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ABSTRACTBackground To optimize resident learning, programs need to readily assess resident well-being. There is a lack of easy-to-use, acceptable instruments for this task.Objective We created a well-being “fuel gauge,” and assessed the acceptability and feasibility of this weekly electronic communication pipeline for residents to report and discuss their well-being.Methods A well-being fuel gauge assessment was administered weekly over the course of 1 academic year (July 2016 to June 2017) in a large internal medicine residency program. The well-being gauge asked residents to report their fuel levels using a 1 to 5 Likert-type scale (1, empty; 3, half tank; and 5, full tank). Residents who provided low scores (1 or 2) were contacted by program leadership, and the program director sent weekly e-mail updates that addressed residents' comments on their well-being fuel gauge.Results Of 163 residents, 149 (91) provided data on their well-being fuel gauge, with a 53 average weekly response rate. Fifty-four percent of residents (80 of 149) reported a low score over the course of the year, and 4 residents only used the assessment to report a low score. Comments on average consisted of 280 characters (SD  357) and were lengthier and more prevalent with lower fuel gauge scores. We analyzed the relationship between scores and comments.Conclusions The well-being fuel gauge was well accepted by most residents and was easy to administer and to oversee by program directors. It facilitated ongoing monitoring of well-being and follow-up to address factors contributing to low well-being.

OBJECTIVE: To examine the association of race/ethnicity with measures of disease activity and severity among male US veterans with rheumatoid arthritis (RA). METHODS: Measures of disease activity and severity were examined in a group of US veterans (n = 573) with RA, comparing measures in African American men (n = 79) with Caucasian men (n = 494). Dichotomous variables were compared using logistic regression while continuous variables were examined using linear regression, adjusting for the effects of age, disease duration, and smoking status. RESULTS: Compared to Caucasians, African Americans were slightly younger (65.0 vs 67.1 yrs; p = 0.09) at enrollment and had a similar age at disease onset (50.5 vs 50.6 years; p = 0.98). After adjusting for age, disease duration, and smoking status, there were no differences based on race/ethnicity in rheumatoid factor positivity, the presence of radiographic changes, physical functioning, swollen joint counts, Disease Activity Score (DAS28), or global well-being scores. In contrast, African Americans were about 50% less likely than Caucasians with RA to have subcutaneous nodules (adjusted OR 0.51, 95% CI 0.30-0.86) and had lower tender joint counts (p = 0.007), associations that were attenuated and not significant with further adjustment for collection site. CONCLUSION: With the possible exception of lower rates of rheumatoid nodules and lower tender joint counts in African Americans, there is little evidence to support the existence of important racial/ethnic differences in RA disease expression between African American and Caucasian men.

To determine the clinical course and optimum treatment of human immunodeficiency virus (HIV)–associated myositis. Sixty-four patients attending a county outpatient HIV/acquired immunodeficiency syndrome facility were referred for the presence of elevated creatine kinase (CK) levels or muscle weakness. Patients underwent neurologic and rheumatologic evaluation, electromyography, and muscle biopsy after exclusion for recreational drug or alcohol use, metabolic/endocrine disorders, zidovudine therapy, and other infections. Thirteen patients (20%) had biopsy-proven myositis. The median duration of HIV infection prior to diagnosis of myositis was 4.3 years (range 0–11 years). Six patients had concomitant diffuse infiltrative lymphocytosis syndrome. There was no correlation of severity of weakness, stage of HIV infection, or retroviral treatment with the CK level at diagnosis. Eight patients received prednisone (60 mg/day) with 5 attaining complete resolution of myositis. The remaining 3 patients received immunosuppressive therapy (azathioprine or methotrexate and intravenous immunoglobulin) and had normalization of strength and CK. Four patients had spontaneous resolution of their myositis without treatment. HIV-associated myositis occurs at any stage of HIV infection, has a relatively good prognosis, responds well to immunosuppressive therapy, and has little evidence of adverse outcome on the HIV infection.

To determine the clinical course and optimum treatment of human immunodeficiency virus (HIV)–associated myositis.Sixty‐four patients attending a county outpatient HIV/acquired immunodeficiency syndrome facility were referred for the presence of elevated creatine kinase (CK) levels or muscle weakness. Patients underwent neurologic and rheumatologic evaluation, electromyography, and muscle biopsy after exclusion for recreational drug or alcohol use, metabolic/endocrine disorders, zidovudine therapy, and other infections.Thirteen patients (20%) had biopsy‐proven myositis. The median duration of HIV infection prior to diagnosis of myositis was 4.3 years (range 0–11 years). Six patients had concomitant diffuse infiltrative lymphocytosis syndrome. There was no correlation of severity of weakness, stage of HIV infection, or retroviral treatment with the CK level at diagnosis. Eight patients received prednisone (60 mg/day) with 5 attaining complete resolution of myositis. The remaining 3 patients received immunosuppressive therapy (azathioprine or methotrexate and intravenous immunoglobulin) and had normalization of strength and CK. Four patients had spontaneous resolution of their myositis without treatment.HIV‐associated myositis occurs at any stage of HIV infection, has a relatively good prognosis, responds well to immunosuppressive therapy, and has little evidence of adverse outcome on the HIV infection.