A Case of a Micronesian Woman in Hawai'i with Lymphoma and the Role of Implicit Bias in Medicine Affecting Her Care.

Medically indigent patients, patients of color, those with insufficient health insurance, or patients with severe diseases have a high rate of poor health care quality caused by unconscious implicit and explicit biases. Awareness of the relationship between unconscious implicit bias and negative health care outcomes is increasing in the health care community. The objective of this case study was to examine implicit biases that negatively affected the patient care of a young Micronesian woman with a severe cutaneous disease in Hawai'i. Her medical care and death may have been affected by a combination of implicit biases, including bias based on her race, type of health insurance, and underlying disease. Implicit biases and their role in health care disparities are often unintentional and not obvious. Increased awareness by health care providers may help to avoid inequities in clinical decision-making and improve outcomes.

Diagnosis and management of atopic dermatitis.

ABSTRACT: Atopic dermatitis is a chronic inflammatory skin condition that affects patients of all ages. The disease is characterized by xerosis (dry skin) and intensely pruritic lesions distributed throughout the body. This article reviews diagnostic features and treatments for atopic dermatitis.

Staphylococcus aureus Antibiotic Susceptibilities in Infections in an Outpatient Dermatology Office on O'ahu.

Staphylococcus aureus is a pathogen that causes skin and soft tissue infections (SSTIs) in dermatology patients. There is an increasing rate of methicillin-resistant S aureus (MRSA) reported in the dermatology literature since 1987. This report profiles the antibiotic susceptibilities of methicillin-sensitive S aureus (MSSA) and MRSA in an outpatient office in Hawai'i. This is a retrospective study done by chart review from 2012 to 2014. Demographics, anatomical site of infection, clinical diagnoses and antimicrobial susceptibility patterns were analyzed and compared. Of the 66 samples, 57% were males and 43% were females. S aureus was more commonly found in impetigo, folliculitis, furuncles and secondarily infected psoriasis and more commonly located on the extremities. MSSA accounted for 73% (48) of the cases and MRSA accounted for 27% (18) of the cases. The antibiotics most effective against all S aureus cultures for outpatients were linezolid (100%), trimethoprim sulfamethoxazole (95%) and tetracyclines (94%). Linezolid (100%), trimethoprim sulfamethoxazole (100%) were most effective against MRSA isolates. Our S aureus and MRSA antimicrobial susceptibility results are similar to the local Hawai'i outpatient antibiogram collected from a large private laboratory in Hawai'i in 2014 and the current Infectious Disease Society of America guidelines. This study may be helpful in guiding empiric treatment of SSTIs suspected to be caused by S aureus.