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Biomedical subjects

D L Ramsay

Publications and source records attributed to D L Ramsay.

12 recordsLinked to original sources

Ultraviolet-B phototherapy for early-stage cutaneous T-cell lymphoma.

BACKGROUND AND DESIGN--Cutaneous T-cell lymphoma (CTCL) is a slowly advancing disease that initially presents in the skin and may later progress to involve the lymph nodes and viscera. Since CTCL most often presents on non-sunlight-exposed regions of the body, a possible protective role for UVB irradiation has been suggested. Recent observations have also found that UVB irradiation serves an immunoregulatory role. Given that limited data are available regarding the use of UVB phototherapy in treating CTCL, a retrospective nonrandomized study of 37 nonconsecutive patients with early CTCL was performed to assess the efficacy of UVB phototherapy in the treatment of CTCL. RESULTS--Twenty-five (71%) of the 35 patients treated with UVB phototherapy (two were unavailable for follow-up) achieved a total clinical remission. Median time to remission was 5 months, and median duration of the remission was 22 months. Twenty-five (83%) of 30 patients with disease limited to patches achieved remission, whereas none of the patients with plaque-level disease achieved a remission. Of the 25 patients who achieved complete remission, five (20%) had a recurrence of CTCL. CONCLUSIONS--Phototherapy with UVB appears to be effective in patients with early patch-stage CTCL.

Adolescent

Cutaneous nevi.

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Adolescent

A study of the practice of dermatology in the United States. Initial findings.

A nationwide study of the practice activities of dermatologists reports that dermatology is a predominantly outpatient specialty, with 97% of patient encounter occurring outside of the hospital. The average dermatologist cares for approximately 7,000 patients a year and functions almost exclusively as a specialist, with only 2.2% of his cases related to nondermatologic problems. The dermatologist performs a type of primary care, however, with seven out of ten patients being self-referred. Eighty-seven percent of dermatologic encounters can be categorized into 25 disease conditions. This study serves to increase the understanding of how the dermatologist cares for his patients.

Adolescent

New health practitioners and dermatology manpower planning.

To assess the need for dermatologists in the United States, the potential role of new health practitioners in this specialty is considered. Available data on physician extenders in general and informed opinion on dermatologist extenders in particular suggest that specially trained, nonphysician personnel could substantially augment the supply of dermatological services. At present, however, widespread adoption of new staffing patterns appears unlikely. A long-run trend toward greater use of all categories of ancillary personnel in this specialty is expected, and the profession is urged to play an early and active role in this trend's development.

Allied Health Personnel

National dermatology manpower requirements: the experience of prepaid group practices.

Ten prepaid group health plans across the country were surveyed as part of an effort to estimate the need for dermatologists in the United States. Although generalizing the experiences of prepaid group practices to the general population is at best an imprecise approach, the dramatic shortage suggested by the data cannot be completely ascribed to the method used. Whereas the average ratio in the surveyed plans was 2.8 dermatologists per 100,00 subscribers, there are only about 1.9 dermatologists providing patient care per 100,000 persons in the general population. The difference between prepaid plan subscribers and the general population in annual visits to dermatologists is even more dramatic: 193 per 1,000 subscribers compared to 84 per 1,000 population.

Dermatology

Dermatologists for the nation. Projections of supply and demand.

Because inappropriate supply of physician specialists involves unnecessary human suffering or waste of human resources and because free market forces are ineffective in the medical sector, deliberate planning of supply is necessary. A model projecting the future supply of dermatologists was formulated on the basis of current residency capacity, which produces 250 dermatologists annually, and current experience regarding life expectancy and retirement. The model implies that an equilibrium supply of 8,800 dermatologists, or three per 100,000 population, will be realized early in the 21st century. A number of methods were used to estimate the demand for care, and, under conditions of general access, three dermatologists per 100,000 appear to be appropriate. Thus, maintaining current training capacity seems to be prudent, but because of many unknown and unpredictable factors, periodic reassessment is necessary.

Adolescent