A research team develops a new monoclonal antibody checkpoint inhibitor for advanced melanoma that has shown promise in animal studies as well as high efficacy and low toxicity in early phase human clinical trials. The research team would now like to compare this drug to existing standard of care immunotherapy for advanced melanoma. The research team decides to conduct a non-randomized study where the novel drug will be offered to patients who are deemed to be at risk for toxicity with the current standard of care immunotherapy, while patients without such risk factors will receive the standard treatment. Which of the following best describes the level of evidence that this study can offer?
ALevel 1
BLevel 3
CLevel 5
DLevel 4
ELevel 2
An 83-year-old man presents to the gastroenterologist to follow-up on results from a biopsy of a pancreatic head mass, which the clinician was concerned could be pancreatic cancer. After welcoming the patient and his wife to the clinic, the physician begins to discuss the testing and leads into delivering the results, which showed metastatic pancreatic adenocarcinoma. Before she is able to disclose these findings, the patient stops her and exclaims, "Whatever it is, I don't want to know. Please just make me comfortable in my last months alive. I have made up my mind about this." Which of the following is the most appropriate response on the part of the physician?
A"If that is your definite wish, then I must honor it"
B"The cancer has spread to your liver"
C"As a physician, I am obligated to disclose these results to you"
D"If you don't know what condition you have, I will be unable to be your physician going forward"
E"Please, sir, I strongly urge you to reconsider your decision"
A 72-year-old man is admitted to the hospital with productive cough and fever. A chest radiograph is obtained and shows lobar consolidation. The patient is diagnosed with pneumonia. He has a history of penicillin allergy. The attending physician orders IV levofloxacin as empiric therapy. On morning rounds the next day, the team discovers that the patient was administered ceftriaxone instead of levofloxacin. The patient has already received a full dose of ceftriaxone and had no signs of allergic reaction, and his pneumonia appears to be improving clinically. What is the most appropriate next step?
AAdminister diphenhydramine as prophylaxis against allergic reaction
BContinue with ceftriaxone as empiric therapy
CSwitch the patient to oral azithromycin in preparation for discharge and home therapy
DSwitch the patient back to levofloxacin and discuss the error with the patient
EContinue with ceftriaxone and add azithromycin as inpatient empiric pneumonia therapy
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