CARDIOLOGY AND CARDIOTHORACIC SURGERY

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1. Endoscopes Gastroenterology devices

Base 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-Invasive

There are ive 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. Population Non-Invasive Gastroenterology Laboratory Endoscopy Day Care Unit Suite No in million No pmp No pmp Malaysia 26.64 100 55 100 2 Sector Public - 4 44 22 40 Private - 5 56 33 60 State Johor 3.17 5 9 2 Kedah Perlis 2.11 5 9 2 Kelantan 1.53 3 5 2 Melaka 0.73 2 4 3 Negeri Sembilan 0.96 4 7 4 Pahang 1.45 2 22 1 3 5 2 Perak 2.28 4 7 2 Terengganu 1.04 Pulau Pinang 1.49 6 11 4 Sabah 3 1 11 1 2 Sarawak 2.36 1 11 5 9 2 Selangor 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 Unit No in million No pmp No pmp No pmp No pmp Malaysia 26.64 31 100 1 26 100 1 3 100 2 100 Sector Public - 19 62 15 58 2 67 1 50 Private - 12 38 11 42 1 33 1 50 State Johor 3.17 2 6 1 2 8 1 Kedah Perlis 2.11 4 13 2 4 15 2 Kelantan 1.53 5 17 3 4 15 3 1 33 1 Melaka 0.73 1 3 1 1 4 1 N. Sembilan 0.96 Pahang 1.45 3 9 2 1 4 1 1 33 1 1 50 1 Perak 2.28 Terengganu 1.04 Pulau Pinang 1.49 5 16 3 5 19 3 Sabah 3 1 3 1 4 Sarawak 2.36 4 13 2 3 12 1 1 34 Selangor WP Kuala Lumpur 6.43 6 20 1 5 19 1 1 50 50 Population External 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 No in million No pmp No pmp No pmp No pmp Malaysia 26.64 1 100 7 100 8 100 2 100 Sector Public - 4 57 6 75 1 50 Private - 1 100 3 43 2 25 1 50 State Johor 3.17 Kedah Perlis 2.11 1 14 1 13 Kelantan 1.53 1 13 1 Melaka 0.73 N. Sembilan 0.96 Pahang 1.45 1 13 1 1 50 1 Perak 2.28 Terengganu 1.04 Pulau Pinang 1.49 1 100 1 3 43 2 2 24 1 1 50 1 Sabah 3 1 14 Sarawak 2.36 Selangor W.P Kuala Lumpur 6.43 2 29 3 37 Population GI breath Test System Capsule Endoscopic System Intestinal Tract Stenting bouginage: TTS dilator Intestinal Tract Stenting bouginage: Savary- Guillard dilator No in million No pmp No pmp No pmp No pmp Malaysia 26.64 8 100 6 100 46 100 2 32 100 1 Sector Public - 1 13 5 83 34 74 19 59 Private - 7 88 1 17 12 26 13 41 State Johor 3.17 6 13 2 2 6 1 Kedah Perlis 2.11 1 17 6 13 3 3 9 1 Kelantan 1.53 1 2 1 5 16 3 Melaka 0.73 1 13 1 2 4 3 3 9 4 N. Sembilan 0.96 1 2 1 2 6 1 Pahang 1.45 1 13 1 3 7 2 3 9 2 Perak 2.28 2 24 1 1 2 3 9 1 Terengganu 1.04 Pulau Pinang 1.49 2 24 1 1 17 1 4 9 3 3 9 2 Sabah 3 1 13 2 4 1 1 4 Sarawak 2.36 9 20 4 1 4 Selangor W.P Kuala Lumpur 6.43 1 13 4 66 1 11 24 2 6 19 1 51 Population Video-endoscopic workstation with: gastroscope and appropriate accessories Video-endoscopic workstation with: duodenoscope and appropriate accessories Video-endoscopic workstation with: enteroscope and appropriate accessories Video-endoscopic workstation with: endoscopic ultrasound and appropriate accessories No in million No pmp No pmp No pmp No pmp Malaysia 26.64 167 100 6 84 100 3 12 100 16 100 1 Sector Public - 84 50 41 49 4 33 9 56 Private - 83 50 43 51 8 67 7 44 State Johor 3.17 19 11 6 8 10 3 1 8 Kedah Perlis 2.11 12 7 6 9 11 4 1 6 Kelantan 1.53 6 4 4 7 8 5 1 6 1 Melaka 0.73 9 5 12 4 5 5 N. Sembilan 0.96 6 4 6 3 4 3 Pahang 1.45 4 2 3 4 5 3 2 17 1 2 13 1 Perak 2.28 14 8 6 6 7 3 1 8 Terengganu 1.04 Pulau Pinang 1.49 20 12 13 9 11 6 1 6 1 Sabah 3 5 3 2 2 2 1 Sarawak 2.36 15 9 6 10 12 4 2 17 1 2 13 1 Selangor W.P Kuala Lumpur 6.43 57 35 9 22 25 3 6 50 1 9 56 1 Population Video-endoscopic workstation with: double balloon enteroscopic system and appropriate accessories Video-endoscopic workstation with: sigmoidoscope and appropriate accessories Video-endoscopic workstation with: colonoscope and appropriate accessories Heater probe for contact dermal device for gastrointestinal bleed No in million No pmp No pmp No pmp No pmp Malaysia 26.64 4 100 47 100 2 137 100 5 27 100 1 Sector Public - 2 50 19 40 66 48 17 63 Private - 2 50 28 60 71 52 10 37 State Johor 3.17 5 11 2 12 9 4 3 11 1 Kedah Perlis 2.11 4 9 2 9 7 4 2 7 1 Kelantan 1.53 3 6 2 11 8 7 2 7 1 Melaka 0.73 2 4 3 6 4 8 N. Sembilan 0.96 3 6 3 4 3 4 Pahang 1.45 1 25 1 3 6 2 4 3 3 3 11 2 Perak 2.28 5 11 2 11 8 5 4 15 2 Terengganu 1.04 Pulau Pinang 1.49 1 2 1 16 12 11 1 4 1 Sabah 3 1 2 5 4 2 1 4 Sarawak 2.36 6 13 3 13 9 6 3 11 1 Selangor W.P Kuala Lumpur 6.43 3 75 14 30 2 46 33 7 8 30 1 53

CHAPTER 14 NEPHROLOGY FACILITIES AND DEVICES

Edited by : Dato’ Dr. Zaki Morad 1 , Dr. Ong Loke Meng 2 With contributions from : Dr. Goh Bak Leong 3 , Dr. Hooi Lai Seong 4 , Dr. Lim Yan Ngo 5 , Dato’ Dr. Rozina Ghazalli 2 , En. A. Suhaili b. Shahri 5 , Sr. Lee Day Guat 6 , Tn. Hj. Mohd Sulaiman B. Dalimi 3 , Tn Haji Wazir Hussin 7 , 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. INTRODUCTION Nephrology 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 signiicant 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 ifteen 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 irst 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 eficient usage and more importantly their impact on the patients’ health.