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"They Make It So Hard on You": How Rurality Shapes Veterans' Health Experiences When Managing Gulf War Illness.
J Gen Intern Med
January 2025
VA Portland Health Care System, Center to Improve Veteran Involvement in Care, 3710 SW U.S. Veterans Hospital Road, Portland, OR, 97239, USA.
Background: Gulf War illness (GWI) is characterized by multiple, persistent symptoms (e.g., fatigue, musculoskeletal pain, concentration problems, and gastrointestinal disorders) across more than one body system that are severe enough to interfere with daily functioning.
View Article and Find Full Text PDFHigh-Value Care Education in the USA: Lessons from a National Value Curriculum for Resident and Fellow Physicians.
J Gen Intern Med
January 2025
General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
Purpose: Physicians are estimated to be responsible for more than 50% of national healthcare costs and hold the greatest potential to improve value by orchestrating quality-driven programs to reduce unnecessary practices and variability. A physician's ability to practice cost-conscious care has been linked to their training, underscoring the importance of integrating cost-conscious practice into training.
Methods: The High Value Practice Academic Alliance was formed to help advance the value-improvement work of individual institutions through a national organization.
"The Forgotten Minority": Perpetuation of Ableism in Medical Education.
J Gen Intern Med
January 2025
Department of Medicine, Harvard Medical School, Boston, MA, USA.
Background: Accounting for approximately 1 in 4 community-dwelling adults in the United States (US), people with disabilities (PWD) experience significant disparities in health care quality, access, and outcomes. At the same time, US physicians have reported feeling unprepared to care for PWD and have revealed significant negative bias about this population.
Objective: To understand how physicians are trained to care for PWD in US medical schools.
Dyspnea with Hemidiaphragm Elevation in a Patient with Giant Cell Arteritis: A Case Report.
Intern Med
January 2025
Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
We herein report the first case of dyspnea with hemidiaphragm elevation in a 68-year-old woman with active giant cell arteritis (GCA), including successful treatment. Contrast-enhanced computed tomography showed a reduced density of the left ophthalmic artery and the left superficial temporal artery with increased soft tissue compared to the other side, indicating that the GCA had flared up and suggesting that the hemidiaphragm elevation might be caused by vasculitis-associated ischemia of the right phrenic nerve. Hemidiaphragm paralysis due to vasculitis-associated ischemia in patients with GCA needs to be distinguished from local infection, tumors, and hepatomegaly, which are the major causes of hemidiaphragm elevation.
View Article and Find Full Text PDFA Case of Severe Hypocalcemia During JAK1/2 Inhibitor Therapy for Myelofibrosis in a Patient with Liver Cirrhosis.
Intern Med
January 2025
Department of Internal Medicine 1, Shimane University Faculty of Medicine, Japan.
We herein report a 56-year-old man with severe hypocalcemia during ruxolitinib therapy for myelofibrosis transitioning from JAK2 mutation-positive polycythemia vera. Blood transfusions were administered every one to two weeks for ruxolitinib-induced anemia. Blood tests revealed hypocalcemia with low TRACP-5b, 25-hydroxyvitamin D (25 (OH) D), and 1,25-dihydroxyvitamin D (1,25 (OH) D) levels within the lower reference range.
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