JAMA : the journal of the American Medical Association
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To assess the short-term outcomes of incidental appendectomy through analysis of hospital administrative data and determine the consistency and plausibility of the observed results. ⋯ These findings suggest that incidental appendectomy is associated with a small but definite increase in adverse postoperative outcomes. However, plausible and consistent findings were only obtained after restricting the analysis to low-risk subgroups in which unmeasured differences in patients' baseline characteristics were less likely to confound adjusted outcome comparisons. This exercise highlights the potential pitfalls in nonrandomized outcomes comparisons using data sources with limited clinical detail, such as hospital discharge abstracts.
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Using data from a recent case-control study, a woman's risk of having a child with a neural tube defect (NTD) was found to be associated with early pregnancy red cell folate levels in a continuous dose-response relationship. These findings were used to calculate the reduction in NTD cases that would be expected under two different strategies to raise folate levels. Targeting high-risk individuals has a small effect on the population prevalence but can substantially change an individual's risk. ⋯ The current guidelines for the prevention of NTD are for an increased folic acid intake of 0.4 mg per day. This would result in a 48% reduction in NTDs, which may be near optimal. The two intervention strategies should be considered complementary in prevention of NTDs.
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Given the success of MD-PhD students in the past and the uncertain future of science and clinical medicine, this article has attempted to review the progress of MD-PhD programs and examine the experiences of some of today's MD-PhD students. Most candidates responding to the questionnaire remain committed to research and its applications. Their future plans are in line with the paths their predecessors have chosen, namely, careers devoted to academic medicine. ⋯ A few of these students seem disenchanted with the benefits conferred by a dual degree. "I don't see the advantages of a combined program that I saw when I was applying," one student explained. "The PhD degree confers no benefit as far as I can tell in how one practices medicine or in how well someone will conduct basic research." Detractors of combined-degree programs have questioned how anyone can succeed in science or medicine if not exclusively dedicated to one program. That achieving this balance was the foremost concern of the students surveyed suggests that doubt lingers for them as well. "I have often wished for more MD-PhD role models," wrote another student. "What have other people done with their combined degree? My career objectives are still vague because I am still not sure of what niche I will fill as an MD-PhD. Perhaps we can fill any niche." Perhaps that was the idea all along.