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Background-Sitagliptin is a new oral glucose lowering medication which acts via the incretin hormone system. The most common side effects are headache and pharyngitis, and few serious adverse events were observed during clinical trials. Dose adjustment is recommended in renal insufficiency, but long-term safety experience is limited.

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Objectives Lung ultrasound (LUS) can accurately diagnose several pulmonary diseases, including pneumothorax, effusion, and pneumonia. LUS may be useful in the diagnosis and management of COVID‐19. Methods This study was conducted at two United States hospitals from 3/21/2020 to 6/01/2020. Our inclusion criteria included hospitalized adults with COVID‐19 (based on symptomatology and a confirmatory RT‐PCR for SARS‐CoV‐2) who received a LUS. Providers used a 12‐zone LUS scanning protocol. The images were interpreted by the researchers based on a pre‐developed consensus document. Patients were stratified by clinical deterioration (defined as either ICU admission, invasive mechanical ventilation, or death within 28 days from the initial symptom onset) and time from symptom onset to their scan. Results N = 22 patients (N = 36 scans) were included. Eleven (50%) patients experienced clinical deterioration. Among N = 36 scans, only 3 (8%) were classified as normal. The remaining scans demonstrated B‐lines (89%), consolidations (56%), pleural thickening (47%), and pleural effusion (11%). Scans from patients with clinical deterioration demonstrated higher percentages of bilateral consolidations (50 versus 15%; P = .033), anterior consolidations (47 versus 11%; P = .047), lateral consolidations (71 versus 29%; P = .030), pleural thickening (69 versus 30%; P = .045), but not B‐lines (100 versus 80%; P = .11). Abnormal findings had similar prevalences between scans collected 0–6 days and 14–28 days from symptom onset. Discussion Certain LUS findings may be common in hospitalized COVID‐19 patients, especially for those that experience clinical deterioration. These findings may occur anytime throughout the first 28 days of illness. Future efforts should investigate the predictive utility of these findings on clinical outcomes.

Background Lung ultrasound (LUS) has received considerable interest in the clinical evaluation of patients with COVID‐19. Previously described LUS manifestations for COVID‐19 include B‐lines, consolidations, and pleural thickening. The interrater reliability (IRR) of these findings for COVID‐19 is unknown. Methods This study was conducted between March and June 2020. Nine physicians (hospitalists: n = 4; emergency medicine: n = 5) from 3 medical centers independently evaluated n = 20 LUS scans ( n = 180 independent observations) collected from patients with COVID‐19, diagnosed via RT‐PCR. These studies were randomly selected from an image database consisting of COVID‐19 patients evaluated in the emergency department with portable ultrasound devices. Physicians were blinded to any patient information or previous LUS interpretation. Kappa values ( κ ) were used to calculate IRR. Results There was substantial IRR on the following items: normal LUS scan ( κ = 0.79 [95% CI: 0.72–0.87]), presence of B‐lines ( κ = 0.79 [95% CI: 0.72–0.87]), ≥3 B‐lines observed ( κ = 0.72 [95% CI: 0.64–0.79]). Moderate IRR was observed for the presence of any consolidation ( κ = 0.57 [95% CI: 0.50–0.64]), subpleural consolidation ( κ = 0.49 [95% CI: 0.42–0.56]), and presence of effusion ( κ = 0.49 [95% CI: 0.41–0.56]). Fair IRR was observed for pleural thickening ( κ = 0.23 [95% CI: 0.15–0.30]). Discussion Many LUS manifestations for COVID‐19 appear to have moderate to substantial IRR across providers from multiple specialties utilizing differing portable devices. The most reliable LUS findings with COVID‐19 may include the presence/count of B‐lines or determining if a scan is normal. Clinical protocols for LUS with COVID‐19 may require additional observers for the confirmation of less reliable findings such as consolidations.

Physicians currently spend as much as half of their day in front of the computer. The Electronic Health Record (EHR) has been associated with declining bedside skills and physician burnout. Medical student EHR use has not been well studied or characterized. However, student responsibilities for EHR documentation will likely increase as the Centers for Medicare and Medicaid Services (CMS) most recent provisions now allow student notes for billing which will likely increase the role of medical student use of the EHR over time. To gain a better understanding of how medical students use the EHR at our institution, we retrospectively analyzed 6,692,994 EHR interactions from 49 third-year clerkship medical students and their supervising physicians assigned to the inpatient medicine ward rotation between June 25 2015 and June 24 2016 at a tertiary academic medical center. Medical students spent 4.42 hours (37%) of each day at the on the EHR and 35 minutes logging in from home. Improved understanding of student EHR-use and the effects on well-being warrants further attention, especially as EHR use increases with early trainees.

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