ABSTRACT
In the United States access to healthcare continues to be a major issue. Although "top down" public policy approaches hold promise for expanding access, a lack of political consensus has hindered progress. A review of the literature was conducted to investigate the efficacy of clinical interventions aimed at expanding access to care from the "bottom up." The greatest improvements in access to care over the past decade have harnessed teledermatology, shared care, appointment scheduling strategies, and team-based care. Optimization of these approaches will require additional population-based, dermatology-specific research. It is clear that dermatologists, using a "bottom up approach," can significantly expand access to care in their communities in a manner that is economically viable and maintains quality of care and patient satisfaction.
Subject(s)
Dermatology/organization & administration , Health Services Accessibility , Telemedicine , Appointments and Schedules , Dermatology/standards , Health Policy , Humans , Medically Underserved Area , Patient Care Team , Patient Satisfaction , Quality of Health Care , Shared Medical Appointments , United StatesABSTRACT
When this patient's chronic stasis ulcer failed to respond to the usual treatment of dressings, elevation, and diuretics, our suspicions led us to an unexpected diagnosis.
Subject(s)
Carcinoma, Basal Cell/complications , Leg Ulcer/etiology , Wound Healing/physiology , Aged, 80 and over , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/physiopathology , Female , Humans , Leg Ulcer/physiopathologyABSTRACT
Haploinsufficiency of RASA1, located on chromosome 5q14.3, has been identified as the etiology underlying the disorder capillary malformation-arteriovenous malformation (CM-AVM). Recently, haploinsufficiency of MEF2C, located 1.33 Mb distal to RASA1 on chromosome 5q14.3, has been implicated as the genetic etiology underlying a complex array of deficits including mental retardation, hypotonia, absent speech, seizures, and brain anomalies. Here we report a patient who is haploinsufficient in both RASA1 and MEF2C who presents with dermatologic and neurologic abnormalities that constitute a 5q14.3 neurocutaneous syndrome. This finding highlights the need to assess for CM-AVM in patients with neurologic features consistent with MEF2C haploinsufficiency, and vice versa.