There are differences in lupus phenotypes between ethnic populations. Although ethnicity was not found to be a significant independent predictor of damage accrual, low income was.

Residents who are more likely to fail the ABS qualifying and certifying examinations can be identified by a low USMLE Step 1 score and by poor performance on the ABSITE at any time during residency. These findings support the use of the USMLE Step 1 score in the surgical residency selection process and a formal academic intervention for residents who perform poorly on the ABSITE.

The aim of this study is to identify and evaluate the quality of videos for patients available on YouTube for learning to self-administer subcutaneous methotrexate. Using the search term "Methotrexate injection," two clinical reviewers analyzed the first 60 videos on YouTube. Source and search rank of video, audience interaction, video duration, and time since video was uploaded on YouTube were recorded. Videos were classified as useful, misleading, or a personal patient view. Videos were rated for reliability, comprehensiveness, and global quality scale (GQS). Reasons for misleading videos were documented, and patient videos were documented as being either positive or negative towards methotrexate (MTX) injection. Fifty-one English videos overlapped between the two geographic locations; 10 videos were classified as useful (19.6 %), 14 misleading (27.5 %), and 27 personal patient view (52.9 %). Total views of videos were 161,028: 19.2 % useful, 72.8 % patient, and 8.0 % misleading. Mean GQS: 4.2 (±1.0) useful, 1.6 (±1.1) misleading, and 2.0 (±0.9) for patient videos (p < 0.0001). Mean reliability: 3.3 (±0.6) useful, 0.9 (±1.2) misleading, and 1.0 (±0.7) for patient videos (p < 0.0001). Comprehensiveness: 2.2 (±1.9) useful, 0.1 (±0.3) misleading, and 1.5 (±1.5) for patient view videos (p = 0.0027). This study demonstrates a minority of videos are useful for teaching MTX injection. Further, video quality does not correlate with video views. While web video may be an additional educational tool available, clinicians need to be familiar with specific resources to help guide and educate their patients to ensure best outcomes.

Despite their established clinical utility, the mode of action for antimalarials remains uncertain despite recent advances and still requires further investigation. By better understanding how antimalarials function, their optimal use in the clinical setting can be ensured.

Background The 21-gene recurrence score assay (RS) stratifies early-stage, estrogen receptor-positive breast cancer by recurrence risk. Few studies have examined how physicians use RS to recommend adjuvant systemic chemotherapy or patient experiences with testing and decision-making. Methods We surveyed 3,880 women treated for breast cancer in 2013-2014, identified by the Los Angeles County and Georgia SEER registries (response rate: 71%). Women reported chemotherapy recommendations, chemotherapy receipt, testing experiences, and decision satisfaction. Registries linked tumor data, RS, and surveys. Regression models examined factors associated with chemotherapy recommendations and receipt by RS and subgroups. Results Of 1,527 patients with Stage I-II, ER/PR(+), HER2-negative disease: 778 received RS (62.6% for node-negative favorable, 24.3% in node-negative, unfavorable, and 13.0% in node-positive disease, p<.001). Overall, 47.2% of patients received a recommendation against chemotherapy and 40.6% received a recommendation for it. RS results correlated with recommendations: nearly all patients with high scores (31-100) received a chemotherapy recommendation (86.9%-96.5% across clinical subgroups), while the majority of patients with low-risk results (0-18) received a recommendation against it (49.2%-78.2% across subgroups). Most patients with high RS received chemotherapy (87.0%, 91.1%, 100% across subgroups), while few patients with low scores received it (2.9%, 9.5%, 26.6% across subgroups). There were no substantial racial/ethnic differences in testing and treatment. Women were largely satisfied with RS and chemotherapy decisions. Conclusions Oncologists use RS to personalize treatment, even in node-positive disease. High satisfaction and absence of disparities in testing and treatment suggests that precision medicine advances have improved systemic breast cancer treatment.