No abstract

Background: Tinea capitis is caused by dermatophyte fungi that utilize keratin as a nutrient source. Scalp erythema, scaling, and crusting are typical signs of this disease. Although most commonly seen in prepubescent children, tinea capitis can occur in adults.Results: Endothrix tinea capitis owing to Trichophyton tonsurans commonly produces generalized scaling and localized perifollicular inflammation reminiscent of lichen planopilaris. Ectothrix tinea capitis owing to Microsporum sp. produces welldemarcated erythematous plaques suggestive of psoriasis. H&E stained biopsy specimens, KOH preparations or fungal cultures will confirm the diagnosis. Conclusion:Because of a low index of suspicion for tinea capitis in adults with scaling and alopecia, diagnosis and appropriate treatment are often delayed. Resistance to treatment for seborrheic dermatitis or psoriasis should prompt a KOH, fungal culture or biopsy to confirm the diagnosis of tinea capitis and initiate systemic antifungal agents.

Background: Early clinical experiences expose students to patient-centered care. However, early incorporation of telehealth communication skills remains limited in health professions education. In this study, we aimed to design and evaluate a telephone-based clinical learning program for students to promote the development of patient-centered communication skills while addressing healthcare disparities experienced by older adults during the COVID-19 pandemic.Methods: We utilized workplace learning principles in designing a telephone-based clinical learning pilot program for health professions students at an academic geriatrics primary care clinic. Students conducted three types of telephone calls to patients that 1) assessed for unmet needs (e.g. food, medication, medical supplies, caregiving, social support, and/or access to medical care) (screening call), 2) addressed social isolation (social call), and 3) helped patients set up videoconferencing software to prepare for telehealth appointments (telehealth-training call). We tracked telephone call completion and outcomes via weekly student reports and the electronic health record. To evaluate program e cacy and learning outcomes, students completed an anonymous post-program survey that assessed pre-and postprogram knowledge and skills acquisition. Data was analyzed using descriptive statistics and Wilcoxon rank-sum tests. Results: Five medical student liaisons led 23 medical and nurse practitioner students in calling 335 patients over 13 weeks. Students successfully reached 247 patients (74%), assisted 25 patients in setting up videoconferencing software, and engaged 30 patients in weekly social calls. Of 21 students who completed the post-program survey, 18 (86%) believed this program provided meaningful clinical exposure. After participation, all students felt comfortable interacting with patients by telephone and 20 (95%) felt con dent in relationship-centered communication. Students reported increased knowledge about vulnerabilities in the geriatric population (p = 0.002). Conclusion: This telephone-based program allowed health professions students to support a vulnerable population and gain patient-centered communication skills. This program could be adapted for implementation in multiple contexts as an effective telehealth clinical learning experience, especially for pre-clerkship health professions students who could gain early exposure to telehealth and practice communication and health coaching skills with patients.

ImportanceRetrospective clinical trials of pulse oximeter accuracy report more frequent missed diagnoses of hypoxemia in hospitalized Black patients than White patients, differences that may contribute to racial disparities in health and health care. Retrospective studies have limitations including mistiming of blood samples and oximeter readings, inconsistent use of functional versus fractional saturation, and self-reported race used as a surrogate for skin color. Understanding the cause of biased readings by pulse oximetry in patients with darkly pigmented skin is high priority given the essential nature of pulse oximetry.ObjectiveTo prospectively measure the contributions of skin pigmentation, perfusion index, sex, and age on pulse oximeter errors.DesignWe studied two pulse oximeters (Nellcor N-595™ and Masimo Radical 7™) in prevalent use in North America, Europe, and Asia-Pacific regions. We analyzed 9,763 matched pulse oximeter readings (SpO2) and arterial oxygen saturation (hemoximetry SaO2) during stable hypoxemia (SaO2 68-100%). Perfusion index (PI) was measured as percent infrared light modulation by the pulse detected by the pulse oximeter probe, with low perfusion categorized as PI <1%.SettingClinical research laboratoryParticipants146 healthy subjects, including 25 with light skin (Fitzpatrick class I-II), 78 with medium (class III-IV), and 43 with dark (class V-VI) skin.ExposuresControlled hypoxemiaMain OutcomesPulse oximeter bias (difference between SaO2 and SpO2) by skin pigment category in a multivariable mixed-effects model incorporating repeated-measures and different levels of SaO2 and perfusion.ResultsSkin pigment, perfusion index and degree of hypoxemia significantly contributed to errors (bias) in both pulse oximeters. The combined frequency of missed diagnosis of hypoxemia (pulse oximeter readings 92-96% when arterial oxygen saturation was <88%) in low perfusion conditions was 1.1% for light, 8.2% for medium and 21.1% for dark skin.Conclusions and RelevanceLow peripheral perfusion combined with darker skin pigmentation leads to clinically significant high-reading pulse oximeter errors and missed diagnoses of hypoxemia. Darkly pigmented skin and low perfusion states are likely the cause of racial differences in pulse oximeter performance in retrospective studies. Both skin pigmentation and low perfusion should be accounted for in regulatory standards for pulse oximeters.Key PointsQuestionLaboratory validation of pulse oximeter performance has found errors in Black subjects that are smaller than those from recent reports of hospitalized Black patients. We test the hypothesis that low perfusion amplifies pulse oximeter error in subjects with dark skin during hypoxemia.FindingsDark skin pigmentation combined with low perfusion produces large errors in pulse oximeter readings in healthy subjects during hypoxemia, sufficient to miss a diagnosis of hypoxemia in about 20% of readings.MeaningAccuracy of pulse oximeters in the diagnosis of hypoxemia is impaired by a combination of low perfusion and dark skin pigmentation. Low perfusion should be accounted for in future testing and regulatory guidelines for pulse oximeters to improve performance and minimize bias in patients with dark skin pigment.

The Pacific Island countries of the Western Pacific Region have some of the highest rates of sexually transmitted Chlamydia trachomatis and Neisseria gonorrhoeae infections in the world. Despite this, there are few research studies that include Pacific Islanders. We conducted a narrative review of original research and surveys, including World Health Organization and Pacific Community reports, to determine the prevalence, management, and treatment of C. trachomatis and N. gonorrhoeae compared to HIV and syphilis from 1980 to 2022. Available epidemiologic data on C. trachomatis and N. gonorrhoeae indicated an extremely high prevalence—approximately 30% and 13%, respectively—among Pacific Islanders during this timeframe. These neglected sexually transmitted infections represent a significant burden and health disparity. Robust epidemiologic research is needed to identify modifiable risk factors for designing interventions and control strategies. Appropriate policies along with regional and international advocacy and aid are required to improve reproductive health among these vulnerable, understudied populations to avert preventable infections and sequelae.