Implementation of an Ultraviolet Phototherapy Service at a National Referral Hospital in Western Kenya: Reflections on Challenges and Lessons Learned.

IntroductionIn order to manage skin conditions at a national referral hospital level in Kenya, specialized dermatology services, such as dermatologic surgery, dermatopathology, phototherapy, and sub-specialty care, should be offered, as is typically available in referral hospitals around the world. A Kenyan patient with prurigo nodularis, whose severe itch remitted after phototherapy treatment at the University of California, San Francisco (UCSF), inspired the development of a phototherapy service at Academic Model Providing Access to Healthcare (AMPATH), a partnership in Western Kenya between Moi Teaching and Referral Hospital, Moi University College of Health Sciences, and a consortium of North American academic medical centers.MethodsInitial project funds were raised through a crowdfunding campaign and fundraising events. A new narrowband ultraviolet B phototherapy unit and replacement bulbs were donated and air shipped to Eldoret, Kenya. A team of dermatologists and phototherapy nurses from UCSF conducted a 2-day training session. US-based dermatologists affiliated with AMPATH provide ongoing support through regular communication and on-site visits.ResultsEarly in implementation, challenges faced included training clinical staff with limited experience in phototherapy and improving communication between nurses and clinicians. More recent challenges include frequent rotation of specialty clinic nurses in the dermatology clinic, adaptation of phototherapy guidelines to balance patient volume with service delivery capacity, and training assessment of disease activity in darkly pigmented skin.ConclusionStrategies that have been helpful in addressing implementation challenges include: increasing on-site and remote training opportunities for clinicians and nurses, developing a tiered payment schema, educating patients to combat misconceptions about phototherapy, dynamic phototherapy referral guidelines to accommodate service delivery capacity, and prioritizing the engagement of a multidisciplinary team

Mirror covered tunnel phototherapy increases the efficacy of phototherapy for neonatal jaundice

Objective: Neonatal jaundice (NJ) is one of the most common cause of neonatal hospital admission. Phototherapy is the main therapy for hyperbilirubinemia of neonatal jaundice. The efficacy of phototherapy depends on the dose and wavelength of light used and the surface area exposed. We increased photons in mirror covered tunnel phototherapy (MCTP) by putting mirrors behind the lamps (mirror covering), without raising the temperature or risk of hyperthermia. This study evaluates the efficacy of this modification. Methods: In this randomized clinical trial study, during a 6-month period 30 neonates were treated for NJ; 60 neonates who had uncomplicated neonatal jaundice requiring only phototherapy were used as controls for the study by the convenience sampling method. The controls received single phototherapy by tunnel phototherapy while the study group underwent MCTP.In this set we put mirrors which were mercury coated 3 mm thick glass behind the bulbs of the set. Serum bilirubin was measured at admission, 24 hr and 48 hr after initiation of treatment, then daily and 24 hr after discharge. Independent sample t-test was used in SPSS version12 software for data analysis . Results: Mean duration of admission in the study group was ignificantly lower than controls (p= 0.027). Likewise the mean decrease in bilirubin level after 24 and 48 hr of phototherapy were significantly lower than controls (p= 0.005 and p= 0.036). Conclusion: Our results show that the use of mirrors behind the bulbs in tunnel phototherapy units can safely increase the efficacy of phototherapy. Keywords: Hyperbilirubinemia, Jaundice, Neonate, Phototherapy

Phototherapy Radiometer with AS7262 Sensor

The phototherapy is a device used in hyperbilirubinemia therapy by using blue light radiation with ranges between 425nm-475nm. The effectiveness of hyperbilirubinemia therapy depends on the amount of energy emitted by light which expressed in μW/cm2. The purpose of this study is to develop a low-cost and high accuracy Phototherapy radiometer. Measurement of blue light irradiance using the AS7262 sensor which can measure the irradiance of visible light with a wavelength of 450nm, 500nm, 550nm, 570nm, 600nm, 650nm with relative responsiveness of 1 time at each wavelength. SD card memory is used to save measurement data of irradiance so that it can be processed later. Based on the blue light irradiance data collected the smallest error value is 0,40% at a distance of 10cm while the biggest error value is 9,01%  at a distance of 30cm. After testing the entire system, the device can be used according to its function and purpose

Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings.

Hyperbilirubinaemia is a ubiquitous transitional morbidity in the vast majority of newborns and a leading cause of hospitalisation in the first week of life worldwide. While timely and effective phototherapy and exchange transfusion are well proven treatments for severe neonatal hyperbilirubinaemia, inappropriate or ineffective treatment of hyperbilirubinaemia, at secondary and tertiary hospitals, still prevails in many poorly-resourced countries accounting for a disproportionately high burden of bilirubin-induced mortality and long-term morbidity. As part of the efforts to curtail the widely reported risks of frequent but avoidable bilirubin-induced neurologic dysfunction (acute bilirubin encephalopathy (ABE) and kernicterus) in low and middle-income countries (LMICs) with significant resource constraints, this article presents a practical framework for the management of late-preterm and term infants (≥ 35 weeks of gestation) with clinically significant hyperbilirubinaemia in these countries particularly where local practice guidelines are lacking. Standard and validated protocols were followed in adapting available evidence-based national guidelines on the management of hyperbilirubinaemia through a collaboration among clinicians and experts on newborn jaundice from different world regions. Tasks and resources required for the comprehensive management of infants with or at risk of severe hyperbilirubinaemia at all levels of healthcare delivery are proposed, covering primary prevention, early detection, diagnosis, monitoring, treatment, and follow-up. Additionally, actionable treatment or referral levels for phototherapy and exchange transfusion are proposed within the context of several confounding factors such as widespread exclusive breastfeeding, infections, blood group incompatibilities and G6PD deficiency, which place infants at high risk of severe hyperbilirubinaemia and bilirubin-induced neurologic dysfunction in LMICs, as well as the limited facilities for clinical investigations and inconsistent functionality of available phototherapy devices. The need to adjust these levels as appropriate depending on the available facilities in each clinical setting and the risk profile of the infant is emphasised with a view to avoiding over-treatment or under-treatment. These recommendations should serve as a valuable reference material for health workers, guide the development of contextually-relevant national guidelines in each LMIC, as well as facilitate effective advocacy and mobilisation of requisite resources for the optimal care of infants with hyperbilirubinaemia at all levels

The Patient's Guide to Psoriasis Treatment. Part 2: PUVA Phototherapy.

BackgroundPUVA treatment is photochemotherapy for psoriasis that combines psoralen with UVA radiation. Although PUVA is a very effective treatment option for psoriasis, there is an absence of patient resources explaining and demonstrating the process of PUVA. Studies have shown that patients who viewed videos explaining the treatment procedures for various medical conditions had a greater understanding of their treatment and were more active participants in their health.ObjectiveTo present a freely available online guide and video on PUVA treatment designed for patient education on PUVA.MethodsThe PUVA treatment protocol used at the University of California-San Francisco Psoriasis and Skin Treatment Center as well as available information from the literature was reviewed to design a comprehensive guide for patients receiving PUVA treatment.ResultsWe created a printable guide and video resource that reviews the benefits and risks of PUVA, discusses the three types of PUVA (hand-foot soak, full body soak, and systemic), demonstrates the PUVA process, and provides practical tips for safe use.ConclusionOnline media and video delivers material in a way that is flexible and often familiar to patients. This new format is beneficial for prospective patients planning to undergo PUVA treatment, health-care providers, and trainees who want to learn more about this treatment

The Patient's Guide to Psoriasis Treatment. Part 4: Goeckerman Therapy.

BackgroundThe Goeckerman regimen remains one of the oldest, most reliable treatment options for patients with moderate to severe psoriasis. Goeckerman therapy currently consists of exposure to ultraviolet B light and application of crude coal tar. The details of the procedure can be confusing and challenging to understand for the first-time patient or provider.ObjectiveTo present a freely available online guide and video on Goeckerman treatment that explains the regimen in a patient-oriented manner.MethodsThe Goeckerman protocol used at the University of California-San Francisco Psoriasis and Skin Treatment Center as well as available information from the literature were reviewed to design a comprehensive guide for patients receiving Goeckerman treatment.ResultsWe created a printable guide and video resource that covers the supplies needed for Goeckerman regimen, the treatment procedure, expected results, how to monitor for adverse events, and discharge planning.ConclusionThis new resource is beneficial for prospective patients planning to undergo Goeckerman treatment, healthcare providers, and trainees who want to learn more about this procedure. Online media and video delivers material in a way that is flexible and often familiar to patients

Progeny, June 2013, Vol 29, no.1

This newsletter from The Department of Public Health about perinatal health care and statistics

A Systematic Review: Light Therapy for Individuals with Dementia and Implications for Practice

This systematic review seeks to answer the question: is light therapy an effective intervention for sundowning symptoms experienced by individuals who have dementia