NEPHROLOGY FACILITIES AND DEVICES

63 DERMATOLOGY FACILITIES AND DEVICES Edited by : Pn Sri Datin Dr. Suraiya H Hussein 1 , Dr. Rohna Ridzwan 2 With contributions from : Dr. Choon Siew Eng 3 , Dr. Asmah Johar 1 1 Kuala Lumpur Hospital MOH, 2 Selayang Hospital MOH, 3 Hospital Tengku Ampuan Aminah MOH HIGH TECHNOLOGY DEVICES IN DERMATOLOGY SERVICES INTRODUCTION The introduction of medical technology in clinical practice has expanded the Dermatology services from mere ofice 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 nurses Nodular dermatitis Basal 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 unit Full body phototherapy cabin broad band UVB UVA Psoriasis Vitiligo extensive Mycosis Fungoides Others Therapeutic Dermatologists and trained Physiotherapists and nurses under supervision by Dermatologists. Full body phototherapy cabin narrow band UVB Psoriasis Scleredema Vitiligo Mycosis Fungoides Therapeutic Full body phototherapy cabin UVA1 Mycosis Fungoides Scleredema Morphoea Adjuvant therapy Hand feet phototherapy unit Hand foot psoriasis Hand feet vitiligo Therapeutic Hand held phototherapy Scalp psoriasis Localized vitiligo Therapeutic PUVA ten UV lamps Localized vitiligo Therapeutic Multi tester Unit UVA UVB Investigative 5 Laser surgical unit Carbon dioxide laser system Benign skin tumours Therapeutic Cosmesis Trained Dermatologist Resurfacing 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 CO 2 Laser system Other Laser systems Phototherapy UVb Phototherapy PUVA No in million No pmp No pmp No pmp No pmp Malaysia 26.64 7 100 7 100 12 100 27 100 1 Sector Public - NC - NC - NC - NC - Private - NC - NC - NC - NC - State Johor 3.17 1 14 2 17 1 2 7 1 Kedah Perlis 2.11 1 14 1 8 2 7 1 Kelantan 1.53 1 4 1 Melaka 0.73 1 14 1 1 17 1 1 2 7 3 Negeri Sembilan 0.96 1 14 1 2 33 2 1 8 1 1 4 1 Pahang 1.45 1 1 1 8 1 1 4 1 Perak 2.28 1 8 2 7 1 Terengganu 1.04 Pulau Pinang 1.49 1 14 1 1 4 1 Sabah 3 1 8 1 4 Sarawak 2.36 1 17 2 17 1 2 7 1 Selangor W.P Kuala Lumpur 6.43 1 14 2 33 3 25 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 Sector Public - NC - NC - NC - Private - NC - NC - NC - State Johor 3.17 5 13 2 3 12 1 3 21 1 Kedah Perlis 2.11 4 11 2 4 15 2 3 21 1 Kelantan 1.53 1 3 1 1 4 1 Melaka 0.73 2 5 3 3 12 4 Negeri Sembilan 0.96 2 5 2 2 8 2 1 7 1 Pahang 1.45 2 5 1 1 4 1 Perak 2.28 4 11 2 2 8 1 1 7 Terengganu 1.04 2 5 2 1 4 1 Pulau Pinang 1.49 4 11 3 2 8 1 1 7 1 Sabah 3 2 5 1 2 8 1 1 7 Sarawak 2.36 5 13 2 2 8 1 1 7 Selangor W.P Kuala Lumpur 6.43 5 13 1 3 12 3 21 65 The National Medical Device Survey was conducted by the Clinical Research Center in year 2007. Two hundred and ifty three hospitals were surveyed. The response to the survey is shown in Fig. 1 Fig. 1 National Medical Device Survey 2007 Respondents Hospital surveyed n=253 Hospital with Dermatology services n=78 Hospital with no Dermatology services n=175 Hospital with Dermatology services that responded n=47 Hospital with Dermatology services that did not respond n=31 MOH Army Hospitals with Dermatology services n=31 Private Hospitals with Dermatology services n=13 University Hospitals with Dermatology services n=3 Johor n=3 Pahang n=1 Malacca n=2 UMMC UKM USM Selangor n=5 Wilayah Persekutuan n=1 Perak n=1 Penang n=1 Sabah n=1 Sarawak n=1 Malacca n=1 Terengganu n=1 N. Sembilan n=2 Kelantan n=3 Selangor n=5 Perlis n=1 Wilayah Persekutuan n=1 Sabah n=3 Perak n=3 Sarawak n=2 Kedah n=4 Penang n=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 CO 2 Laser System Other Laser System Phototherapy UVB Phototherapy PUVA Cryosurgical Unit Electrosurgical Unit Iontophoresis Unit PERLIS PENANG

1.49 Mil

lion PERAK

2.28 Million

PAHANG

1.45 Million

KELANTAN

1.53 Million

TERENGGANU

1.53 Million

SELANGOR WILAYAH PERSEKUTUAN

2.11 Million

MELAKA

2.36 Million

N. SEMbILAN

2.36 Million

jOHOR

2.36 Million

KEDAH

2.11 Million

1 4 4 3 The numbers in the igures above denote the quantity of equipment available. Key : 1 1 1 4 2 1 1 1 4 2 1 1 2 1 1 1 2 1 1 2 3 12 5 3 3 2 1 1 1 1 1 2 1 2 1 2 1 1 1 2 2 3 2 1 2 3 3 2 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. SARAWAK

2.36 Million

SAbAH

2.36 Million

1 2 2 1 1 1 2 1 2 5 2