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The efficacy of glucocorticoids in COVID-19 is unclear. This study was designed to determine whether systemic glucocorticoid treatment in COVID-19 patients is associated with reduced mortality or mechanical ventilation. This observational study included 1,806 hospitalized COVID-19 patients; 140 were treated with glucocorticoids within 48 hours of admission. Early use of glucocorticoids was not associated with mortality or mechanical ventilation. However, glucocorticoid treatment of patients with initial C-reactive protein (CRP) ≥20 mg/dL was associated with significantly reduced risk of mortality or mechanical ventilation (odds ratio, 0.23; 95% CI, 0.08- 0.70), while glucocorticoid treatment of patients with CRP

A 47-year-old woman presented with sicca symptoms, polyarthralgias, polymyalgias and dysphagia. She was found to have positive antinuclear, anti-SSA-Ro and anti-SSB-La antibodies. Slit lamp exam confirmed the presence of keratoconjunctivitis sicca, and the patient was diagnosed with Sjögren’s syndrome. Three years later, she was referred for evaluation of gait instability associated with recent falls. On physical examination, the patient was found to have bilateral ptosis, percussion myotonia, distal upper and lower extremity weakness, and a steppage gait. Electromyography demonstrated electrical myotonia. Genetic testing revealed expanded CTG repeats (733 and 533) in the myotonic dystrophy type 1 (DM1) protein kinase gene, confirming the diagnosis of DM1. Dysphagia, pain and eye discomfort may occur in both Sjögren’s syndrome and DM1, and in this case, may have delayed the diagnosis of muscular dystrophy.

Premedical students commonly shadow physicians to gain an understanding of what careers in medicine entail. The authors reviewed the literature to explore (1) whether shadowing achieves this goal consistently and effectively, (2) the ethical issues involved, and (3) other reasons that individuals shadow physicians.The authors searched the MEDLINE database via Ovid for English-language articles published from 1948 to March 2011. Eligible articles described physician shadowing programs and/or assessed the value of physician shadowing independently or in comparison with other educational methods.Of 770 articles identified, 13 articles about physician shadowing programs met inclusion criteria. Two of the 13 programs involved shadowing only, whereas 11 included other educational initiatives. Participants varied; shadowers included students (high school, college, medical school), recent medical school graduates, or international medical graduates. Few studies addressed shadowing by premedical students. Most studies involved programs outside the United States. Shadowing program objectives and characteristics differed. Data reported from focus groups, interviews, and surveys suggest that shadowing experiences generally increased participants' interest in medicine (or a specialty) or improved participants' confidence in transitioning to a new position. Some articles raised ethical and practical concerns related to shadowing.The few shadowing programs described in the literature were heterogeneous and often involved other activities. Further research is warranted; objective outcomes measures would be useful. The authors propose developing guidelines and introducing a code of conduct for premedical students, to enhance the consistency of shadowing experiences and address ethical and practical considerations.

Background Social media use by physicians offers potential benefits but may also be associated with professionalism problems. The objectives of this study were: 1) to examine and compare characteristics of social media use by medical students and faculty; 2) to explore the scope of self- and peer-posting of unprofessional online content; and 3) to determine what actions were taken when unprofessional content was viewed. Methods An anonymous, web-based survey was sent to medical students and faculty in October, 2013 at the Albert Einstein College of Medicine in Bronx, New York. Results Three-quarters of medical students reported using social media “very frequently” (several times a day), whereas less than one-third of faculty did so (p

Objective Despite the frequency of ethical issues arising in patient care, ethical discourse in the rheumatology literature is negligible. To better understand the scope of ethical problems occurring in our specialty, the American College of Rheumatology (ACR) Committee on Ethics and Conflict of Interest surveyed ACR members. Specific objectives of the survey were 1) to learn the perceived frequency of ethical issues in rheumatology, 2) to identify activities that pose ethical problems in rheumatologic practice, 3) to determine the extent of education on, and self-perceived knowledge about, ethics among ACR members, and 4) to determine member interest in, and suggest content for, future ACR-sponsored educational activities related to bioethics. Methods The survey included 12 non–open-ended questions addressing 5 core areas: 1) ethical dilemmas in daily practice, 2) ethical concerns in basic and clinical research, 3) influence of industry, 4) ethics of regulatory policies, potential conflicts, and disclosure, and 5) personal education on and interest in ethics. Two open-ended questions were also included, asking respondents to list the ethical issues most relevant to rheumatology and to provide any comments. Data analysis was descriptive. Results Seven hundred seventy-one responses were received. Respondents believed that ethical issues arise most frequently in practice and in clinical research. The most common ethical issues cited were the high cost of treatment for patients (51% of respondents) and for society (48%), and the practice of defensive medicine (45%). Conclusion The survey results suggest that ethical problems in rheumatology are of concern to the ACR membership. Further, there is a perceived need for educational programs targeted at helping members address such professional challenges.

SHADOWING PHYSICIANS HAS BECOME AN ACCEPTED WAY for college students to learn what it is like to be a physician. Students follow practicing physicians in their daily activities that almost always include patient care; indeed patient interactions seem to be the high point of the experience. But there are ethical concerns about physician shadowing by college students. Shadowing is not a new idea in medical education. Historically, learning through observation has been a central component of training physicians and remains an important mechanism for medical students to learn history taking and physical examination skills, as well as to become familiar with various aspects of a physician’s life. Currently, firstand second-year medical students are routinely assigned to shadow physicians. Medical students are also introduced to various specialties through shadowing experiences. However, shadowing of physicians by college students is a relatively new practice, and it is difficult to measure the frequency with which it occurs. Students do not necessarily list physician shadowing per se as an extracurricular activity on their medical school applications, but may describe the experience in other terms, such as volunteering, acting as a medical assistant, or working in a physician’s office. One survey of 317 students who requested to be on the premedical advisor’s e-mail list at a small liberal arts college revealed that of the 101 respondents, 80.2% reported some experience with physician shadowing. According to one premedical society Web site, “Hospital shadowing is a must for aspiring MDs—not just because med school admissions committees won’t take an applicant seriously if he or she has never been inside a hospital before, but because hospital experience will help you decide whether you even want to be a doctor, and provide you much-needed exposure to hospital life, physicians, and patients.” Some undergraduate premedical programs actively sponsor physician shadowing programs so students can “see what it means to be a practicing physician.” Participation in at least 1 shadowing experience is often recommended. Other schools use their career networks to enable students “to experience some period of time in the shoes of health care professionals.” Shadowing is also touted as a way to enhance medical school applications because it shows that students have “taken the time to investigate your career choice and to learn about professionals in your career field.” Yet physicians have multiple ethical obligations to their patients that might be violated by allowing college students to shadow their work. First, the relationship between a professional and a client is considered fiduciary, meaning that it is based on trust, and shadowing may be a breach of the physician’s fiduciary obligation to the patient. Physicians, as fiduciaries, must always act in their patients’ best interests, and subordinate their own selfinterests and the interests of others. How is a patient’s welfare served by having a college student present during an appointment with his or her physician? If physician shadowing by a college student may not be in a patient’s best interest, why is shadowing by medical students acceptable? Shadowing by medical students may ultimately benefit society by providing a valuable educational experience that produces more humane, competent physicians. In addition, college students differ from medical students in several fundamental ways: medical students have committed themselves to the study and practice of medicine, whereas college students have not; medical students have been evaluated and admitted into training for the medical profession, whereas college students have not; the primary purpose of shadowing by medical students is to learn medicine, whereas the purposes of shadowing by college students are to help them choose a career and gain admission to medical school; and medical students, from day 1 of medical school, are expected to behave in a professional manner. Many medical schools hold rituals to acknowledge admission into the profession for entering students; some involve the recitation of oaths of professionalism. In addition to their fiduciary obligations, physicians have other duties to their patients that are breached by college student shadowing, including maintaining privacy

PURPOSE This review was undertaken (1) to determine the antitumor activity of agents studied in phase II trials in small-cell lung cancer (SCLC) patients, (2) to evaluate the adequacy of published trials, (3) to determine if previously treated patients are suitable for phase II trials in SCLC, and (4) to develop an improved design for phase II trials. DESIGN English-language, single-agent efficacy trials in SCLC, published from 1970 to 1990, were reviewed. Study design and reporting of results were assessed for clinical and statistical methodology. Response rates observed in previously treated patients were compared with those observed in previously untreated patients. RESULTS One hundred forty-one articles evaluating 57 agents in 3,042 patients were reviewed. Eleven drugs were active (defined as a response rate greater than or equal to 20% in a trial with greater than or equal to 14 assessable patients), and 12 were inactive. Due to methodologic problems with the clinical trials, the usefulness of the remaining 34 drugs (60%) remains uncertain. Deficiencies identified in trials include inappropriate sample sizes, poorly defined response criteria, and failure to report important prognostic factors. When studied in adequate trials, all agents known to be active in SCLC had an observed response rate greater than or equal to 10% in previously treated patients. CONCLUSIONS Over the past 2 decades, phase II trials in SCLC have failed in their primary task of effectively identifying agents that warrant further clinical study and rejecting inactive agents. If only previously treated patients had been entered into these trials, no useful agent would have been missed provided that a lower observed response rate had been used as evidence of antitumor activity. We propose a two-stage sequential study design, entering previously treated patients, for future phase II trials in SCLC.