Introduction: Conventional Chest Physiotherapy (CCPT) remains the mainstay of treatment for sputum mobilization in patients with productive cough such as bronchiectasis and “Chronic Obstructive Airway Disease” (COPD). However CCPT is time consuming requires the assistance of a physiotherapist and limits the independence of the patient. Mechanical percussors which are electrical devices used to provide percussion to the external chest wall might provide autonomy and greater compliance. We compared safety and efficacy of a mechanical chest percusser devised by Formedic Technology with conventional chest percussion. Methods: Twenty patients (mean age 64years) were randomly assigned to receive either CCPT or mechanical percussor on the first day and crossed over by “Latin square randomisation” to alternative treatment for 6 consecutive days and the amount of sputum expectorated was compared by dry and wet weight. Adverse events and willingness to use was assessed by a home diary and a questionnaire. Results: There were 13 males and 7 females, eight diagnosed as bronchiectasis and 12 COPD. The mean dry weight of sputum induced by CCPT (0.54g + 0.32) was significantly more compared with MP (0.40g + 0.11); p-value = 0.002. The mean wet weight of sputum with CCPT (10.71g + 8.70) was also significantly more compared with MP (5.99g + 4.5); p-value < 0.001. There were no significant difference in adverse events and majority of patients were willing to use the device by themselves. Conclusion: The mechanical percussor although produces less sputum is well tolerated and can be a useful adjunct to CCPT

Introduction: As pharmacological treatment of hypertensionhas become a burden worldwide, the study looked into nonpharmacological ways of reducing blood pressure. Theobjective was to determine if music guided, slow and deepbreathing will reduce the blood pressure among patientswith hypertension in eight weeks.Methods: A participant blinded, multi-centre, randomisedcontrolled trial was conducted in which the participants inthe intervention group (IG) practiced deep breathingexercise guided by sound cues and those in the controlgroup (CG) listened to the music. The primary end point wasreduction in blood pressure at eight weeks.Results: 87 patients, 46 males and 41 females with mean ageof 61.1 years were recruited and 93.1% of them successfullycompleted the study. There was significant reduction insystolic and diastolic Blood Pressure from baseline by 8weeks in both groups. The reduction in Mean systolic bloodpressure (SBP) in the control arm was 10.5mmHg comparedto 8.3mmHg (p<0.001) in intervention group. Diastolic bloodpressure (DBP) reduction in control and intervention groupswere 5.2 mmHg (p<0.001) and 5.6 mmHg (p<0.001)respectively. The absolute difference in SBP reduction frombaseline in IG & CG was -2.2 (95%CI: -7.8 to 3.5) and DBPwas -0.4 (95%CI: -2.9 to 3.6). However, blood pressurereduction between the two groups was not significant.Conclusions: Both listening to music and deep breathingexercise were associated with a clinically significantreduction in SBP and DBP. However, deep breathingexercise did not augment the benefit of music in reducingBP.

In Malaysia, dialysis-treated end stage renal disease (ESRD) patients have been increasing rapidly. Haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) use a disproportionately large amount of limited healthcare resources. This study aims to estimate the costs of HD and CAPD from the Ministry of Health (MOH) perspective. One year prospective multicentre study was conducted from October 2016 to September 2017 to assess direct medical costs of 90 HD patients and 73 CAPD patients from five large MOH dialysis centres. A mixed method of activity-based costing and step-down was used. The capital costs included land, building, medical equipment and furnishing. The recurrent costs included staff emoluments, facility utilities, patients’ medical costs and dialysis consumables. One-way sensitivity analysis was performed to investigate variability in the data. One hundred and forty-one patients (82%) completed the study comprising of 77 patients on HD and 64 patients on CAPD. Majority of the patients were between 46-65 years old (n=75, 53.2%). The most common aetiology of ESRD was diabetes mellitus (44.2% in HD and 48.4% in CAPD). Cost per patient per year was RM39,790 for HD and RM37,576 for CAPD. The main cost drivers were staff emoluments (37.6%) and dialysis consumables (70.5%) for HD and CAPD respectively. HD is highly sensitive towards all the variables analysed except for dialysis consumables. In CAPD, there are minimal sensitivities except for the 5% discount rate. Knowledge of the costs of modalities are useful in the context of planning for dialysis services and to optimise the number of kidney failure patients treated by dialysis within the MOH.
Haemodialysis ; continuous ambulatory peritoneal dialysis ; end stage renal disease ; cost ; Malaysia