OTORHINOLARYNGOLOGY AND AUDIOLOGY Invasive 3. Non-Invasive

82 4. Olympic Cool Cap System for Selective Head Cooling Availability: Marketed. Function: Therapeutic. Existing Alternative Options: Supportive therapy, no deinitive 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 hypothermia 3. 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. 4 83 Table 19.4 Orthopaedic and Traumatology Technologies. Gaps in Medical Technology in Malaysia Expert Opinion Rank of 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 morbidity Life-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: Assistive Existing Alternative Options: - Clinical Effectiveness: Very good reduced morbidity. Life-Saving Outcomes: Very good. Health-Cost Implications: Cost effective Safety Issues: Nil Prioritization: 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: Assistive Existing Alternative Options: - Clinical Effectiveness: Very good reduced morbidity Life-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. 5 84 Table 19.5 Physiotherapy and Occupational Therapy Technologies. Gaps in medical Technology in Malaysia Expert Opinion Rank of Importance 1. Real Time Ultrasound Imaging Physiotherapy Availability: Marketed Function: Diagnostic and therapeutic Existing Alternative Option: Nil Clinical Effectiveness : Enables identiication of inlammation, tears and ruptures, lesions, luid collections and soft tissues masses so that intervention can be speciic to the problems. Muscle actions can be viewed and used to assist patients to work effectively. Life – saving outcomes: Improves quality of patients’ life Health – 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 effects Prioritization: to introduced in the next 2 years. 1 2. VO2max Indirect Spirometry with gas analysis - O 2 consumption and CO 2 production Availability: Marketed Function: Diagnostic purpose Existing Alternative Option: Portable oxymeter. Clinical Effectiveness: To determine lung function, gas exchange secretion retention in the lung. Life-Saving outcomes: Improves quality of life Health-Cost Implication: RM 50,000.00 Moderate cost Safety Issues: Minimal effects Prioritization: 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 5000.00 Safety Issues: Minimal effects. Prioritization: Urgent introduction required 1 4. E-link Upper and Lower Extremity evaluation and exercise system Availability: Marketed Function: Therapeutic Preventive Diagnostic Existing 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 life Health – 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 effects Prioritization: To be introduced within next 5 years. 2 85 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 effects Prioritization: to be introduced in next 5 years. 3 6. Muscle tester with Mega EMG system Availability: Marketed Function: Diagnostic Existing 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 ield, treatment room or in biomechanics laboratory Life-Saving outcomes: Evidence based measurement Health-Cost Implication: Low cost. Below RM100, 000 Safety Issues: Relatively very safe Prioritization: To introduced in the next 2 years. 4 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 eficient in achieving treatment goals. Health-Cost Implication: High cost more than RM100, 000.00 Safety Issues: Minimal effects Prioritization: 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 effects Prioritization: to be introduced within next 5 years 6 86 9. Balance system – static and dynamic balance testing and training with ive 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 effects Prioritization: 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 conident enough to handle the machine. Though it is a machine with high technology but it only beneits a small client group such as the industrial workers for the purposes of compensation .