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Abstract Background Sarcoidosis is an inflammatory disease characterized by the formation of granulomas, which involve the heart in up to 25% of patients. Cardiac sarcoidosis can lead to life threatening arrhythmias and heart failure. While corticosteroids have been used as a treatment for over 50 years, they are associated with hypertension, diabetes, and weight gain, further increasing cardiovascular risk. Interleukin-1 (IL-1) is the prototypical proinflammatory cytokine that works to activate the nuclear transcription factor NF-kB, one of the targets of glucocorticoids. IL-1 also plays an important role also in the pathophysiology of heart disease including atherosclerosis, myocardial infarction, and myocarditis. Methods Building on a network of research collaborators developed in the Cardiac Sarcoidosis Consortium, we will investigate the feasibility and tolerability of treatment of CS with anakinra at two National Institute of Health Clinical and Translational Science Award (CTSA) hubs with expertise in cardiac sarcoidosis. In this pilot study, up to 28 patients with cardiac sarcoidosis will be recruited to compare the administration of an IL-1 blocker, anakinra, 100 mg daily on top of standard of care versus standard of care only for 28 days and followed for 180 days. Utilizing surrogate endpoints of changes in systemic inflammatory biomarkers and cardiac imaging, we aim to determine whether IL-1 blockade with anakinra can combat systemic and cardiac inflammation in patients with cardiac sarcoidosis. Discussion The current trial demonstrates an innovative collaborative approach to clinical trial development in a rare, understudied disease that disproportionately affects females and minorities. Trial Registration The trial was registered prospectively with ClinicalTrials.gov on July 12, 2019, identifier NCT04017936.

Abstract Introduction This resource is designed for use within a preclinical skills course to teach first and second-year medical students fundamental physical exam (PE) skills. PE skills are a vital competency for medical students to master. Since bedside teaching of the PE during clerkships is infrequent, students entering clerkships must have a strong foundation in PE skills that will enable them to function autonomously. Methods This resource helps students develop all the essential tools in their clinician PE toolbox. Students first learn a head-to-toe exam with associated provocative tests according to detailed checklists and PE videos that provide significant scaffolding for the novice learner. While detailed, the checklists and videos are designed to emphasize flexibility, and can expand or contract to a core exam based on what is needed for patient care. Once students have a firm foundation of PE skills, they can begin to learn to select the appropriate tools for the job by learning to perform hypothesis-driven physical exams as support is gradually diminished. Results The PE checklists and videos have been refined based on student and faculty feedback in an iterative process over more than 10 years of use at the Warren Alpert Medical School of Brown University. The color-coding schema with core/provocative tests was introduced last year and received very favorably. The effectiveness of physical exam instruction is consistently ranked at Brown as very good (4.7 out of 6.0 in 2014) on a scale from poor to outstanding. Discussion Clinical skills course directors wishing to develop a physical exam thread or seeking to improve their current PE instruction are likely to find this resource valuable. Although this resource was designed for medical students, physician assistant or nurse practitioner training programs may also find it useful.