JAMA : the journal of the American Medical Association
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Because of the size and growth of the international medical graduate (IMG) contribution to graduate medical education (GME) in the United States, and subsequently to the US physician workforce, it is essential to understand the demographics and patterns of IMG training and practice as well as the routes of entry into the United States. ⋯ In recent years, participation of IMGs in GME and practice has increased significantly. Most IMGs in GME are not exchange visitors, but are either permanent residents or US citizens. Patterns of specialization and location of IMGs ultimately mirror those of USMGs. National IMG policy must be examined in light of the projected surplus of physicians in the United States. The best option for long-term control of the number of physicians in practice, USMG or IMG, is a system of specifying the number of GME positions nationally.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Transfusion requirements in critical care. A pilot study. Canadian Critical Care Trials Group.
To evaluate the effects of a restrictive and a liberal red blood cell (RBC) transfusion strategy on mortality and morbidity in critically ill patients. ⋯ In this small randomized trial, neither mortality nor the development of organ dysfunction was affected by the transfusion strategy, which suggests that a more restrictive approach to the transfusion of RBCs may be safe in critically ill patients. However, the study lacked power to detect small but clinically significant differences. Therefore, further investigations of RBC transfusion strategies are warranted.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study.
To determine whether the addition of carotid endarterectomy to aggressive medical management can reduce the incidence of cerebral infarction in patients with asymptomatic carotid artery stenosis. ⋯ Patients with asymptomatic carotid artery stenosis of 60% or greater reduction in diameter and whose general health makes them good candidates for elective surgery will have a reduced 5-year risk of ipsilateral stroke if carotid endarterectomy performed with less than 3% perioperative morbidity and mortality is added to aggressive management of modifiable risk factors.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized clinical trial of active compression-decompression CPR vs standard CPR in out-of-hospital cardiac arrest in two cities.
To compare the effectiveness of active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) with a handheld suction device vs standard manual CPR in victims of out-of-hospital cardiopulmonary arrest. ⋯ There was no improvement in outcome with ACD CPR in out-of-hospital cardiac arrest in these two cities. Differences in study design, demographics, EMS systems, response intervals, training, and technique performance may contribute to the lack of improvement in initial resuscitation with ACD CPR compared with previous studies. Future research needs to control these variables to determine the reason for these differences in outcome.