathered from all leads and fed into a computer and results in a series of waveform tracings, which enable the technician to visualize the various waveforms, assign a score for the test, and assist in the diagnostic process. The PSG monitors many body functions including brain(EEG), eye movements (EOG), muscle activity or skeletal activation (EMG) heart rhythm (ECG), and breathing function or respiratory effort during sleep. PSG is useful in identifying the abnormality in sleep disorders such as dyssomnias and parasomnias.

32

Transcranial Doppler ultrasound (TCD) is used in the management of ischemic stroke and subarachnoid haemorrhage. In ischemic stroke, TCD can detect any stenosis in the intracranial arteries (anterior and posterior circulation) and also the degree of stenosis. It can indirectly detect internal carotid artery stenosis too. Microemboli in the cerebral arteries can also be detected and this may help in the medical management of the patients. In subarachnoid haemorrhage, TCD is used to evaluate the degree of vasospasm, and this will help the neurosurgeons in determining the subsequent management either medically or surgically. TCD can be used to look for cerebral vasoreactivity and can be used as a supplementary investigation in brain death. It is also used as a screening tool for PFO looking for emboli during bubble contrast injection in the peripheral vein. A possible new indication for TCD is sonothrombolysis, increasing the recanalisation rate of thrombosed arteries in acute stroke when used together with rtPA. This is still being researched.

The data collected from the previous MOH and private survey regarding the neuromedical devices are not complete and under reported. This is most likely secondary to poor response from the concerned units. The data for the Selangor state should be separated from the Federal Territory as there are 3 federal states currently which are Kuala Lumpur, Labuan and Putrajaya. This will show a better picture of the current statistics. The Nerve Conduction Velocity measurement system and EMG machine should be tabulated as a single medical device in the statistics instead of reporting it as two separate devices because both tests are done in the same machine. Till today there are no Ambulatory EEG services in Malaysia, which will enable patient to continue with their daily living activities. There should be data survey for DBS (deep brain stimulation) for Parkinson’s disease management, PET/SPECT imaging services in Malaysia, Depth Electrode monitoring for epilepsy, availability of Genetic studies for hereditary Neurological diseases as well as HLA B 1502 allele testing for all patients started on Carbamazepine as well as Aquaporine a-4 testing for NMO patients.

The public sector data is corrected up to date. However the private sector data is dependant on voluntary and accurate submission of the statistics reported and therefore its difficult to verify and comment. In summary this chapter shows the importance of the neurophysiology units in providing diagnostic studies for the increasing work-up demand in the discipline of Neurology.

The tables below show the number of neurophysiology units and the diagnostic equipments available in Malaysia in year 2007.

Table 1: Available Therapeutic and Diagnostic Facilities in Neurology

Neurophysiology Unit



StateJohor 3.17 1 4 0Kedah & Perlis 2.11 1 4 0Kelantan 1.53 1 4 1Melaka 0.73 1 4 1N. Sembilan 0.96 1 4 1Pahang 1.45 2 8 1Perak 2.28 1 4 0Terengganu 1.04 1 4 1Pulau Pinang 1.49 3 13 2Sabah 3 3 13 1Sarawak 2.36 3 13 1Selangor & W.P Kuala Lumpur 6.43 6 25 1

33

Table 2: Available Medical Devices in Neurology.

PopulationElectro-

encephalography (EEG) machine

Ambulatory Electro-encephalography (EEG) machine

Evoked Potential (EP)

system

Video Telemetry Recording

System



StateJohor 3.17 2 4 1 1 5 0 1 3 0 0 0 0Kedah & Perlis 2.11 3 6 1 1 5 0 1 3 0 1 9 0Kelantan 1.53 1 2 1 1 5 1 7 24 5 2 18 1Melaka 0.73 3 6 4 2 10 3 0 0 0 0 0 0N. Sembilan 0.96 1 2 1 1 5 1 1 3 1 0 0 0Pahang 1.45 2 4 1 0 0 0 1 3 1 1 9 1Perak 2.28 5 10 2 1 5 0 2 7 1 0 0 0Terengganu 1.04 1 2 1 1 5 1 1 3 1 0 0 0P. Pinang 1.49 9 18 6 3 14 2 5 17 4 1 9 1Sabah 3 4 8 1 1 5 0 1 3 0 1 9 0Sarawak 2.36 3 6 1 1 5 0 0 0 0 1 9 0Selangor & W.P Kuala Lumpur 6.43 17 33 3 8 38 1 9 31 1 4 36 1

Population Electromyography (EMG) machine Nerve Conduction Velocity (NCV) Measurement System

NMDS DataEMG/NCS

(Sourced from Expert Panel)

EP/EMG/NCS(Sourced from Expert Panel)

No in million No % pmp No % pmp No % pmp No % pmpMalaysia 26.64 36 100 1 27 100 1 4 - - 17 - -

SectorPublic - 20 56 18 67 - 4 - 17 -Private - 16 44 9 33 - ND - ND -



34

Population Transcranial DopplerNMDS Data




35

CHAPTER 10PSYCHIATRY FACILITIES AND DEVICES

Expert Panel MembersChairperson : Dato’ Dr. Suarn Singh1

Members: Dr. Siti Nor Aizah Ahmad2 (Author), Dr. Hj. Mohd Rasidi M. Saring3, Dr. Hj. Mohd Daud Dalip4, Prof. Dr. Mohd Fadzillah Abdul Razak5

1 Hospital Bahagia Ulu Kinta, 2 Hospital Kuala Lumpur, 3 Hospital Sultanah Bahiyah, 4 Hospital Mesra, 5 Universiti Malaysia Sarawak

REPORTMental health disorders are diverse spectrum of diseases encompassing alterations in thinking, mood and behaviour. The prevalence of mental health disorders among Malaysians is 10.7% [1]; and ranked fourth as the leading cause of burden of disease-by-disease categories [2]. The novel discoveries and rapid advances in understanding psychiatric disorders in the last few decades catalyzed the changing structures in the treatment modalities, management and delivery of mental health services. The challenging issue is to ensure the services and facilities are equally available and accessible to all citizens.

Since the era of deinstitutionalization, the psychiatric-related rehabilitation services gradually developed into broad categorization of hospital-based and community-based services. The day care centers and training shelter workshop constitute the hospital-based rehabilitation services; whereas psychosocial rehabilitation centers and psychiatric nursing homes are facilities based in the community.

The number of facilities seems fairly equally distributed in hospital and community. This concurs with the direction in mental health service to deliver and develop more community mental health facilities. However, the distributions of these facilities are not uniform throughout the country. This could reflect that specialized psychiatric rehabilitation expertise and service are currently only available in certain states. In comparison, the percentage of service contact in community mental health service in Australia was at least 50%; and it reached 98% in certain states [3].

The hospital-based facilities form 53.5% of the total available facilities. However, 94% of the hospital-based facilities are manned by the public sector. All states in Malaysia have at least 1 day care center except Melaka, Pahang and Perlis. The training and shelter workshops are only available in 6 states. The psychosocial rehabilitation centers and psychiatric nursing homes are entirely run by public sector.

It must be noted that once the Mental Health Act 2001 is enforced, the available therapeutic and diagnostic facilities will have to be recategorized into the 3 facilities as provided for in the said Act. The facilities are as follows:

“Psychiatric Hospital” (means a government psychiatric hospital or a private psychiatric hospital including a gazetted private psychiatric hospital)

“Psychiatric Nursing Home” (means a government psychiatric nursing home or a private psychiatric nursing home, and includes a gazetted private psychiatric nursing home)

“Community Mental Health Centre” (means a government community mental health centre or a private community mental health centre, and includes a gazetted private community mental health centre)

36

Although its exact mechanism of action is still unknown, electroconvulsive therapy is an effective treatment modality to achieve rapid and short-term improvement in especially severe depression, severe mania and catatonia [4]. This device is widely available nationwide, mainly in hospitals, but also available in private practice (13%). Its use in England is less, probably attributed to better antidepressants and psychotherapeutic interventions [5]. It is a safe treatment but its adverse effect resulting in cognitive impairment and retrograde amnesia which may happen to some patients, is a significant concern.

Table 1: Available Diagnostic and Therapeutic Facilities in Psychiatry

Population

Hospital-based rehabilitation facilities

Community-based rehabilitation facilities

Day Care CentreTraining

and Shelter Workshop

Psychosocial Rehab. Centre

Psychiatric Nursing Home


Malaysia 26.64 16 100 1 7 100 0 6 100 0 5 100 0

Sector

Public - 15 94 7 100 6 100 5 100

Private - 1 6 0 0 0 0 0 0

State

Johor 3.17 3 19 1 1 14 0 1 17 0 2 40 1

Kedah & Perlis 2.11 1 6 0 0 0 0 0 0 0 0 0 0

Kelantan 1.53 1 6 1 0 0 0 1 17 1 0 0 0

Melaka 0.73 0 0 0 0 0 0 0 0 0 0 0 0

N. Sembilan 0.96 2 13 2 0 0 0 1 17 1 0 0 0

Pahang 1.45 0 0 0 1 14 1 0 0 0 0 0 0

Perak 2.28 1 6 0 1 14 0 1 17 0 0 0 0

Terengganu 1.04 1 6 1 0 0 0 1 17 1 0 0 0

P. Pinang 1.49 1 6 1 0 0 0 0 0 0 0 0 0

Sabah 3 0 0 0 1 14 0 0 0 0 0 0 0

Sarawak 2.36 2 13 1 1 14 0 0 0 0 3 60 1


37

Table 2 Available Medical Devices in Psychiatry

Population Electroconvulsive Therapy (ECT) machineNo in million No % pmp

Malaysia 26.64 45 100 2

SectorPublic - 39 87 -Private - 6 13 -

StateJohor 3.17 3 7 1Kedah & Perlis 2.11 3 7 1Kelantan 1.53 4 9 3Melaka 0.73 1 2 1Negeri Sembilan 0.96 1 2 1Pahang 1.45 2 4 1Perak 2.28 6 13 3Terengganu 1.04 1 2 1Pulau Pinang 1.49 7 16 5Sabah 3 2 4 1Sarawak 2.36 6 13 3Selangor & W.P. Kuala Lumpur 6.43 9 20 1

References:1. The National Health Morbidity Survey, 1996.2. Division of Burden of Disease, Institute for Public Health, Malaysian Bureau of Disease and

Injury Study in Health Prioritisation: Burden of Disease Approach.2004, Ministry of Health Malaysia

3. Australian Institute of Health and Welfare (AIHW) 2008. Mental health services in Australia 2005–06. Mental health series no. 10. Cat no. HSE 56. Canberra: AIHW.

4. National Institute for Clinical Excellence, United Kingdom (2003)5. Royal College of Psychiatrists, United Kingdom (2008)

39

CHAPTER 11CARDIOLOGY AND CARDIOTHORACIC SURGERYFACILITIES AND DEVICES

Edited by:Dr. Aizai Azan1

With contributions from:Dr. Alan Yean Yip Fong2, Dr. Chong Wei Peng3, Dr. Ernest Ng4, Dr. Faisal B. Ismail1,

Co-contributors: Prof. Dr. Sim Kui Hian2, Dr. Ong Tiong Kiam2

1 Institut Jantung Negara, 2 Hospital Umum Sarawak, 3 Pusat Perubatan Universiti Malaya, 4 Hospital Serdang

REPORTIn 2007, there were 73 dedicated coronary care units (CCU) reported in Malaysia. There were 36 cardiac catheterization laboratories, 47 echocardiography laboratories and 3 invasive electrophysiology laboratories. There was a single heart transplant unit located in the Klang Valley, which is complemented by all the acquired left ventricular assist devices (LVADs) in the country. They were 16 cardio-pulmonary rehabilitation programmes, which were not well represented nationwide.

Table 1: Available Therapeutic and Diagnostic Facilities in Cardiology and Cardiothoracic Surgery

PopulationCoronary Care

Unit (CCU)Electrophysiology

Laboratory

Echocardiography(Non-Invasive Cardiology) Laboratory

Cardio-Pulmonary

Rehabilitation Programme


Malaysia 26.64 73 100 3 3 100 0 47 100 2 16 100 1

SectorPublic - 41 56 - 1 33 22 47 12 75Private - 32 44 - 2 67 25 53 4 25


Kelantan 1.53 3 4 2 0 0 0 3 6 2 1 6 1Melaka 0.73 4 5 5 0 0 0 5 11 7 1 6 1

N. Sembilan 0.96 4 5 4 0 0 0 3 6 3 0 0 0

Pahang 1.45 4 5 3 0 0 0 1 2 1 1 6 1Perak 2.28 7 10 3 0 0 0 4 9 2 2 13 1Terengganu 1.04 1 1 1 0 0 0 1 2 1 1 6 1Pulau Pinang 1.49 9 12 6 1 33 1 5 11 3 0 0 0Sabah 3 4 5 1 0 0 0 5 11 2 2 13 1Sarawak 2.36 5 7 2 0 0 0 3 6 1 1 6 0


40

PopulationCardiac

Catheterization Laboratory (Cathlab)

Invasive Cardiovascular Lab

Cardiac Transplant Unit


Malaysia 26.64 36 100 1 9 100 0 1 100 0

SectorPublic - 28 78 - 4 44 0 0Private - 8 22 - 5 56 1 100


Regarding the actual medical devices recorded, data was obtained for numbers of ambulatory blood monitoring system, ECG telemetry system, Holter system and Electrophysiology monitoring system. These devices were well represented nationwide. For invasive support systems, intra-aortic balloon pumps and heart-lung bypass units were located at facilities, which offered interventional cardiology and cardiac surgery procedures. Other non-invasive diagnostic devices data were obtained for Doppler (vascular) machines, echocardiography systems and transoesophageal echocardiography systems. In the main, these non-invasive devices were more commonly available compared to the invasive systems.

41

Table 2: Available Medical Devices in Cardiology and Cardiothoracic Surgery.

Population

Ambulatory blood Pressure

Monitoring System

ECG Telemetry System Holter system

Electrophysiology monitoring

system


Malaysia 26.64 217 100 8 97 100 4 87 100 3 42 100 2


StateJohor 3.17 17 8 5 6 6 2 4 5 1 10 23 3

Kedah & Perlis 2.11 2 1 1 3 3 1 3 3 1 0 0 0

Kelantan 1.53 1 0 1 0 0 0 4 5 3 0 0 0Melaka 0.73 3 1 4 0 0 0 6 7 8 0 0 0N. Sembilan 0.96 15 7 16 0 0 0 3 3 3 2 5 2Pahang 1.45 9 4 6 2 2 1 3 3 2 5 12 3Perak 2.28 5 2 2 1 1 0 5 6 2 1 2 0Terengganu 1.04 2 1 2 4 4 4 0 0 0 0 0 0Pulau Pinang 1.49 17 8 11 19 19 13 15 17 10 9 21 6Sabah 3 8 4 3 0 0 0 6 7 2 3 7 1Sarawak 2.36 2 1 1 4 4 2 6 7 3 0 0 0Selangor & W.P Kuala Lumpur 6.43 136 62 21 58 59 9 32 36 5 12 28 2

Population

Extra-Corporeal Membrane Oxygenator

(ECMO) Machine

Intra-aortic balloon Pump

(IAbP) Machine

Heart-Lung bypass Unit

Left Ventricular Assist Device

(LVAD)


Malaysia 26.64 1 100 0 62 100 2 32 100 1 1 100 0


StateJohor 3.17 0 0 0 7 11 2 3 9 1 0 0 0Kedah & Perlis 2.11 0 0 0 2 3 1 1 3 0 0 0 0Kelantan 1.53 0 0 0 5 8 3 1 3 1 0 0 0Melaka 0.73 0 0 0 4 6 5 2 6 3 0 0 0N. Sembilan 0.96 0 0 0 0 0 0 0 0 0 0 0 0Pahang 1.45 0 0 0 2 3 1 0 0 0 0 0 0Perak 2.28 1 100 0 1 2 0 1 3 0 0 0 0Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0Pulau Pinang 1.49 0 0 0 12 19 8 8 25 5 0 0 0Sabah 3 0 0 0 2 3 1 1 3 0 0 0 0Sarawak 2.36 0 0 0 3 5 1 4 13 2 0 0 0Selangor & W.P Kuala Lumpur 6.43 0 0 0 24 39 4 11 34 2 1 100 0

42

Population Doppler machine

Echocardiography system

Trans-Oesophageal

Echocardiogr. (TEE) system

Intravascular Ultrasound

(IVUS) machine


Malaysia 26.64 30 100 1 153 100 8 45 100 2 7 100 0

Sector

Public - 21 70 66 43 21 47 3 43

Private - 9 30 87 57 24 53 4 57

State

Johor 3.17 1 3 0 7 5 2 3 7 1 1 14 0

Kedah & Perlis 2.11 0 0 0 10 7 5 3 7 1 0 0 0

Kelantan 1.53 1 3 1 10 7 7 1 2 1 0 0 0

Melaka 0.73 2 7 3 7 5 10 2 4 3 1 14 1

N. Sembilan 0.96 0 0 0 6 4 6 0 0 0 0 0 0

Pahang 1.45 1 3 1 5 3 3 1 2 1 0 0 0

Perak 2.28 1 3 0 10 7 4 2 4 1 0 0 0

Terengganu 1.04 0 0 0 2 1 2 0 0 0 0 0 0

Pulau Pinang 1.49 5 17 3 17 10 11 9 20 6 0 0 0

Sabah 3 1 3 0 11 7 4 1 2 0 0 0 0

Sarawak 2.36 0 0 0 12 8 5 9 20 4 1 14 0


Commentary• Concentration of services and devices in the Klang Valley.• Despite the wide availability of coronary care units, there is a relative lack of cardio-pulmonary

rehabilitation programmes.• Interventional electrophysiology laboratories are a very specialized area of Cardiology and

resources are limited to a few centres.• We note that there are more heart-lung bypass units in the private sector.• Current data not available for implantable cardiac devices eg pacemakers, defibrillators and

cardiac heart valves.• More detailed information on the cardiac surgery devices and facilities will be available in the

future.• More detailed information on non-invasive devices used in cardiology diagnostics to be

available in the future eg treadmill machines and tilt table devices.• National registries, concentrated at tertiary, and hospital-based, will provide targeted

information at their respective levels eg Acute Coronary Syndrome, cardiac bypass surgery and percutaneous coronary intervention.

43

CHAPTER 12RESPIRATORY FACILITIES AND DEVICES

Edited by :Dato’ Dr. Abdul Razak Abdul Mutalif1

With contributions from :Ass. Prof. Dr. Roslina Abdul Manap2, Dr. Ashari Yunus3, Dr. Norhaya Mohd. Razali4, Ass. Prof. Dr. How Soon Hin5

1 Hospital Pulau Pinang, 2 Pusat Perubatan Universiti Kebangsaan Malaysia, 3 Institut Perubatan Respiratori, 4 Hospital Sultanah Zahirah, 5 Universiti Islam Antarabangsa Malaysia, Kuantan

REPORTThe National Medical Devices Survey (NMDS), a service initiated and supported by the Ministry of Health, gives complete information on the availability of devices and services in all states in Malaysia. This information is very important for future planning and financing of equipment and manpower. As can be seen later, some states have more manpower and equipment when compared to others. These discrepancies can be due to availability of trained doctors and facilities in some states and none in the others. The data available in this survey can also aid in clinical and epidemiological research.

Data on the availability of therapeutic and diagnostic facilities shows some variations in the public and private sector. With the public hospitals having problems in space and patient load, there is no specific High Dependency Wards for respiratory cases. Almost all public hospitals use general intensive care units (ICU) to treat respiratory cases. The public hospitals however are well equipped with pulmonary physiology laboratories and sleep laboratories (Table 1).

Lung transplantation is a very new service provided by the Malaysian hospital. Only one hospital, National Heart Center with the collaboration of the Institute of Respiratory Medicine, screens cases and performs surgery. On the other hand, smoking cessation is a very well established activity in many health clinics and some public hospitals. A total of one hundred centers carry out this service. This is not enthusiasm of providing service is not noticed in the field of Pulmonary Rehabilitation, as only four public hospital provide it. This is probably due to lack of manpower in the physiotherapy units (Table 1).

Medical devices in the respiratory medicine are well equipped in the public hospitals all over Malaysia. The commitment of the Health Ministry in early diagnosis of COPD is noted in the availability of spirometers, thrice higher then in the private hospitals. This is due to its cheap costs now and easier to use devices. Almost all states have at least one polysomnograph system in their hospitals and some also have portable somnograph machines (Table 2). Body box is a very specialized device and very costly. It is available in most regional public hospitals. Broncho-videoscope systems are freely available in both public and private hospitals. This device is the most important equipment for diagnosis of several lung diseases, like cancers, infections and parenchymal lung disorders. Medical pleuroscope is also a new technology, done by physicians in the wards; this is in all public hospitals. In the private hospitals, rigid scopes were used by surgeons both for thoracoscopy and bronchoscopy for diagnostic and therapeutic procedures, done sometimes by surgeons. This is only done in some public hospitals and not yet available in private hospitals. BiPAP and CPAP systems are used in many public and private hospitals in the treatment of COPD and obstructive apneas.

This report is done with the data provided by the contributors from all states. Some of the states cannot obtain accurate data from all hospitals, especially in the private hospitals. The future survey should look into other ways and methods of obtaining better information on the devices and services in the field of Respiratory Medicine.

44

Table 1: Available Therapeutic and Diagnostic Facilities in Respiratory Medicine

PopulationHigh Dependency

(Respiratory) Ward

bronchoscopy Suite

Respiratory Laboratory

Sleep Laboratory


Malaysia 26.64 24 100 1 34 100 1 15 100 1 16 100 1



Population Lung Transplant Unit Smoking Cessation Centre

Pulmonary Rehabilitation Unit


Malaysia 26.64 1 100 0 12 100 9 6 100 0


StateJohor 3.17 0 0 0 2 17 1 0 0 0

Kedah & Perlis 2.11 0 0 0 1 8 0 0 0 0

Kelantan 1.53 0 0 0 1 8 1 0 0 0Melaka 0.73 0 0 0 1 8 1 0 0 0

Negeri Sembilan 0.96 0 0 0 0 0 0 0 0 0

Pahang 1.45 0 0 0 1 8 1 1 17 1Perak 2.28 0 0 0 1 8 0 0 0 0Terengganu 1.04 0 0 0 0 0 0 0 0 0Pulau Pinang 1.49 0 0 0 0 0 0 1 17 1Sabah 3 0 0 0 1 8 0 1 17 0Sarawak 2.36 0 0 0 1 8 0 0 0 0Selangor & W.P. Kuala Lumpur 6.43 1 100 0 3 25 0 3 50 0

45

Table 2: Available Medical Devices in Respiratory Medicine

Population SpirometerPneumo-

tacography Machine

Total Polysomnograph

System

Portable Polysomnograph

MachineNo in million No % pmp No % pmp No % pmp No % pmp

Malaysia 26.64 94 100 3 5 100 0 19 100 1 5 100 0



Populationbody

pletysmograph (“body box”)

Adult bIPAP system

Adult CPAP system

Adult broncho-videoscope

System



StateJohor 3.17 0 0 0 4 4 1 5 9 2 9 6 3

Kedah & Perlis 2.11 0 0 0 1 1 0 2 4 1 3 2 1

Kelantan 1.53 0 0 0 5 5 3 1 2 1 11 7 7Melaka 0.73 0 0 0 8 7 11 10 18 14 9 6 12

N. Sembilan 0.96 0 0 0 4 4 4 2 4 2 7 5 7

Pahang 1.45 1 14 1 12 11 8 2 4 1 9 6 6Perak 2.28 0 0 0 9 8 4 2 4 1 8 5 4Terengganu 1.04 1 14 1 5 5 5 0 0 0 2 1 2Pulau Pinang 1.49 1 14 1 6 6 4 10 18 7 25 17 17Sabah 3 1 14 0 4 4 1 4 7 1 6 4 2Sarawak 2.36 0 0 0 5 5 2 2 4 1 13 9 6


46

Population Medical Pleurascope

Paediatric CPAP Flow Driver

Paediatric biPAP system with Appropriate

Mask

Paediatric bronchoscopy

(rigid) Set


Malaysia 26.64 7 100 0 41 100 1 10 100 0 18 100 1

Sector

Public - 6 86 29 71 7 70 6 33

Private - 1 14 12 29 3 30 12 67

State

Johor 3.17 0 0 0 3 7 1 0 0 0 1 6 0

Kedah & Perlis 2.11 1 14 0 5 12 2 1 10 0 0 0 0

Kelantan 1.53 0 0 0 2 5 1 0 0 0 1 6 1

Melaka 0.73 0 0 0 3 7 4 1 10 1 1 6 1Negeri Sembilan 0.96 0 0 0 3 7 3 0 0 0 0 0 0

Pahang 1.45 1 14 1 2 5 1 3 30 2 0 0 0

Perak 2.28 0 0 0 8 20 4 0 0 0 2 11 1

Terengganu 1.04 1 14 1 1 2 1 0 0 0 0 0 0

Pulau Pinang 1.49 1 14 1 1 2 1 1 10 1 4 22 3

Sabah 3 1 14 0 0 0 0 0 0 0 1 6 0

Sarawak 2.36 0 0 0 0 0 0 0 0 0 2 11 1


47

CHAPTER 13 GASTROENTEROLOGY FACILITIES AND DEVICES

Chairperson: Dr. Hj. Rosemi Salleh1

Secretary: Dr. Hjh. Rosaida Hj. Md. Said2

Representative: Y. Bhg. Dato’ Dr. Hj. Muhammad Radzi bin Abu Hassan3, Dr. Sheikh Anwar Abdullah4

Contributors: Dr. Jeyaram Menon 5, Dr. S. Ganesananthan2

1 Hospital Raja Perempuan Zainab II, 2 Hospital Kuala Lumpur, 3 Hospital Sultanah Bahiyah, 4 Pusat Perubatan Universiti Kebangsaan Malaysia, 5 Hospital Queen Elizabeth.

REPORTFor the first time in Malaysia, we are able to report national estimates on the devices pertaining to Gastroenterology Units.

Gastroenterology is one of the medical subspecialties which involve a substantial amount of medical devices. These devices cover use for therapeutic as well as diagnostic purposes. The provision of therapeutic and diagnostic facilities in Gastroenterology can be divided into 1) Non-Invasive Gastroenterology Laboratory; and 2) Endoscopy Day Care Unit/Suite. Non-invasive gastroenterology laboratory refers to provision of devices that do not involve endoscopes, for example capsule endoscopic system, manometry and breath test system.

In Malaysia, more services are provided in endoscopy day care units or suites (55). This is in comparison to only 9 non-invasive gastroenterology laboratories available around the country, in Pahang, Sabah, Sarawak and Selangor & Kuala Lumpur. This may be because the expertise/ technologies were not readily available in the past. Now, there are more and more centres providing these non-invasive services, but they are incorporated into the endoscopy day care units or suites. Those with separate non-invasive laboratories were mostly from the private sector. As there are more private health services available in the Klang Valley, this may explain why the most number of non-invasive gastroenterology laboratories were recorded for Selangor & W.P. Kuala Lumpur.

The endoscopy day care units/suites are available in all states except Terengganu. The highest number was recorded by Selangor & W.P. Kuala Lumpur (17) followed by Pulau Pinang (6), with Sarawak, Johor and Kedah & Perlis having the 3rd highest number (5).

The case of Terengganu having no available therapeutic and diagnostic facilities in gastroenterology may not be fully accurate, as the data is based on the feedback provided only. If there is a lack of cooperation or communication between the departments or in the feedback process, there will be under-reported data.

The devices that related to gastroenterology specialty can be divided into:

1. Endoscopes / Gastroenterology devices2. Invasive 3. Non-invasive

48

1. Endoscopes / Gastroenterology devicesBase on the survey done last year (2007), the gastroduodenoscope and colonoscope devices are the most available in Malaysia with the average of 6 and 5 per million population respectively.

Gastroduodenoscope systems have the largest number in the country, which is about 167, followed by 137 colonoscopes.

Other endoscopic devices are 84 duodenoscopes followed by 47 sigmoidoscopes, 16 Endoscopic ultrasound (EUS), 12 enteroscopy and 4 Double Balloon Enteroscopic (DBE) systems.

Majority of these devices are located in Selangor and Wilayah Persekutuan.

Based on the survey, the number of availability is still not enough for screening purposes, for example screening for colorectal cancer.

Other devices such as DBE and EUS are still low in numbers due to the need of special trainings and their usage are still low.

2. Invasive

3. Non-InvasiveThere are five non-invasive procedures in which four of them are considered relatively new in Malaysia. The newer non-invasive procedures involve the total water perfused low compliance software pneumohydraulic pump with transducers for anorectal and oesophageal manometry, total 24-hour digitrap per recording device, wireless 48 hour bravo pH recording system, GI breath test system and capsule endoscopic system.

The newer non-invasive procedures are technically simpler and easier to do, and may replace some of the invasive procedures. However, the limitations of these tests are costly and need expertise. Thus, the non-invasive tests will not be available in every centre but to the targeted main centre chosen.

Presently, the individual non-invasive procedures that available in Malaysia are as stated below:-

49

Table 1: Available Therapeutic and Diagnostic Facilities in Gastroenterology.

PopulationNon-Invasive

Gastroenterology Laboratory

Endoscopy Day Care Unit/Suite

No in million No % pmp No % pmpMalaysia 26.64 100 0 55 100 2 SectorPublic - 4 44 22 40Private - 5 56 33 60 StateJohor 3.17 0 0 0 5 9 2Kedah & Perlis 2.11 0 0 0 5 9 2Kelantan 1.53 0 0 0 3 5 2Melaka 0.73 0 0 0 2 4 3Negeri Sembilan 0.96 0 0 0 4 7 4Pahang 1.45 2 22 1 3 5 2Perak 2.28 0 0 0 4 7 2Terengganu 1.04 0 0 0 0 0 0Pulau Pinang 1.49 0 0 0 6 11 4Sabah 3 1 11 0 1 2 0Sarawak 2.36 1 11 0 5 9 2Selangor & W.P. Kuala Lumpur 6.43 5 56 1 17 32 3

Table 2: Available Medical Devices in Gastroenterology

Population Total biliary Lithotripter Unit

Mechanical biliary Lithotripter Unit

Electro-hydraulic biliary Lithotripter Unit

Laser biliary Lithotripter

UnitNo in million No % pmp No % pmp No % pmp No % pmp

Malaysia 26.64 31 100 1 26 100 1 3 100 0 2 100 0


StateJohor 3.17 2 6 1 2 8 1 0 0 0 0 0 0

Kedah & Perlis 2.11 4 13 2 4 15 2 0 0 0 0 0 0

Kelantan 1.53 5 17 3 4 15 3 1 33 1 0 0 0Melaka 0.73 1 3 1 1 4 1 0 0 0 0 0 0N. Sembilan 0.96 0 0 0 0 0 0 0 0 0 0 0 0Pahang 1.45 3 9 2 1 4 1 1 33 1 1 50 1Perak 2.28 0 0 0 0 0 0 0 0 0 0 0 0Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0Pulau Pinang 1.49 5 16 3 5 19 3 0 0 0 0 0 0Sabah 3 1 3 0 1 4 0 0 0 0 0 0 0Sarawak 2.36 4 13 2 3 12 1 1 34 0 0 0 0Selangor & WP Kuala Lumpur 6.43 6 20 1 5 19 1 0 0 0 1 50 0

50

PopulationExternal short wave biliary

lithotripter unit

Low compliance software

pneumohydraulic pump with

transducers for anorectal and oesophageal manometry

24-hr digitrap per recording

device

Wireless 48 hour bravo

pH recording system




Population GI breath Test System

Capsule Endoscopic System

Intestinal Tract Stenting

bouginage: TTS dilator

Intestinal Tract Stenting

bouginage: Savary-Guillard dilator




51

Population

Video-endoscopic workstation

with: gastroscope and appropriate

accessories

Video-endoscopic workstation with:

duodenoscope and appropriate

accessories


with: enteroscope and appropriate

accessories


with: endoscopic ultrasound and

appropriate accessories


Malaysia 26.64 167 100 6 84 100 3 12 100 0 16 100 1



Population


double balloon enteroscopic system and appropriate accessories


sigmoidoscope and appropriate

accessories


with: colonoscope and appropriate

accessories

Heater probe for (contact dermal

device) for gastrointestinal

bleed


Malaysia 26.64 4 100 0 47 100 2 137 100 5 27 100 1



53

CHAPTER 14NEPHROLOGY FACILITIES AND DEVICES

Edited by :Dato’ Dr. Zaki Morad1 , Dr. Ong Loke Meng2

With contributions from :Dr. Goh Bak Leong3, Dr. Hooi Lai Seong4, Dr. Lim Yan Ngo5, Dato’ Dr. Rozina Ghazalli2, En. A. Suhaili b. Shahri5, Sr. Lee Day Guat6, Tn. Hj. Mohd Sulaiman B. Dalimi3, Tn Haji Wazir Hussin7,

En. Chua Kee Long

1 Ampang Puteri Specialist Hospital,2 Hospital Pulau Pinang, 3 Hospital Serdang, 4 Hospital Sultanah Aminah,5 Hospital Kuala Lumpur, 6 Pusat Penyelidikan Klinikal HKL, 7 Hospital Tengku Ampuan Rahimah. INTRODUCTIONNephrology as a distinct specialty developed in this country in the 1970s. From the very beginning, the public image of nephrology was haemodialysis (HD) treatment and the machines associated with it. Both haemodialysis and peritoneal dialysis treatment maintain their pre-eminent place in Nephrology practice because they consume a disproportionate share of the budget. A significant proportion of the cost of care in Nephrology goes to purchasing and maintaining the dialysis machines. The National Renal Registry has captured data on dialysis practice in the country for the last fifteen years. They have data not only on the numbers but also the utility of these machines. Such information is useful in planning for services and as a guide for purchases in the future.

Apart from the HD machines there are other machines that are used in dialysis practice but have not been captured in this first attempt. They include water treatment machines (or more popularly called the Reverse Osmosis machine), dialyzer reprocessor machine, dialyzer rinsing machines and other related equipment. It is hoped that subsequent endeavours will include these machines to give a comprehensive picture of the dialysis program in the country.

Doctors in general do not have deep interest in the workings of these machines. Yet they place their patients regularly under these machines. It is hoped that the Medical Device Directory will spur greater interest amongst doctors and other healthcare providers who regularly use these machines on how these machines work, their cost, their efficient usage and more importantly their impact on the patients’ health.

54

RESULTSTable 1: Available Therapeutic and Diagnostic Facilities in Nephrology

Population Peritoneal Dialysis Unit Chronic Haemodialysis Unit


Malaysia 26.64 31 100 1 455 100 17 SectorPublic - 25 81 146 32Private - 6 19 309 68 StateJohor 3.17 4 10 1 63 14 20Kedah & Perlis 2.11 1 3 0 32 7 15Kelantan 1.53 2 7 1 18 4 12Melaka 0.73 2 7 3 20 4 27Negeri Sembilan 0.96 2 7 2 19 4 20Pahang 1.45 2 7 1 17 4 12Perak 2.28 3 10 1 50 11 22Terengganu 1.04 1 3 1 10 2 10Pulau Pinang 1.49 2 7 1 42 9 28Sabah 3 2 7 1 26 6 9Sarawak 2.36 1 3 1 29 6 12


Table 1 shows the distribution of peritoneal dialysis (PD) and haemodialysis (HD) centres in the country. The information was obtained from the National Medical Device survey and the National Renal Registry (NRR) (1). In the survey the overall response rate was 57% with 66% response from the public sector and 46% from the private sector. The response rate in the NRR was 100%.

The public sector is the major providers of PD while the private sectors the major provider of HD. Twenty-five (80.6%) of the 31 PD units are located in public sector. PD units with both adult and paediatric nephrologists are regarded as separate units. On the other hand, two-thirds of the haemodialysis centres are private (comprising non-governmental organization and HD units in private sector) while 32% (146) are in the public sector.

There is a wide variation in distribution of PD and HD centres in Malaysia. The number of HD centres in each state ranged from 9 to 28 centres per million population (pmp). The states with the lowest population least served were Sabah, Terengganu and Kelantan. Most (71%) of the PD centres are located in west coast states of West Malaysia. Only 3 (9.7%) centres are located in East Malaysia. The dominance of HD over PD can largely explained by the increase in HD centres runned by non-governmental organizations following the introduction of government subsidy for haemodialysis.

55

Table 2: Available Medical Devices in Nephrology

Population Haemodialysis machine

Peritoneal Dialysis Cycler

Continuous Renal Replacement Therapy

(CRRT) machine


Malaysia 26.64 5008 100 188 112 100 4 61 100 2


StateJohor 3.17 730 15 230 6 5 2 4 7 1Kedah & Perlis 2.11 337 7 160 7 6 3 4 5 1Kelantan 1.53 143 3 93 1 1 1 3 3 1Melaka 0.73 219 4 300 3 3 4 4 3 3Negeri Sembilan 0.96 216 4 225 5 4 5 2 3 2Pahang 1.45 182 4 126 3 3 2 3 3 1Perak 2.28 553 11 243 8 7 4 3 5 1Terengganu 1.04 115 2 111 0 0 0 1 2 1Pulau Pinang 1.49 472 9 317 8 7 5 8 12 5Sabah 3 202 4 67 4 4 1 2 3 1Sarawak 2.36 307 6 130 4 4 2 5 8 2Selangor & W.P Kuala Lumpur 6.43 1532 31 238 63 56 10 28 47 4

Table 2 shows the distribution of HD, PD cycler and continuous renal replacement therapy (CRRT) machines.

There were more HD machines (188 pmp) compared with PD cyclers (4 pmp). However the survey included only PD cyclers in health facilities and home based machines for patients on automated PD were not included. There were 5008 (188 pmp) HD machines (range 67 - 317 machines pmp), 112 PD cyclers (range 0 - 10 pmp) and 61 CRRT machines (range 1-5 pmp) in Malaysia. 72.3% of the haemodialysis, 27.9% of CRRT machines but only 4.5% of PD cyclers were located in the private sector.

There was a wide variation of distribution of HD machines among the states in Malaysia. The west coast states of West Malaysia had the highest number of machines. Selangor and Federal Territory had the highest absolute number of HD machines (1532) while Penang was the highest population served (317 pmp). The least served states were Sabah (67 pmp), Kelantan (93 pmp) and Terengganu (111 pmp).

A vast majority (95.5%) of the PD cyclers are located in the public sector. Selangor and the Federal Territory of Kuala Lumpur (FTKL) had the highest number of PD cyclers: 63 (10 pmp). The surveyhowever included only the cyclers located in health facilities and did not include cyclers used at home by patients. Furthermore the number of PD cyclers under estimates the use of peritoneal dialysis as continuous ambulatory peritoneal dialysis does not require the use of PD cycler.

72.1% of CRRT machines are in the public sector with the best served states in west coast of Peninsular Malaysia (Selangor & FTKL, Penang and Melaka). This is not unexpected as CRRT is an expensive modality in the treatment of acute renal failure.

56

SummaryThis is the first report on the nephrology and urology services available in the country. There may be gaps in the data collected and this be filled with subsequent reports.

HD penetration is better compared with PD in Malaysia. The private sector is the major provider of HD facilities while the public sector is the major provider of PD. There is an inequity in distribution of nephrology facilities in the country with the highest population served in the West Coast of states of West Malaysia (Penang, Selangor & FT and Perak) and the lowest in Sabah, Terengganu and Kelantan. Future planning should include increasing the number of PD centres as the demand for human resource, cost and office space is less.

References1. 15th report of the Malaysian Dialysis and Transplant Registry 2007.

57

CHAPTER 15UROLOGY FACILITIES AND DEVICES

Authors :Dr. Murali Sundram Abdullah1, Dr. Clarence Lei Chang Moh2

1 Hospital Kuala Lumpur, 2 Normah Medical Centre.

REPORTResponse Rates

Of the 92 hospitals purported to provide urology services, 73% responded to the survey. To our knowledge, of these 92 hospitals, only 50 have full time resident urologists offering the full range of general urology services. Of these 52 hospitals, roughly 2/3 (37) are private institutions.

Table 1: Available Diagnostic and Therapeutic Facilities in Urology

Population Stone Center Renal Transplant Center Robotic Centre Urodynamic

Laboratory


Malaysia 26.64 47 100 2 7 100 0 3 100 0 7 100 0

Sector

Public - 12 25 4 57 - 2 67 - 3 43 -

Private - 35 75 3 43 - 1 33 - 4 57 -

State

Johor 3.17 4 9 1 0 0 0 0 0 0 1 14 0

Kedah & Perlis 2.11 3 6 1 0 0 0 0 0 0 1 14 0

Kelantan 1.53 1 2 1 0 0 0 0 0 0 0 0 0

Melaka 0.73 3 6 4 0 0 0 0 0 0 1 14 1

Negeri Sembilan 0.96 2 4 2 0 0 0 0 0 0 0 0 0

Pahang 1.45 2 4 1 0 0 0 0 0 0 0 0 0

Perak 2.28 3 6 1 0 0 0 0 0 0 0 0 0

Terengganu 1.04 1 2 1 0 0 0 0 0 0 0 0 0

Pulau Pinang 1.49 6 13 4 0 0 0 0 0 0 0 0 0

Sabah 3 2 4 1 0 0 0 0 0 0 0 0 0

Sarawak 2.36 3 6 1 0 0 0 1 33 0 1 14 0


58

Population Andrology Laboratory


Malaysia 26.64 2 100 0 SectorPublic - 0 0Private - 2 100 StateJohor 3.17 1 50 0Kedah & Perlis 2.11 0 0 0Kelantan 1.53 0 0 0Melaka 0.73 0 0 0Negeri Sembilan 0.96 0 0 0Pahang 1.45 0 0 0Perak 2.28 0 0 0Terengganu 1.04 0 0 0Pulau Pinang 1.49 0 0 0Sabah 3 0 0 0Sarawak 2.36 0 0 0Selangor & W. P. Kuala Lumpur 6.43 1 50 0

Some of the facilities listed under urology suffer from a lack of strict definition and hence the possibility of false reporting.

A stone centre is a stand-alone centre with dedicated facilities for the treatment of all types of urinary stones. The centre should have the full range of endoscopic and percutaneous methods of stone clearance; either possesses or has access to an ESWL machine and should have a resident urologist. This definition may not be applied strictly because some centers have general surgeons who practice urology and some centers have visiting urologists who offer some but not the entire range of urological services.

A renal transplant centre is a stand-alone center that provides a continuum of comprehensive care to patients undergoing kidney transplantations both living related and cadaveric. The service may include monitoring of patients awaiting transplantation, medical and surgical therapies, and follow-up care inclusive of management of immunosuppressive therapy. There are 4 public centers, which do the majority of the transplants, and 3 private centers all of which are in the Klang valley.

A robotic centre is a stand-alone center equipped with capabilities to perform robotic assisted laparoscopic surgical procedures. Possession of a robotic machine must be a perquisite. There are 2 in the public and 1 in the private.

An urodynamic laboratory is a stand-alone center dedicated to performing urodynamic assessments for the diagnosis and management of incontinence, lower urinary tract dysfunctions and prolapses. Possession of a urodynamic machine (with or without fluoroscopy) is a prerequisite. The total of 7 recorded is too small as the public sector alone has 10. Urodynamic machines under the urogynaecologists are not shown here.

An andrology laboratory is a stand-alone center that specifically provides male infertility testing services. It may or may not provide cryopreservation or sperm banking services. Although many hospitals offer hormonal assays and semen analysis and have urologists on staff, it is not clear if this constitutes an andrology laboratory.

59

Table 2: Available Medical Devices in Urology

Population

Total Extracorporeal

Shockwave Lithotripter (ESWL) unit

Extracorporeal Shockwave Lithotripter

(ESWL) with Fluoroscopy unit


(ESWL) with Ultrasound unit


(ESWL) with Vital Data Monitoring

CapabilityNo in million No % pmp No % pmp No % pmp No % pmp

Malaysia 26.64 70 100 3 22 100 1 27 100 1 20 100 1



PopulationTotal

Intracorporeal Lithotripter Unit

Intracorporeal Lithotripter Unit with Lithoclast

Intracorporeal Lithotripter Unit with Ultrasound

Intracorporeal Lithotripter Unit

with Laser


Malaysia 26.64 73 100 3 42 100 2 24 100 1 5 100 0



60

ESWL machine numbers are grossly overestimated probably because of over reporting in the last column (ESWL with vital data monitoring) and this should be left out in future surveys. To our knowledge there are a total of 45 ESWL machines in Malaysia of which only 14 are in the public sector. 40% are located in Selangor & WP area and the rest quite evenly distributed among the other states capitals.

The most common intracorporeal lithotripsy device is the lithoclast followed by the ultrasonic lithotripter. Laser lithotripsy, which is delivered via a flexible fiber, is the latest lithotripsy device.

Population Total Urodynamic machine

Uroflowmetry with urodynamic

machine

Uroflowmeter in a separate toilet

bladder scan to measure residual bladder volume


Malaysia 26.64 21 100 1 16 100 1 31 100 1 16 100 1

Sector

Public - 7 33 4 25 14 45 6 38

Private - 14 67 12 75 17 35 10 62

State

Johor 3.17 2 10 1 2 13 1 3 10 1 1 6 0

Kedah & Perlis 2.11 2 10 1 2 13 1 2 6 1 2 13 1

Kelantan 1.53 1 5 1 1 6 1 2 6 1 0 0 0

Melaka 0.73 0 0 0 2 13 3 3 10 4 1 6 1

N. Sembilan 0.96 1 5 1 0 0 0 0 0 0 0 0 0

Pahang 1.45 1 5 1 1 6 1 1 3 1 1 6 1

Perak 2.28 0 0 0 0 0 0 1 3 0 0 0 0

Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0

Pulau Pinang 1.49 4 19 3 3 19 2 4 13 3 3 19 2

Sabah 3 0 0 0 0 0 0 1 3 0 1 6 0

Sarawak 2.36 3 14 1 2 13 1 2 6 1 2 13 1


The table on urodynamic equipment is flawed. There should be only 3 categories – Bladder scan, Uroflowmetry and Urodynamic machine. The first two are basic urodynamic devices available in most urological centers and the numbers given appear too small whereas the numbers for urodynamic machines (which are mainly found in high volume public centers) are too high.

61

Population Resectoscope Nephroscope(rigid)

Ureteroscope (flexible)

Ureteroscope (rigid)


Malaysia 26.64 95 100 4 56 100 2 23 100 1 79 100 3

Sector

Public - 40 42 24 43 9 39 28 35

Private - 55 58 32 57 14 61 51 65

State

Johor 3.17 10 11 3 7 13 2 3 13 1 12 15 4

Kedah & Perlis 2.11 6 6 3 5 9 2 1 4 0 6 8 3

Kelantan 1.53 4 4 3 4 7 3 2 8 1 5 6 3

Melaka 0.73 6 6 8 3 5 4 3 13 4 7 9 10

N. Sembilan 0.96 1 1 1 1 2 1 0 0 0 1 1 1

Pahang 1.45 3 3 2 3 5 2 1 4 1 3 4 2

Perak 2.28 8 8 4 3 5 1 0 0 0 2 3 1

Terengganu 1.04 4 4 4 1 2 1 0 0 0 2 3 2

Pulau Pinang 1.49 8 8 5 6 11 4 1 4 1 9 11 6

Sabah 3 4 4 1 2 4 1 0 0 0 3 4 1

Sarawak 2.36 13 15 6 8 14 3 4 17 2 8 10 3Selangor & W.P Kuala Lumpur 6.43 28 29 4 13 23 2 8 35 1 21 27 3

Population Cystoscope (flexible) Cystoscope (rigid)


Malaysia 26.64 62 100 2 124 100 5


StateJohor 3.17 6 10 2 19 15 6Kedah & Perlis 2.11 7 11 3 7 6 3Kelantan 1.53 3 5 2 5 4 3Melaka 0.73 4 6 5 6 5 8Negeri Sembilan 0.96 1 2 1 4 3 4Pahang 1.45 3 5 2 3 2 2Perak 2.28 2 3 1 9 7 4Terengganu 1.04 1 2 1 1 1 1Pulau Pinang 1.49 8 13 5 12 10 8Sabah 3 3 5 1 6 5 2Sarawak 2.36 7 11 3 15 12 6Selangor & W.P Kuala Lumpur 6.43 17 28 3 37 30 6

62

Endoscopic and percutaneous technology has revolutionized the practice of urology and this is reflected in the various types of endoscopes both rigid and flexible. The rigid cystoscope is the most common because it is also used by the non-urologist. The resectoscope is the most common tool of the urologist (n= 95). The rigid ureteroscope, rigid nephroscope and flexible cystoscope are the workhorses for the urologist and average about 60 in each category. Flexible ureteronephroscopes number 23. Although 2/3 of all hospitals offering the standard urology services are private institutions, the numbers of scopes are distributed almost equally between private and public hospitals reflecting the difference in workload.

SummaryThere are 50 hospitals offering the full range of urological services with a resident urologist(s). 13 are public and 37 private. Urolithiasis constitutes the main workload of Malaysian urologists and all 50 of these hospitals are considered stone centers with 90% having ESWL machines. Of the 45 ESWL machines in the country, 30% are in public hospitals and 40% are in the Klang Valley. Most of the public urological centers are also urodynamic centers. Transplant and Robotic services are mainly in public hospitals.There are probably another 40 hospitals that offer limited urology services provided by a visiting urologists or a general surgeon with an interest in urology.

The resectoscope is the most common instrument, followed by the flexible cystoscope, rigid ureteroscope and rigid nephroscope. The most common intracorporeal devices are the lithoclast and ultrasonic.

63

CHAPTER 16DERMATOLOGY FACILITIES AND DEVICES

Edited by :Pn Sri Datin Dr. Suraiya H Hussein1, Dr. Rohna Ridzwan2

With contributions from :Dr. Choon Siew Eng3, Dr. Asmah Johar1

1 Kuala Lumpur Hospital MOH, 2 Selayang Hospital MOH, 3 Hospital Tengku Ampuan Aminah MOH

HIGH TECHNOLOGY DEVICES IN DERMATOLOGY SERVICES

INTRODUCTIONThe introduction of medical technology in clinical practice has expanded the Dermatology services from mere office consultation to that of investigative and therapeutic Dermatology services. The medical devices range from simple cryosurgical units to the sophisticated and bulky Phototherapy cabins and Laser surgical machines. Table 1 shows the devices in decreasing order of cost.

Table 1 Dermatology Devices - Indication and Credentialed Operators

Medical Device Indication of usage Mode of Management Credentialed operator

1 Cryosurgical unit Benign skin tumours Therapeutic Trained doctors & nursesNodular dermatitisBasal cell carcinoma Therapeutic Trained dermatologist

2 Electrosurgical unit Benign skin tumours Therapeutic Trained doctors

3 Iontophoresis Palmar & plantar Hyperhidrosis Interim therapy Doctors and trained physiotherapist

4 Phototherapy unitFull body phototherapy cabin (broad band UVB & UVA)

PsoriasisVitiligo (extensive)Mycosis FungoidesOthers

Therapeutic Dermatologistsand trained

Physiotherapists and nurses under supervision by Dermatologists.

Full body phototherapy cabin (narrow band UVB)

PsoriasisScleredemaVitiligoMycosis Fungoides

Therapeutic

Full body phototherapy cabin (UVA1)

Mycosis FungoidesScleredemaMorphoea

Adjuvant therapy

Hand & feet phototherapy unit Hand & foot psoriasisHand & feet vitiligo

Therapeutic

Hand held phototherapy Scalp psoriasisLocalized vitiligo

Therapeutic

PUVA ten (UV lamps) Localized vitiligo TherapeuticMulti tester Unit (UVA & UVB) Investigative

5 Laser surgical unitCarbon dioxide laser system Benign skin tumours

Therapeutic&

Cosmesis

Trained DermatologistResurfacing of scars

Intense pulse light laser system

Hair removal, resurfacing of scars, photo rejuvenation

Pigment laser system Hyperpigmented disorders, tattoos,hair removal

Vascular laser system Port wine stains, haemangioma, telangiectasia / varices

64

Table 2: Available Therapeutic and Diagnostic Facilities in Dermatology

No Data to Date

Table 3: Available Medical Devices in Dermatology

Population CO2 Laser system

Other Laser systems

PhototherapyUVb

PhototherapyPUVA


Malaysia 26.64 7 100 0 7 100 0 12 100 0 27 100 1


StateJohor 3.17 1 14 0 0 0 0 2 17 1 2 7 1Kedah & Perlis 2.11 1 14 0 0 0 0 1 8 0 2 7 1Kelantan 1.53 0 0 0 0 0 0 0 0 0 1 4 1Melaka 0.73 1 14 1 1 17 1 0 0 1 2 7 3Negeri Sembilan 0.96 1 14 1 2 33 2 1 8 1 1 4 1Pahang 1.45 1 0 1 0 0 0 1 8 1 1 4 1Perak 2.28 0 0 0 0 0 0 1 8 0 2 7 1Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0Pulau Pinang 1.49 1 14 1 0 0 0 0 0 0 1 4 1Sabah 3 0 0 0 0 0 0 1 8 0 1 4 0Sarawak 2.36 0 0 0 1 17 0 2 17 1 2 7 1Selangor & W.P Kuala Lumpur 6.43 1 14 0 2 33 0 3 25 0 12 44 2

Population Cryosurgical Unit Electrosurgical Unit Iontophoresis Unit No in million No % pmp No % pmp No % pmp

Malaysia 26.64 38 100 1 26 100 1 14 100 0

SectorPublic - NC - NC - NC -Private - NC - NC - NC -

StateJohor 3.17 5 13 2 3 12 1 3 21 1Kedah & Perlis 2.11 4 11 2 4 15 2 3 21 1Kelantan 1.53 1 3 1 1 4 1 0 0 0Melaka 0.73 2 5 3 3 12 4 0 0 0Negeri Sembilan 0.96 2 5 2 2 8 2 1 7 1Pahang 1.45 2 5 1 1 4 1 0 0 0Perak 2.28 4 11 2 2 8 1 1 7 0Terengganu 1.04 2 5 2 1 4 1 0 0 0Pulau Pinang 1.49 4 11 3 2 8 1 1 7 1Sabah 3 2 5 1 2 8 1 1 7 0Sarawak 2.36 5 13 2 2 8 1 1 7 0Selangor & W.P Kuala Lumpur 6.43 5 13 1 3 12 0 3 21 0

65

The National Medical Device Survey was conducted by the Clinical Research Center in year 2007. Two hundred and fifty three hospitals were surveyed. The response to the survey is shown in Fig. 1

Fig. 1 National Medical Device Survey 2007 Respondents

Hospital surveyedn=253

Hospital with Dermatology services

n=78

Hospital with no Dermatology services

n=175

Hospital with Dermatologyservices that responded

n=47

Hospital with Dermatologyservices that did not respond

n=31

MOH & Army Hospitals withDermatology services

n=31

Private Hospitals withDermatology services

n=13

University Hospitals withDermatology services

n=3

Johorn=3

Pahangn=1

Malaccan=2

UMMC

UKM

USM

Selangorn=5

WilayahPersekutuan

n=1

Perakn=1

Penangn=1

Sabahn=1

Sarawakn=1

Malaccan=1

Terengganun=1

N. Sembilann=2

Kelantann=3

Selangorn=5

Perlisn=1

WilayahPersekutuan

n=1

Sabahn=3

Perakn=3

Sarawakn=2

Kedahn=4

Penangn=1

66

The National survey investigation enabled a more comprehensive understanding of the availability and use of dermatological devices both in the public and private sectors. Nevertheless the response rate of only 60.2 % could be improved in the future surveys.

Fig. 2 Malaysian Population Accessibility to Dermatology Medical Devices in Year 2007

CO2 Laser System

Other Laser System

Phototherapy (UVB)

Phototherapy (PUVA)

Cryosurgical Unit

Electrosurgical Unit

Iontophoresis Unit

PERLIS

PENANG1.49 Million

PERAK2.28 Million

PAHANG1.45 Million

KELANTAN1.53 Million TERENGGANU

1.53 Million

SELANGOR &WILAYAH PERSEKUTUAN

2.11 Million

MELAKA2.36 Million

N. SEMbILAN2.36 Million

jOHOR2.36 Million

KEDAH

2.11 Million1 4

43

* The numbers in the figures above denote the quantity of equipment available.

Key :

1

1

1

4 2

1 1

14 2

1

1 2

1

1

1 2

1

1 2

3 12

5 3

3

2

11

1

1

12

121

21

11

2 2

3

21 2

332

67

The data in this report is limited by the absence of data from stand alone clinics providing Dermatology service which was not surveyed and the under reporting of availability of the device in private hospitals. Nevertheless, the effort by the National Medical Device Survey team has enabled the government as well as the private sector to plan for the future expansion and assure availability of appropriate dermatological devices both in private and public sectors to meet the needs of the Malaysian public and for medical tourism.

SARAWAK2.36 Million

SAbAH2.36 Million

1

2 2

1 1

1 2

1

2 5

2

69

CHAPTER 17OTORHINOLARYNGOLOGY AND AUDIOLOGYFACILITIES AND DEVICES

Authors/Contributors :Prof Madya Dr. Rahmat Omar1, Dato’ Dr. Abdul Majid Md Nasir2, Dr. Junainah Sabirin3, Muhammad Almyzan Awang4, Nor Shahrina Mohd Zawawi4

1 Pusat Perubatan Universiti Malaya, 2 Hospital Kuala Lumpur, 3 Cawangan Penilaian Teknologi Kesihatan, 4 Pusat Perubatan Universiti Kebangsaan Malaysia.

Response RatesOtorhinolaryngology : 47 hospitals and medical centers did not respond to the NMDS survey despite the availability of ORL services. These include 22 within Selangor and Kuala Lumpur, which are expected to be within reach of this survey. The results are expected to change dramatically as more centers respond in the future.

Audiology : 59 hospitals that responded have no audiology services. These include several well-established hospital likes Pusat Pakar Tawakal, Pantai Cheras Medical Center and Hospital PUSRAWI Sdn Bhd. Even high bed strength hospitals like Likas Hospital and Sultan Ismail Hospital, Johor Bahru have no audiology services.

Table 1: Available Therapeutic and Diagnostic Facilities in Otorhinolaryngology and Audiology.

Population Sound Treated Room Speech Lab


Malaysia 26.64 10 100 0 4 100 0

Sector

Public - 4 40 2 50

Private - 6 60 2 50

State

Johor 3.17 1 10 0 1 25 0

Kedah & Perlis 2.11 0 0 0 0 0 0

Kelantan 1.53 1 10 1 0 0 0

Melaka 0.73 0 0 0 1 25 1


Pahang 1.45 0 0 0 0 0 0

Perak 2.28 0 0 0 0 0 0

Terengganu 1.04 0 0 0 0 0 0

Pulau Pinang 1.49 2 20 1 0 0 0

Sabah 3 1 10 0 0 0 0

Sarawak 2.36 2 20 1 0 0 0


70

Figures in the table above reflected under-reporting and does not correspond with the expected availability especially in the city like those within Selangor and W.P.Kuala Lumpur as well as Johor Bahru.

Table 2: Available Medical Devices in Otorhinolaryngology and Audiology.

Population

Auditory brainstem

Response (AbR) Unit

(portable and static)

Portable Auditory

brainstem Response (AbR)

Unit

Otoacoustic Emission (OAE)

Unit(portable and

static)

Portable Otoacoustic

Emission (OAE) Unit


Malaysia 26.64 55 100 2 24 100 1 65 100 2 42 100 2

Sector

Public - 38 69 16 67 45 69 30 71

Private - 17 31 8 33 20 31 12 29

State

Johor 3.17 4 7 1 2 8 1 7 11 2 4 10 1

Kedah & Perlis 2.11 2 4 1 1 4 0 3 5 1 2 5 1

Kelantan 1.53 3 5 2 1 4 1 7 11 5 5 12 3

Melaka 0.73 2 4 3 1 4 1 2 3 3 2 5 3

Negeri Sembilan 0.96 3 5 3 1 4 1 3 5 3 2 5 2

Pahang 1.45 4 7 3 1 4 1 4 6 3 3 7 2

Perak 2.28 4 7 2 3 13 1 3 5 1 3 7 1

Terengganu 1.04 2 4 2 1 4 1 2 3 2 2 5 2

Pulau Pinang 1.49 7 13 5 4 17 3 6 9 4 5 12 3

Sabah 3 3 5 1 2 8 1 3 5 1 1 2 0

Sarawak 2.36 3 5 1 1 4 0 4 6 2 2 5 1


71

PopulationAudiometer (static and portable)

Portable Audiometer

Functional Endoscopic

Sinus Surgery system (FESS)

Microdebrider System


Malaysia 26.64 22 100 1 65 100 2 40 100 2 32 100 1



Population ORL Endoscopic Camera System (flexible and rigid)




As expected, there were more FESS systems as compared to microdebrider systems as the former is more commonly used for sinus surgery. However the microdebrider system is gaining more acceptance as technology advances.

73

CHAPTER 18OPHTHALMOLOGY AND OPTOMETRY FACILITIES AND DEVICES

Edited by :Datin Dr. Mariam Ismail1, Dr. Goh Pik Pin1

With contribution from :Dato’ Dr. Balaravi Pillai2; Dato’ Dr.Vasantha Kumar3, Dr. Mutalib Othman4, Dr. Jamalia Rahmat5

1 Selayang Hospital, 2 Ipoh Hospital, 3 Hospital Tengku Ampuan Afzan, 4 Queen Elizabeth Hospital,5 Kuala Lumpur Hospital

INTRODUCTIONOphthalmology and optometry services are amongst the highly technology dependent services, where devices are used in the examination of patients, investigation and procedures to arrive at a diagnosis and plan patient management. In addition, devices in these fields are being revised, improved with new features and newer technology introduced all the time.

Results of the first 2007 National Medical Device Survey have a poor response rate. Out of the 256 health care providers, 141 (55.1%) responded to the survey. Response rate was slightly higher among Ministry of Health (MOH only) facilities, 60.6% as compared to private facilities (48.7%). Among the 141 respondents, 95(67.4%) provide and 46 (32.6%) did not provide ophthalmology and optometry service. Hence, the 2007 survey findings are not really representative and only findings on essential facilities and devices that are considered fairly reliable are reported.

A subsequent phone survey was conducted from 21 July to 25 July 2008 on 36 MOH ONLY Ophthalmology departments and 9 district hospitals with Optometrists but without Ophthalmologist. These data collated by the expert panel replaced the NMDS data where they were deemed necessary.

Results

Therapeutic and Diagnostic Facilities

Of the 95 centres with ophthalmology services that responded, 28 (29.5%) have an eye casualty clinic, a clinic which see ‘walk –in’ patients with acute or emergency eye problems. More than half of the eye care facilities have a laser room (53, 55.8%).

Ophthalmology and Optometry Medical Devices

Though the survey includes all types of medical devices used in ophthalmology and optometry services, we report only essential devices required to provide eye care service such as A scan and phacoemulsification unit for cataract surgery, imaging such as B scan, fundus camera and Ophthalmic laser systems.

A Scan, B Scan and Phacoemulsification Machine

Survey findings indicated that there are 118 A scan, 64 B Scan and 76 phacoemulsification units. The states with the highest number of these devices are Selangor and Wilayah Persekutuan and Penang. The state with the highest number of A and B Scan per million population is Penang whilst Melaka ranks highest for phacoemulsification unit. (Table 2)

74

Fundus camera

Survey results showed availability of 40 fundus cameras in ophthalmology clinics that is one fundus camera per million population in Malaysia. Of these, more than half are in the public eye care facilities. The state with the highest number of fundus camera is Selangor and Wilayah Persekutuan and Penang. (Table 2). This survey did not include fundus cameras located at the Ministry of Health Klinik Kesihatan for the screening of diabetic retinopathy.

Ophthalmic Laser System

The most common laser machine available is Argon laser (58 units), followed by Nd YAG laser (46 units), Diode laser (26 units) and Endolaser (19 units). Most of these lasers are located in public hospitals. (Table 2)

DISCUSSION / CONCLUSIONData collected from the National Medical Device survey 2007 are incomplete and thus not representative. Effort in getting more complete return with better approach will be done for 2008 survey.

Table 1: Available Therapeutic and Diagnostic Facilities in Ophthalmology and Optometry Specialties.

Population Eye Casualty Clinic

Ophthalmology Laser Room Refraction Room


Malaysia 26.64 28 100 1 53 100 2 - - -

Sector

Public - 22 79 33 62 46 -

Private - 6 21 20 38 ND -

State

Johor 3.17 2 7 1 4 8 1 4 10 1

Kedah & Perlis 2.11 4 14 2 4 8 2 5 12 2

Kelantan 1.53 1 4 1 3 6 2 2 5 1

Melaka 0.73 3 11 4 4 8 5 1 2 1

Negeri Sembilan 0.96 2 7 2 2 4 2 2 5 2

Pahang 1.45 1 4 1 2 4 1 1 2 1

Perak 2.28 3 11 1 5 9 2 4 10 2

Terengganu 1.04 1 4 1 1 2 1 2 5 2

Pulau Pinang 1.49 3 11 2 7 13 5 2 5 1

Sabah 3 0 0 0 3 6 1 6 14 2

Sarawak 2.36 0 0 0 5 9 2 6 14 3

Selangor & W.P Kuala Lumpur 6.43 8 29 1 13 25 2 7 17 1

75

Table 2: Available Medical Devices in Ophthalmology and Optometry Specialties.

Population A scan b ScanPhaco-

emulsification machine

Fundus Camera


Malaysia 26.64 118 100 4 64 100 2 76 100 3 40 100 1



Population Slit Lamp Indirect Ophthalmoscope

Anterior Segment Camera

Operating Microscope


Malaysia 26.64 - - - - - - - - - - - -

SectorPublic - 267 - 143 - 18 - 83 -Private - ND - ND - ND - ND -


76

Population Cryo Machine Vitrectomy Machine


Malaysia 26.64 - - - - - -

SectorPublic - 32 - 28 -Private - ND - ND -

StateJohor 3.17 1 3 0 3 11 1Kedah & Perlis 2.11 6 19 3 5 18 2Kelantan 1.53 2 6 1 1 4 1Melaka 0.73 0 0 0 1 4 1


Pahang 1.45 2 6 1 1 4 1Perak 2.28 3 9 1 0 0 0Terengganu 1.04 1 3 1 1 4 1Pulau Pinang 1.49 1 3 1 1 4 1Sabah 3 1 3 0 1 4 0Sarawak 2.36 3 9 1 2 7 1

Selangor & W.P Kuala Lumpur 6.43 10 31 2 11 39 2

Ophthalmic Laser Systems

Population Nd. YAG Endolaser Nd. Argon Diode


Malaysia 26.64 46 100 2 19 100 1 58 100 2 26 100 1


StateJohor 3.17 3 7 1 0 0 0 5 9 2 3 11 1Kedah & Perlis 2.11 4 8 2 4 21 2 4 7 2 3 11 1Kelantan 1.53 0 0 0 1 5 1 3 5 2 2 8 1Melaka 0.73 3 7 4 1 5 1 3 5 4 1 4 1N. Sembilan 0.96 0 0 0 0 0 0 2 3 2 1 4 1Pahang 1.45 2 4 1 0 0 0 2 3 1 3 12 2Perak 2.28 3 7 1 1 5 0 4 7 2 2 8 1Terengganu 1.04 1 2 1 1 5 1 1 1 1 0 0 0Pulau Pinang 1.49 8 17 5 3 16 2 7 12 5 2 8 1Sabah 3 4 9 1 1 5 0 5 9 2 1 4 0Sarawak 2.36 2 4 0 1 5 0 4 7 2 1 4 0


77

Population Excimer


Malaysia 26.64 4 100 0

Sector

Public - 1 25

Private - 3 75

State

Johor 3.17 1 25 0

Kedah & Perlis 2.11 0 0 0

Kelantan 1.53 0 0 0

Melaka 0.73 0 0 0

Negeri Sembilan 0.96 0 0 0

Pahang 1.45 0 0 0

Perak 2.28 0 0 0

Terengganu 1.04 0 0 0

Pulau Pinang 1.49 1 25 1

Sabah 3 1 25 0

Sarawak 2.36 0 0 0

Selangor & W.P Kuala Lumpur 6.43 1 25 0

79

CHAPTER 19 GAPS IN MEDICAL TECHNOLOGY IN MALAYSIA

Table 19.1 Imaging & Diagnostic Technologies.

# Gaps in Medical Technologyin Malaysia Expert Opinion Rank of

Importance

1. High Resolution Computed Tomography (CT) system for Neuroradiology and Cardiac work.

Availability: Marketed. Function: Diagnostic.Existing Alternative Options: MRI, angiographyClinical Effectiveness: Capable to reduce up to 25% of interventional neuroangiography, excellent perfusion CT angiography.Life-Saving Outcomes: Improves selection criteria for interventional neuroangiography with improved outcomes.Health-Cost Implications: Will increase health cost but maybe offset by more selective neuro –angiograms.Safety Issues: Increase radiation dose.Prioritization: Required in the next 5 years.

1

2. Cone-beam Breast Computed Tomography (CBBCT)

Availability: Experimental Function: Diagnostic.Existing Alternative Options: Mammography, ultrasonography.Clinical Effectiveness: Higher resolution hence more sensitive. Radiation dose comparable to 2-view mammography, imaging post op breast with deformity.Life-Saving Outcomes: Improves image quality with 3-D images, hence improving cancer detection rates.Health-Cost Implications: Increase true put, duration of scan less than 1 minute.Safety Issues: - Prioritization: To be introduced within the next 5 years.

2

3. Magnetic resonance spectroscopy

Availability: Marketed Function: DiagnosticExisting Alternative Options: -Clinical Effectiveness: -Life-Saving Outcomes: Faster and more accurate diagnosis.Health-Cost Implications: Increased access to MRI and increased unit cost compared to alternative.Safety Issues: Quick and less radiation.Prioritization: To be introduced within the next 5 years.

3

80

Table 19. 2 Oncology Technologies.


Importance

1. Helical TomoTherapy machine. Availability: Marketed. Function: Therapeutic.Existing Alternative Options: Linear accelerator.Clinical Effectiveness: Less morbidity associated with treatment, better dose escalation. Good to consider technological improvement in terms of reduction radiation exposure.Life-Saving Outcomes: Better with more precise treatment.Health-Cost Implications: Very expensive machine, treatment cost per patient is very much higherSafety Issues: Increased risk if used by inexperienced doctorsPrioritization: To be introduced within the next 5 years.

1

81

Table 19. 3 Anaesthesiology and Intensive Care Technologies.


Importance

1. Whole-body cooling system. Availability: Marketed. Function: Assistive.Existing Alternative Options: Water blankets/ mattresses.Clinical Effectiveness: Avoids immediate and long- term morbidity associated with hypothermia. Ease of use and easier monitoring.Life-Saving Outcomes: Reduces mortality and morbidity associated with newborn hypothermia.Health-Cost Implications: Less costly than selective head cooling system.Safety Issues:Prioritization: To be reintroduced within the next 2 years

1

2. Amplitude-integrated Electroencephalography (aEEG)

Availability: Marketed Function: Diagnostic and assistiveExisting Alternative Options: Clinical assessment. The conventional full 12-lead EEG for the same indication is impractical.Clinical Effectiveness: Detection of seizures, level of consciousness, state of sleep or sedation of baby. Able to provide trending over a period of time especially for newborns with moderate to severe birth asphyxia.Life-Saving Outcomes: Health-Cost Implications: Safety Issues: Need to interpret aEEG correctly.Prioritization: To be introduced within the next 2 years.

2

3. Infant Transport Mattress Availability: Marketed. Function: Assistive.Existing Alternative Options: None.Clinical Effectiveness: This chemical mattress is used together with the overhead radiant warmer during the resuscitation of extremely low birth weight babies and transport to the neonatal intensive care (NICU) following the resuscitation. This would avoid the complications of hypothermia.Life-Saving Outcomes: Reduces mortality.Health-Cost Implications: -Safety Issues: May occasionally overheat the baby.Prioritization: To be introduced within the next 5 years.

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4. Olympic Cool Cap System for Selective Head Cooling

Availability: Marketed. Function: Therapeutic.Existing Alternative Options: Supportive therapy, no definitive therapy available.Clinical Effectiveness: Has been shown to reduce mortality and neuro-developmental abnormalities associated with birth asphyxia. Induced hypothermia needs to be carefully controlled and Cool Cap is often used with amplitude EEG monitoring. Life-Saving Outcomes: Reduces mortality.Health-Cost Implications:

1. Expensive system may not be easily available. 2. Total cost with EEG is about RM200,000.

However, if effective in reducing disabilities, it may save cost of rehabilitation for both parents and the Ministry of Health.

Safety Issues: 1. FDA approved.2. Complications associated with hypothermia3. Sinus bradycardia, arrhythmias, hypotension,

coagulopathy and increased risk of infections 4. Does technology reduce mortality but increase

major disability in survivors?Prioritization: To be introduced within the next 5 years.

Additional comments: 1. Although theoretically, the whole body cooling

system is more effective, there are no studies comparing these two modalities and results of 3 large multicentre randomized clinical trials on the safety and effectiveness of the whole body cooling systems are still pending.

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Table 19.4 Orthopaedic and Traumatology Technologies.


Importance

1. ISO-C C-ARM Imaging System. Availability: Marketed. Function: Assistive.Existing Alternative Options: -Clinical Effectiveness: Very good reduced morbidity.Life-Saving Outcomes: Very good. Health-Cost Implications: Cost effective.Safety Issues: X-ray precautions are required.Prioritization: Urgent introduction required.

1

2. Radiolucent operating tables. Availability: Marketed.Function: Assistive.Existing Alternative Options: -Clinical Effectiveness: Very good reduced morbidityLife-Saving Outcomes: Very good Health-Cost Implications: Cost effective.Safety Issues: -Prioritization: Urgent introduction required.

2

3. Navigation systems for trauma surgery.

Availability: Marketed Function: AssistiveExisting Alternative Options: -Clinical Effectiveness: Very good reduced morbidity.Life-Saving Outcomes: Very good.Health-Cost Implications: Cost effectiveSafety Issues: NilPrioritization: Urgent introduction required.

3

4. SomatoSensory Evoked Potential (SSEP) device for intraoperative monitoring during cervical spine surgery.(Used in combination with Motor Evoked Potential (MEP))

Availability: Marketed Function: AssistiveExisting Alternative Options: -Clinical Effectiveness: Very good reduced morbidityLife-Saving Outcomes: Very good Health-Cost Implications: Cost effective.Safety Issues: -Prioritization: Urgent introduction required.

4

5 Bone morphogenic proteins. Availability: Marketed Function: Therapeutic.Existing Alternative Options: Other modalities such as Autologous Bone Graft and Synthetic. Bone Graft.Clinical Effectiveness: For faster fracture union and very good reduced morbidity.Life-Saving Outcomes: Very good. Health-Cost Implications: Cost effective.Safety Issues: -Prioritization: see other existing technologies currently being used.

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Table 19.5 Physiotherapy and Occupational Therapy Technologies.

# Gaps in medical Technologyin Malaysia Expert Opinion Rank of

Importance

1. Real Time Ultrasound Imaging (Physiotherapy)

Availability: Marketed Function: Diagnostic and therapeuticExisting Alternative Option: NilClinical Effectiveness: Enables identification of inflammation, tears and ruptures, lesions, fluid collections and soft tissues masses so that intervention can be specific to the problems. Muscle actions can be viewed and used to assist patients to work effectively.Life – saving outcomes: Improves quality of patients’ lifeHealth – Cost Implication: RM60,000,00. It is cost effective in the long term because it can be applied and used in measurement and reeducation of muscles in musculoskeletal and uro-gynaecological cases.Safety Issues: minimal effectsPrioritization: to introduced in the next 2 years.

1

2. VO2max Indirect Spirometry with gas analysis - O2 consumption and CO2 production

Availability: Marketed Function: Diagnostic purposeExisting Alternative Option: Portable oxymeter.Clinical Effectiveness: To determine lung function, gas exchange & secretion retention in the lung.Life-Saving outcomes: Improves quality of lifeHealth-Cost Implication: RM 50,000.00 (Moderate cost)Safety Issues: Minimal effectsPrioritization: High

1

3. Acapella Counterweighted plug and accessories

Availability: Marketed. Function: Therapeutic and Assistive.Existing Alternative Option: Flutter.Clinical Effectiveness: Effective in secretion clearance and improves lung ventilation.Life-Saving outcomes: Small device easy to use, can be administered by patient with minimal supervision from clinicians.Health-Cost Implication: Low cost below RM 5000.00Safety Issues: Minimal effects.Prioritization: Urgent introduction required

1

4. E-link Upper and Lower Extremity evaluation and exercise system

Availability: Marketed Function: Therapeutic / Preventive / DiagnosticExisting Alternative Option: Manual techniques and varieties of evaluation tools e.g goniometer, measuring tape, sensory evaluation tools etc.Clinical Effectiveness: Able to accurately and objectively assesses joints and motor performance and to plan appropriate therapeutic interventions according to patients’ needs.Life – Saving outcomes: Improve patients’ quality of lifeHealth – Cost Implication: RM200,000.00. Reduce cost of hospitalization as precise plan of treatment can be undertaken according to the patients’ impairment.Safety Issues: Minimal effectsPrioritization: To be introduced within next 5 years.

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5. High Frequency Radial Shockwave Therapy

Availability: Marketed. Function: Therapeutic.Existing Alternative Option: Ultrasound therapy and laser therapy.Clinical Effectiveness: Shown to be effective in pain management of musculoskeletal conditions based on the mechanical application of vibrating pulses to tensed, shortened or overstretched muscles and tendons by means of the shock frequencies.Life-Saving outcomes: Improves quality of patients’ life.Health-Cost Implication: RM70,000,00. Effective treatment outcome is effective and duration of treatment is shortened compared to conventional therapeutic devices.Safety Issues: Minimal effectsPrioritization: to be introduced in next 5 years.

3

6. Muscle tester with Mega EMG system

Availability: Marketed Function: DiagnosticExisting Alternative Option: Nil Clinical Effectiveness: Measurement of muscles performance and biomechanic analysis and its’ data can be processed for research purposes. Easy application in the field, treatment room or in biomechanics laboratoryLife-Saving outcomes: Evidence based measurementHealth-Cost Implication: Low cost. (Below RM100, 000)Safety Issues: Relatively very safePrioritization: To introduced in the next 2 years.

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7. Pediatric Lokomat, Intensive Locomotion Therapy for children

Availability: Marketed Function: Therapeutic and Assistive Existing Alternative Option: Manually assisted ambulation.Clinical Effectiveness: Effective intervention for improving walking function in children with disabilities. Life-Saving Outcomes: Reduced the manual labour required for ambulation training. More efficient in achieving treatment goals.Health-Cost Implication: High cost more than RM100, 000.00Safety Issues: Minimal effectsPrioritization: To introduced in next 5 years.

5

8. Gait analyzer Availability: Marketed. Function: Assessment of impairment.Existing Alternative Option: digital video camera. Clinical Effectiveness: Shown to be accurate in analyzing gait impairment enable the therapist to make appropriate physiotherapy impression in order to plan physiotherapy management.Life-Saving Outcomes: Improve patients’ quality of life.Health-Cost Implication: RM 500,00.00. Reduce cost of hospitalization as precise plan of treatment can be undertaken according to the patients’ impairments. Safety Issues: minimal effectsPrioritization: to be introduced within next 5 years

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9. Balance system – static and dynamic balance testing and training with five interactive training modes (Biodex)

Availability: Marketed.Function: Therapeutic and diagnostic.Existing Alternative Option: Balance foam for balance training.Clinical Effectiveness: Effective in balance training for patients with vestibular impairment or neurological conditions especially in geriatrics. Provides fast and accurate fall risk assessment plus closed chain, weight bearing assessment and training for lower extremity training. Life-Saving Outcomes: Improves quality of life.Health-Cost Implication: Moderate cost RM100, 000.00.Safety Issues: Minimal effectsPrioritization: To be introduced in the next 5 years.

7

Note: 1. The Acapella and Vo2 max indirect spirometry with gas analysis are urgently required for effective chest care and

respiratory rehabilitation.2. Real Time Ultrasound Imaging (Physiotherapy) is our top priority in view of physiotherapists’ expanded role in the

care of musculoskeletal problems and urogynaecology cases. With this machine, we are able to provide more effective treatment by active participation from patients through viewing of images of muscle work on the screen which is in line with our evidence-based practice.

3. The DBC is the least priority among others because of its high costs and maintenance, and also the space required to place the machine. Besides this, there is a requirement for staff to be well and intensively trained before they are confident enough to handle the machine. Though it is a machine with high technology but it only benefits a small client group such as the industrial workers for the purposes of compensation.

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Table 19.6 Obstetrics and Gynaecology Technologies.

# Gaps in Medical Technology in Malaysia Expert Opinion Rank of

Importance

1. Polar probe. Availability: Marketed Function: Diagnostic (Screening for cervical cancer)Existing Alternative Options: PAP Smear or spectrometry.Clinical Effectiveness: Can be used on its own or as an additional test for screening. Studies have shown that use of polar probe increases overall detection and reduces the false negative rate by pap smear. Many previous trials conducted with sensitivity and specificity of 98 and 91% respectively.Life-Saving Outcomes: Reduces morbidity and mortality associated with cervical cancer.Health-Cost Implications: This system offer faster, simpler and cost effective standardized diagnosis.Safety Issues: -Prioritization: Required in the next 5 yrs.

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2. Cryoprobe. Availability: Marketed.Function: Therapeutic.Existing Alternative Options: Conventional treatment.Clinical Effectiveness: Enables cervical cryosurgery to be conducted. The equipment is cheap, easy to maintain and has a short learning curve.Life-Saving Outcomes: Treatment failure is observed in about 5-10% of women. Health-Cost Implications: -Safety Issues: Limitations include: 1. Cryosurgery is not usually feasible for large

abnormal areas. 2. The procedure removes abnormal, but

noncancerous, tissue by freezing it.3. As a result of the procedure, some patients

experience cramping, watery discharges, temporary changes in menstrual periods and increased risk of transmissibility of HIV infection.

However, cryosurgical treatment is very well tolerated by patient as there is little to no discomfort in most cases, negating the requirement of anaesthesia. It is considered safe with minimal complication and less than 1% develops cervical incompetence and no effect on fertility. Prioritization: To be introduced within the next 5 years.

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3. AmniSure Placental Alpha Microglobulin-1 Rapid Immunoassay

Availability: Marketed Function: DiagnosticExisting Alternative Options: - All current methods used are deficient in diagnosing Premature Rupture of Membrane (PROM).Clinical Effectiveness: A rapid bedside strip test that can detect rupture of foetal membranes with a high degree of predictive accuracy. Testing for PAMG-1 increases the sensitivity of detecting small quantities of amniotic fluid in the vagina.Life-Saving Outcomes: Reduces both maternal and foetal morbidity and mortality related to premature ruptures of membranes.Health-Cost Implications: As aboveSafety Issues: -Prioritization: To be introduced within the next 5 years.

3

4. Robotics surgery equipment Availability: Marketed Function: DiagnosticExisting Alternative Options: Conventional medical treatment / surgery including laparoscopic surgery. Clinical Effectiveness: It utilizes high definition 3-dimension vision and intuitive motion and therefore, gives greater ability to dissect compromised anatomy and tissue places as well as ability to operate on large pathology and obese patients. There is superior visualization of tissue planes, superior ability to reconstruct defect and more precise and potentially safer dissection of pelvic pathology.Life-Saving Outcomes: As above.Health-Cost Implications: Less pain with fewer complications and shorter hospital stays. Therefore, patients may have faster recoveries. Safety Issues: -Prioritization: Robotics is a surgical avenue that has to be assessed for its potential in future gynaecological surgery.

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Table 19.7 Neurology Technologies.


Importance

1. Stroke unit facility. Availability: -Function: Therapeutic.Existing Alternative Options: -Clinical Effectiveness: Various clinical papers on effectiveness of having a stroke unit.Life-Saving Outcomes: Improve outcome morbidity.Health-Cost Implications: -Safety Issues: -Prioritization: Urgent introduction required.

1

2. 256-slice computed tomography (CT) system.

Availability: Marketed Function: DiagnosticExisting Alternative Options: MRI, angiography.Clinical Effectiveness: Capable to reduce up to 25% interventional neuroangiographies, excellent perfusion CT angiography.Life-Saving Outcomes: Improve selection criteria for interventional neuro-angiographies with improved outcomes.Health-Cost Implications: Will increase health cost but maybe offset by more selective neuroangiograms.Safety Issues: Increase radiation dose.Prioritization: Urgent introduction required (should be come along with stroke unit facility)

2

3. Computer software to register all stroke patients.

Availability: Marketed Function: AssistiveExisting Alternative Options: -Clinical Effectiveness: Facilitate clinical audit/ research studies.Life-Saving Outcomes: -Health-Cost Implications: -Safety Issues: -Prioritization: Required urgently in public hospitals.

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4. Serology testing for paraneoplastic panel/antibodies

Availability: Marketed.Function: Diagnostic.Existing Alternative Options: serology conducted in Australia.Clinical Effectiveness: Detect and confirm paraneoplastic syndromes based on presence of paraneoplastic antibodies.Life-Saving Outcomes: Early treatment with immunomodulating therapies.Health-Cost Implications: Improve quality of life, reduce mortality.Safety Issues:Prioritization: Urgent introduction required.

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5. MERCI Clot Retriever. Availability: Marketed Function: Therapeutic.Existing Alternative Options:Clinical Effectiveness: MERCI trial published.Life-Saving Outcomes: Improves morbidity outcomes.Health-Cost Implications:-Safety Issues:-Prioritization: Required in the next 5 years.

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6. VNS Therapy device.

Availability: Marketed/ experimental.Function: Therapeutic.Existing Alternative Options: -Clinical Effectiveness: Used for treatment-resistant epilepsy and in treatment-resistant depression, VNS Therapy may provide limited relief as an adjunctive treatment for long-term depression patients.Life-Saving Outcomes: Reduces the number of suicides in the long term.Health-Cost Implications: -Safety Issues: No new evidence for safety and effectiveness.Prioritization: -

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Table 19.8 Psychiatry and Mental Health Technologies.


Importance

1. Transcranial Magnetic Stimulation (TMS) device.

Availability: Experimental.Function: Therapeutic.Existing Alternative Options: Antidepressant Therapy, Psychotherapeutic Interventions & Electroconvulsive TherapyClinical Effectiveness: Uncertain.Life-Saving Outcomes: No.Health-Cost Implications: Cost of purchasing machines Safety Issues: Not reported.Prioritization: Required within the next 5 years.Comments:It is currently considered an alternative when everything else fails, or those who are not keen to undergo ECT. In USA, it is not approved yet by FDA and its use is for research purposes.

To be considered when more evidence

available

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Table 19. 9 Cardiology and Cardiothoracic Surgery Technologies.


Importance

1. Emerging Biomarkers Availability: ExperimentalFunction: Preventive and diagnostic.Existing Alternative Options: -Clinical Effectiveness: Research purposes. (need for local community data)Life-Saving Outcomes: Potentially life-saving.Health-Cost Implications: Cost will be higher at the initial stages.Safety Issues: -Prioritization: Urgent introduction required.

1

2. Hand held Echocardiography unit (community based use).

Availability: Marketed Function: Preventive and Diagnostic.Existing Alternative Options: Currently available hospital based. Clinical Effectiveness: Reasonable but technologies continue to improve.Life-Saving Outcomes: Enables earlier referrals well as avoids unnecessary referrals.Health-Cost Implications: Earlier diagnosis of heart failure and valvular heart disease.Safety Issues: -Prioritization: Community-based use should be introduced urgently or at least within the next five years.

2

3. Percutaneous valvular interventions.

Availability: Marketed/ Experimental Function: Therapeutic.Existing Alternative Options: -Clinical Effectiveness: There has been continuous improvement in this technology and will definitely replace surgery.Life-Saving Outcomes: Life–saving.Health-Cost Implications: Technology will progressively be cheaper compared to surgery.Safety Issues: -Prioritization: Technology should be introduced urgently or at least within the next five years.

3

4. Percutaneous Left Ventricular Assist device.

Availability: MarketedFunction: AssistiveExisting Alternative Options: Intra-aortic balloon pump.Clinical Effectiveness: Bridge to transplant.Life-Saving Outcomes: Prolongs life.Health-Cost Implications: $200,000 initial costSafety Issues: Unsuitable for long term usePrioritization: Urgent introduction required.

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5. Stereotactic Intervention Availability: Marketed/ Experimental Function: Diagnostic and therapeutic.Existing Alternative Options: -Clinical Effectiveness: Allows remote control without the need for radiation. Life-Saving Outcomes: Technology is replacing the current percutaneous techniques.Health-Cost Implications: Need to be looked into.Safety Issues: -Prioritization: To be introduced within the next five years. To be considered

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Table 19. 10 Respiratory Technologies.


Importance

1. Positive Expiratory Pressure Devices (PAP) with mask/ mouthpiece

Availability: Marketed and availableFunction: Therapeutic.Existing Alternative Options:1) Autogenic drainage techniques.2) Active cycles of breathing techniques.Clinical Effectiveness: Provide constant backpressure to airways during expiration to assist / improve secretion clearance by building up gas behind mucus via collateral ventilation. Shown to be effective in secretion clearance.Life-Saving Outcomes: -Health-Cost Implications: Low cost.Safety Issues: -Prioritization: Urgent introduction required.

1

2. Smartinhaler. Availability: Experimental. Not availableFunction: Therapeutic.Existing Alternative Options: -Clinical Effectiveness: A digital asthma management device that incorporates a microcomputer for automated collection of data on medication usage, lung function and dose reminder alarm. The data are uploaded online by the patient, and is accessible to their clinician. Life-Saving Outcomes: Reduces morbidity, improves quality of life of patient and potential decrease in use of emergency care. Health-Cost Implications: Increased cost compared to alternative treatment option. The increased cost in capital investment may be offset by the potential reduction in emergency care due to improved patient management.Safety Issues: Diarrhoea.Prioritization: Urgent introduction needed

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3. Serum Procalcitonin (PCT) test kit. Availability: Marketed. Function: Diagnostic and assistive.Existing Alternative Options: Blood cultures (lower sensitivity and specificity especially in nosocomial infection).Clinical Effectiveness: Effective in diagnosing and identifying nosocomial pneumonia accurately. It is useful as a marker of severe sepsis.Life-Saving Outcomes: Patients have good outcome. It is critical in the intensive care setting.Health-Cost Implications: It is very cost- effective as patients with SIRS and sepsis can be differentiated. It avoids unnecessary treatment.Safety Issues: -Prioritization: Urgent introduction required.

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4. Pneumococcal Antigen test Availability: Marketed. Function: Diagnostic.Existing Alternative Options: Culture and sensitivity tests. Organism identification is difficult to obtain due to poor yield via sputum or blood. In addition, they are lengthy and less reliable.Clinical Effectiveness: Provides quick results to identify definite organism (Streptococcus Pneumonia)Life-Saving Outcomes: Patients have better outcome as appropriate antibiotic choice will be given to patients. Health-Cost Implications: This 15- minute urine dipstick test is able to diagnose Pneumococcal Pneumonia and cuts down unnecessary invasive investigations.Safety Issues:Prioritization: Urgent introduction required.

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5. Anti-viral Resistance Study for Influenza.

Availability: Marketed. Function: Preventive and Therapeutic.Existing Alternative Options: None.Clinical Effectiveness: Life-Saving Outcomes: Health-Cost Implications: Assist MOH in stockpiling of antiviral drug against influenza as part of National Influenza Pandemic Preparedness PlanSafety Issues: Not applicable.Prioritization: Urgent introduction required.

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6. Hand held (portable) “Exhaled nitric oxide measurement” devices - more user friendly.

Availability: Marketed. Not in useFunction: Preventive and diagnostic.Existing Alternative Options: Exhaled nitric oxide measurement device.Clinical Effectiveness: For early management intervention and follow up of asthmatic patientsLife-Saving Outcomes: Health-Cost Implications: It is very cost effective and should be made available in all centre of excellence for respiratory - for both, patient management and research purposes.Safety Issues: -Prioritization: Required within the next 2 years.

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7. Automated lung sound analysis Availability: EducationalFunction: Diagnostic.Existing Alternative Options: Radiological examinationClinical Effectiveness: -Life-Saving Outcomes: -Health-Cost Implications: -Safety Issue : -Prioritization: Required within the next 5 years

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8. Obstructive Sleep Apnea (OSA) detector with alertness index to monitor SpO2 level.

Availability: Marketed/ experimental and not availableFunction: Preventive and Diagnostic.Existing Alternative Options: Overnight Polysomnography in Sleep Lab/ Home (ambulatory) PSG and CPAP machine.Clinical Effectiveness: Life-Saving Outcomes:Health-Cost Implications:Safety Issues: Prototype may not be user friendly and experimental.Prioritization: Introduction required within next 5 years.

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9. SLE 5000 ventilator Availability: Marketed. Function: Therapeutic.Existing Alternative Options: Bear cup ventilator.Clinical Effectiveness: Improves patient outcome.Life-Saving Outcomes: Improve the quality of life.Health-Cost Implications: Reduce hospital staySafety Issues:Prioritization Required within the next 5 years.

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Table 19.11 Urology Technologies.


Importance

1. Hexaminolevulinate fluorescence blue-light cystoscopy

Availability: Marketed Function: DiagnosticExisting Alternative Options: Cystoscopy and urine cytology.Clinical Effectiveness: Improves detection of precursor lesions, dysplasia, and CISLife-Saving Outcomes: earlier detection with earlier treatment may translate to better outcomesHealth-Cost Implications: -Safety Issues: -Prioritization: High

1

2. Brachytherapy Availability: Marketed Function: TherapeuticExisting Alternative Option: Surgery or RadiotherapyClinical Effectiveness: Proven for low grade low stage tumours.Life-Saving Outcomes: Reduces morbidity and mortality of patients.Health-Cost Implications: Cost of radioactive seedsSafety Issues: Precaution needed to handle radioactive material.Prioritization: High.

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Table 19.12 Dermatology Technologies.

# Gap in medical technology in Malaysia Expert opinion Rank of

Importance

1. Excimer Laserfor Treatment of Psoriasis and Vitiligo

Availability: Marketed.Function: Therapeutic.Existing Alternative Option: Regional phototherapy unit.Clinical Effectiveness: Localised resistant psoriasis and vitiligo.Life-Saving outcome: Nil of note.Health-Cost Implication: Costly.Safety Issue: Safe.Prioritization: Within 5 years.

1

2. Compliment of Laser System for Cosmetic Dermatology

Availability: MarketedFunction: TherapeuticExisting Alternative Option: Laser’s with varied dermatological specific function. Clinical Effectiveness: Pigmentary, vascular and ablative tumour/scar related skin problemLife-Saving outcome: Nil of noteHealth-Cost Implication: CostlySafety issue: safePrioritization: Within 5 years

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3. Photodynamic therapy (PDT). Availability: Marketed.Function: Therapeutic.Existing Alternative Option: Nil.Clinical Effectiveness: Useful for solar keratosis, Bowen’s disease and Squamous Cell Carcinoma.Life-Saving outcome: Nil of note.Health-Cost Implication: Costly.Safety Issue: safe.Prioritization: Within 5 years.

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4. Extracorporeal Photophoresis for Sezary Syndrome and Mycosis Fungoides.

Availability: Marketed.Function: Therapeutic.Existing Alternative Option: Electron beam or chemotherapy.Clinical Effectiveness: Sezary syndrome or Mycosis Fungoides requiring electron beam or chemotherapy.Life-Saving outcome: Prolong survivalHealth-Cost Implication: CostlySafety Issue: Potential procedure related complicationsPrioritization: Within 5 years

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Table 19.13 Otorhinolaryngology and Audiology Technologies.


Importance

1. Tinnitus retraining therapy devices.

Availability: Marketed.Function: Therapeutic.Existing Alternative Options: Ear level devices (tinnitus maskers, hearing aids).Clinical Effectiveness: -Life-Saving Outcomes: NilHealth-Cost Implication: -Safety Issues: -Prioritization: Urgent introduction required.

1

2. Middle ear implant. Availability: Marketed.Function: Assistive.Existing Alternative Options: Conventional hearing aid.Clinical Effectiveness: Improves quality of life.Life-Saving Outcomes: Nil.Health-Cost Implications: Reduced cost of maintenance and disposable battery compared to conventional hearing aid.Safety Issues: Must be conducted by credentialed surgeon.Prioritization: Required in the next 2/3 years

2

3. Auditory brainstem implant. Availability: Marketed. Function: Advance Assistive.Existing Alternative Options: NilClinical Effectiveness: For selected/suitable patients.Life-Saving Outcomes: Nil of note.Health-Cost Implications: Very costly.Safety Issues: Possible migrationPrioritization: Required in the next 5 years.

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Table 19.14 Ophthalmology & Optometry Technologies


Importance

1. Nd:YAG laser for Selective Laser Trabeculoplasty.

Availability: Marketed Function: TherapeuticExisting Alternative Options: Argon Laser trabeculoplasty.Clinical Effectiveness: The technique can successfully lower intraocular pressure in about 80% of cases and treatment is painless or nearly painless for most patients. Life-Saving Outcomes: -Health-Cost Implications: Can be performed on an outpatient basis.Safety Issues: It causes no burning or scarring of the trabecular meshwork and is repeatable with minimal risk.Prioritization: High

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Rahmat O; Mariam I.


Lim T.O.

2007



Malaysian Statistics On MEDICAL DEVICES 2007 · Malaysian Statistics On MEDICAL DEVICES A...

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