RCT comparing 0.9% saline with balanced crystalloids (LR or PlasmaLyte).
N=15,802 over 5 ICUs
Some big results: -Balanced crystalloids had fewer adverse kidney events (14.3%) compared to saline (15.4%) [OR 0.91, p=0.04] -Trend for new renal-replacement therapy was less for balanced crystalloid (2.5%) compared to NS (2.9) [p=0.8]
And the big kicker
- Overall 30-day in-hospital mortality was 10.3% in balanced crystalloids compared to 11.1% in the saline group [p=0.06] with NNT of 96!
Hey fellow medfag. I’ve tried making a few topics before, but they hardly get many replies. If we had a med general I know for sure I would check Veeky Forums more often.
I saw those papers in the newest NEJM, although I don’t care so much anymore since I’m going into psych. The conclusion I get from this is that crystalloids and saline are practically interchangeable. The different in outcomes is small and only a few are actually significant (with big p-values). This goes for both papers on the subject, and really, people who love crystalloids are going to swear by them and use them no matter what research says, so at least we know they are equal or maybe even marginally superior to saline.
Carson Ross
>Medical Professionals
you mean brainlet professional?
Medtards can't even integrate
James Jones
>significant >big p-values
Christopher Turner
IIRC Psych gets a couple inpatient rotations, so you can always impress your colleagues by recommending NS.
So, without getting to pedantic, all of the fluids studied in the paper are crystalloids. Normal Saline is a crystalloid.
Basically the argument goes: 1) If both crystalloids confer, essentially, the same benefit (volume resus-wise) 2) One crystalloid (LR) has a mild mortality and renal-protective benefit over another (NS) 3) Why would you use NS?
And the outcomes are significant...
I can't disagree with that! Math hard.
I think you know what he means.
Aaron Jones
I'm a sophomore at an Ivy League university and have a 2.9 GPA as a physics major. I already took the MCAT and received a 525. How fucked am I for Med School admissions?
I know people always say where you go to med school doesn't matter. but I want to go to a top-tier one. Is there still a remote chance of me doing so with my GPA? How can I improve my chances?
Wyatt Murphy
I hate the fact that society sees medfags as superior. When people ask what I do and I say I'm a math student they almost cringe. what the fuck.
Nicholas Davis
I'm not at all involved in application and far enough removed to not know what sort of MCAT score would be competitive. I would say that your GPA makes your chances rather slim.
What sort of extra-curriculars/research/connections do you have? What's your science GPA?
Charles Robinson
I don't see myself as superior to you, user. Math is incredibly rigorous and demanding. I value your work and fully recognize that we all stand on the shoulders of giants.
Medicine owes itself to biology/physiology/etc. Which, in turn owes itself to chemistry, physics, and fundamentally mathematics.
Thomas White
Having a P of .04 is still a 4% chance that it is due to random chance. Very unlike a p-value of 0.00001 for example, where it would be very hard to argue it is due to random chance.
Sat down and actually looked at the paper. All the significant ORs pass so closely to the null (CI for major kidney event was .82 to .99), and no change in mortality makes me feel there isn’t really a case to make here for balanced crystalloids. It looks like they had more renal-replacement therapy free days, but having literally the same median, mean, and SD is a very marginal benefit, if actually real and not a chance finding.
There was also no difference in mortality, icu stay, or even final creatinine ratio from baseline (which contradicts what was defined as a “major adverse kidney event”. It is likely only difference in renal replacement days contributed to that difference).
The paper didn’t even acknowledge how close to the null all these findings are and that strikes me as bad. The very high n leads to small CI, but that doesn’t mean those differences are clinically important.
Dylan Lopez
med student fag here. i like surgery but not enough to not have a life outside the OR. any good procedural specialties i should look at that allows me to have a life?
Josiah Morgan
your MCAT is pretty good but as you know ur GPA is garbo. just work ur tail off next 2 years and pull your GPA up. ur chances at a top tier school aren't great with a bad GPA but you should still be ok for med school in general.
John Evans
>I don't see myself as superior to you
what are you doing on this vietnamese cookie decoration's Veeky Forums board? It's all about IQ and superiority
Grayson Moore
At lot of medfag start believing it and acting as if they were superior. But you’ll find that just like in every field, there are great and humble people who are just plain great to be around.
Have you talked to your advisor? Medicine is pretty great in that you can be successful without needing to go to a top tier med school (you might even make less money that way, as academic medicine pays very little compared to only doing private practice). I wouldn’t worry about it and just try to make your gpa better for when you apply. A master in a health-care related subject wouldn’t hurt.
Joseph Robinson
cuz we deal with life and death situations + the average lay person has dealt with a medfag IRL from either being sick or their family member being sick.
doing math is impressive but you're not saving chad's life so he DGAF.
Easton Walker
Interventional cardiology is a good option, although training is long and competitive.
OB-GYN has both a strong clinical and surgical component, so you might also enjoy that. I also think it has a better life-style balance than surgery, but it can still get pretty hectic.
Dylan Bell
Interventional Radiology.
Some surgery specialties have really nice lives. ENT, Uro, Optho being the prime examples.
But there are lots of gen surgeons working at smaller centers who have great hours.
Jonathan Gomez
Okay both Interventional Cards and OB/Gyn have arguably worse lifestyles than general surgery (maybe the former being slightly better)
Those are not good examples of chill interventional specialties.
Ryan Gray
i've looked into those and they both seem competitive.
what about private practice ortho? or interventional pain
Owen Richardson
I thought “life outside of the OR” meant “seeing more patient in a clinical setting instead of just in the operating room”.
I would argue that all surgical specalties can have a great lifestyle if you choose to not do emergencies and have only a few elective procedures a day. Most do not choose to do this because they make so much money otherwise, not because a relaxed life-style isn’t possible.
Add platics to the list, too.
Joseph Scott
Ortho is pretty competitive as well.
Most non-surgical interventional fields with decent lifestyles are going to be things like GI.
PMR and EM have really good lives and do lots of procedures.
Anesthesia is becoming *less* competitive interestingly and has a fair number of coolp rocedures.
Some specialties have terrible lifestyles, regardless of setting. Vascular surgeons, CT surgeons, Neurosurgeons, and Trauma Surgeons all work terrible hours.
Charles Peterson
Ortho is probably one of the most competitive specialties right now because of how massive your paycheck can be. Most orthos do only elective surgery and spend most of their day in the OR.
Oliver Morales
I would disagree highly with EM, most EM physicians I have met talk about the high burn-out rate and how EM physicians are retiring earlier and earlier every year. EM needs to go through some massive changes if it wants to remain an attractive specialty for medical students.
I agree that anesthesia is a great choice if you want a good lifestyle. They also make great money and you can go on to do pain management if that’s what you are into.
Adrian Cook
Is there a way to work less than 30h a week as a med fag?
Brayden Lee
I think I would like anesthesia as it has a good amount of procedures, decent $$$/lifestyle. why is it less competitive now? CRNAs?
Josiah Young
you could prob find a way to work part time but obviously you'd be paid a lot less and might not be worth it if you can't recoup your losses from student debt or opportunity cost.
Landon Foster
So, having worked in an ED and considering it strongly before switching to CritCare, I would say that the burnout has more to do with how the specialty is organized.
EM is one of the newest specialties. By the time it was formalized, the people who grandfathered into it were people like internists, surgeons, and family docs who had no desire to do the shiftwork lifestyle.
Burnout is way down and satisfaction quite high for new graduates and docs with
Michael Thompson
Every single senior EM doc has told me to avoid EM at all costs. They say it's understaffed and underpaid. But if things are going the way you're saying then I'm glad. I would hate to have a whole specialty abandoned because of the work culture surrounding it.
To start a topic on something interesting (so the thread doesn't die out) what are your guy's opinion on the new effort to limit resident work hours? 80 hours still feels like a lot of time, and I think 60 hours would be much more reasonable, but at least there's a cap on 24 continuous hours. Do you guys think this is an overreaction? Do you think this is a great move? Is there much better we can do here?
Also, resident suicides are still happening. I blame the competitive, and often toxic work environment many medical residency programs have much more than the long work hours. People aren't comfortable expressing their deficiencies, despite this being the purpose of being in a teaching program to begin with.
Jacob Cook
>They say it's understaffed and underpaid.
I'm sure it's institution dependent. The ED I work at is very well staffed.
I know some EM docs that make 400+, which is pretty bank considering shiftwork.
>80 hours still feels like a lot of time, and I think 60 hours would be much more reasonable, but at least there's a cap on 24 continuous hours. Do you guys think this is an overreaction?
I hate to say it, but 80 hours is not that bad. Honestly for learning purposes you gotta be in the hospital.
MOST residencies and MOST rotations don't reach 80 hours.
You bring up a great point though.
John King
You guys are Brainlets, that user got a fucking near-perfect score on MCAT (>99.9 percentile)
You're obviously very intelligent user. Get your shit together grade-wise and do something that really sets you apart in your extracurriculars and you'll be good for med school
I don't know the new MCAT scoring system. I don't participate in admissions anymore.
Brandon Edwards
Hi, how hard is it for a foreigner to get into research residencies?
I don't have a PhD, because in my country you can't do an MD and PhD at the same time like in the US, but I am actively doing research (and collaborating with a professor in the US).
Like, if I get good step grades is it doable?
Bentley Scott
Congratulations on the amazing MCAT score. Bring your GPA up as much as you can, only As from here on out. Some schools like to see upward trends and will weigh later semesters more heavily when calculating your GPA. If at the end of your undergrad your GPA is still in the low 3s, I would do a formal SMP and ace it to prove you can hack it in medical school.
If you don’t want to do that, apply to DO schools. They’ll likely admit you if you have decent ECs solely on the basis of your insane MCAT score.
Mason Flores
Why would you want to when you make 80-500+/hr?
Just saw that you mentioned wanting to go to a top tier school. It’s possible based on your MCAT score but you have to bring your grades way up to an A average. The sad fact is most adcoms don’t care about your UG major or institution, they just want to see a GPA close to a 4.0. Write off your social life, bust your ass and it can be done. Your MCAT score likely means many top tier schools will take a chance in you even if your GPA isn’t perfect.
Julian Howard
Thank you user. I'm also a first-generation white guy, how much do you think that will help, especially with my GPA?
I'm taking graduate physics class right now and I have highest grade in it. Do admission committee give two shits about that? I'm planning on taking some medical physics classes at medical school next semester too
Lincoln Price
You need connections. Your best bet is to try to find a research fellowship or do a masters or PhD in the US if you are sincerely interested in research.
You step grades sort of stop mattering if you go that far (unless very competitive specialty). It's not too hard to find fellowships if you are reputable in your own country (research experience and publications), but you might struggle otherwise.
Liam Moore
What counts for relevant research experience? I hope to have by the end of the year a paper published(in an ok journal). I also have presented other works 7 times at conferences and such. All of this is mathematical modeling. Is this good enough, at least for a research fellowship?
Mason Roberts
you have to go back
Ethan Miller
Go back where?
William Stewart
The fact you have an actual project is good, and that you’ve presented at conferences.
I recommend you do a fellowship or find a research position in what you want to do. (You mentioned a connection to US research, he might be a good person to talk to about where to look for those opportunitites). Ultimately, unless you have everything ready for next years match (applications are due in september) you will have a year or two were you won’t be able to start residency, so you might as well should put that time into research.
What field is your research in? Have you done the usmle? Is your school internationally registered?
Parker Evans
>doing math is impressive but you're not saving chad's life so he DGAF That math is saving tons of lives though. Look at anything that is used in modern medicine and there is a hard math behind it. I work in the pediatric operating theatre and I would have a hard time pointing to an item that we would still be privileged to use without the existence of math studies. Even the basics like microbiological sterilization of equipment or general anesthesia exists only because of a statistical analysis.
Cutting edge diagnostics like IBM Watson or even fMRI are all complex maths. There is not a single thing in the med field that is not predated by it. And I believe that the future of medicine lies in the practical applications of this rigorous field.
Joseph Rivera
Thanks for the response!
I still have a year and a half of medical school here, until I finish, so I have time to take the usmles.
As for research, I am doing mathematical modelling. I have done a project on the electrophysiology of the heart, and now I am working on a model that describes the inflammatory process in rheumatoid arthritis (which I am doing with the guy in the US).
I'd love to do clinical work as well, because I enjoy that a lot, but ideally combine it with the research I am doing. I was thinking of going into neurology, as they have some neat math modeling of neurons etc.
Does all this sound realistic? Or is there something I am missing?
Mason Taylor
Ah this issue gets brought up a lot.
Was always told that (and will likely preach to the choir) that this is a non issue unless you’re ordering bags and bags of shit.
Gavin Hall
Listen I'm not gonna suggest that mathematics isn't incredibly useful in medicine.
Fuck, nearly every adjustment I make to keep people breathing on a ventilator is verified and validated mathematically.
But fMRI and Watson are pretty bad examples. lol.
So is that rather sloppily dissected heart.
That research sounds really good. Try to get a couple pubs out of it.
Yes, but
Ryder Jones
You should consider looking into meta-research or masters or fellowships in clinical research or epidemiolgy, unless you want to only research in a very specific field (then go to that field).
I think the fact you have actual projects and ideas puts you miles ahead of most people when looking for research opportunities.
If you are 100% desicated to research, you could do a PhD and then apply to residency, but I still think doing a year or two of research while getting everything together is your best bet.
What do you see yourself doing in 10 years? After finishing residency and everything.
(Sorry for any mistakea, I’m phone posting).
Christopher Butler
>But fMRI and Watson are pretty bad examples. lol. Why? >So is that rather sloppily dissected heart. You should sniff more sevorane vapors before posting my dude.
Isaiah Edwards
In 10 years I would ideally keep doing research but see patients as well. I wouldn't do any hardcore specialty or anything, just see and treat patients to keep my feet on the ground and have contact with the real world.
Of course, the best thing would be if I can connect the research I am doing with the clinical practice.
And hopefully, leave the old country, as it is corrupt as shit and research is unheard of.
Jack Torres
If you actuallt want to talk about different oportunities, give me your e-mail.
I’m in a bit of a similar position as you, and know people who have followed a path like yours.
Gavin Rodriguez
Do dentalfags count? D1 here.
Ian Collins
Hello fags. Ms3 here finishing a phd. I’m older and have been through a hell of a lot.
To the guy posting a photo of yourself and the mcat score- good luck. Youll prob get bored of med school.
My field is cancer immunology. I posted some of my problems here and someone identified me and my pubs but whatever. Definitely going into pathology due to lifestyle. I don’t want to work to death.
Jack Cox
My friend is a radiologist and I needed his help for a medical software patent so he taught me some shit that I needed and I later found out he gave me the quick rundown of linealg.
Kayden Allen
Yup dental fags are welcome.
That's good stuff. You planning on subspecializing?
Radiologists and radonc use a fair amount of math.
Luis Lopez
>Why would you want to when you make 80-500+/hr?
you just answered yourself, friend. because I can live a comfy life while working few hours
Grayson Young
Sup. Finished my uni a year and a half ago,currently setting up private practice. Things are very expensive.
Angel James
Clinical path, molecular path, heme path
Hudson Phillips
How do you guys deal with people dying? I am taking it pretty hard so far.
Mason Scott
Everyone dies. Why take it hard? I find it much more emotionally taxing when lives are unnecessarily prolonged.
Hudson Baker
math virgins are pathetic lol
Blake Walker
Just go to a caribbean med school and work your ass off. You'd do well as long as you get a good step 1 score (240+)
Kevin Martinez
We take it hard because it is hard. It does get easier with time and rationalization certainly helps.
But, occasionally, people who shouldn't die will die.
Hell I just got home from a shift where a 3 month old died. We think he had some kind of spontaneous pulmonary hemorrhage. The code was perfect in terms of timings, interventions, et cetera. But realistically the kid came into my resus. bay dead on arrival.
It sucks. I'm gonna go lift to get some stress relief with a buddy. We debriefed after the code. I'm gonna touch base with my therapist.
The biggest recommendations I have are:
1) Healthy coping mechanisms. Relax, read, give yourself permission to break away, watch a show or movie you like, exercise, eat healthy for a week at least after the event.
2) Talk to someone. A friend, a family member, a counselor. Someone. It matters.
Blake Peterson
I can't go from an Ivy to a caribbean med school. My ego is too big for that
Matthew Williams
Don't do Caribbean whatever you do. DO is fine except from some competitive specialities that don't have a lot of DO programs like neurosurgery but Caribbean is just signing up for primary care at best if you get anything. Yeah there's cases here and there but they're rare.
Owen Reed
>tfw is blocked out of med school because of history of average grades
keep on going bros, I really respect the dediction and disciplines you guys have. I wish I could go back in time.
William Sanchez
dedication and discipline.
sorry I had a stroke
Christopher Stewart
Considering your research focus, why not go into oncology or hematology?
Eli Cruz
>touch base Why do medfags and business type people specifically always say this? I've heard literally no one else ever say this in order to say "meet up with," it's uncanny
Brody Collins
partly why i am going into path
Easton Reyes
i like people but i dont want to do physical exams all the time and manage labs. i find molecular data more interesting. personalities are a variable i dont want to engage
Luis Collins
>deal with more dead people
also, how do i learn all the anatomy for the musculoskeletal system?
Brayden Taylor
So I heard some schools are taking off the general science 2 year prerequisites so pretty much anyone can apply now given they take the MCAT... What do you guys think about this?
Zachary Scott
Unspecified heart murmur and daily alcohol use, age 33. Will I make it to 60? I hope not.
I am generally interested in heart murmur morbidity and other hazards if medfags care to give me advice about my car. It's all you're good for, after all.
Mason Nelson
That licks ass. Probably to be more inclusive of majors like womens studies. Can you link me?
Pre-meds are the worst people in any class. Absolutely insufferable assholes who only care about the grade and nothing else.
Jeremiah Martinez
Pharmacy student here
James James
is there still a stigma regardimg primary care?
Connor Hughes
What the fuck is an unspecified heart murmur?
Adrian Hill
Anesthesia resident reporting in
If youre an average white male youll need a GPA of at least 3.7. The system is built to discriminate against you. That or have family members that have gone to med school that can get you in as a legacy.
vast majority of PA programs require some sort of clinical exposure IE working in a hospital as a nurse/aide/something full time for at least a year or two.
No they just dont make much money.
This path into a US career is rapidly closing off/closed off. Theres really no more residency spots for students who come from the carribean except for the lowest of the low garbage tier programs where you work as a slave and will really have no hope of a fellowship/advanced training in whatever field you wind up in. Going to the carribean is just a ticket to being several hundred thousands of dollars in debt without a job. If they dont kick you out first (they aggressively kick people out to make their scores/students look better for marketing purposes). I have a friend from college who went that route and didnt match and now hes not really doing anything. Hes a doctor but no residency = no license = no job.
Brody Watson
Does first generation not help as a hook? Neither of my folks went to college
Christopher Ross
Are there pa programs that don't require these things or is it a bad idea ?
Awman
What if I was a medical accessions for a year
Luis Martin
Don't do Caribbean wtf. If you must go overseas go to Ireland but with your MCAT you can probably get into a low tier MD school and definitely a DO school if you pull your GPA up in the next 2 years.
Camden Fisher
Canadafag here
Non science major. Prepping with khan Academy and going to be taking a ton of MCAT prep/crash courses outside of uni and writing the MCAT next year. I'm naturally pretty good at CARS so will definitely apply to McMaster but my GPA is shit. Probably like a 3.6 cGPA but with certain weighing formulas I should have a 3.8ish providing I don't fucking eat shit this semester.
Any advice? I feel like I'm already fucked. I really just want to get into psych frankly.
Andrew Sanchez
I thought psyc in mcmaster was an undergrad thing.
Wyatt Hernandez
No I meant psychiatry (which is a medical specialty). Although my degree is in psychology anyway which is useful in preparing for the social sciences section on the MCAT.
Chase Wood
You are good, gpa wise. Just need to get the extra stuff.
Jason Cooper
Thanks, really hoping I can. I'm retarded at math and half assed high school chemistry with a B- I think. Then again I didn't put much effort into it and did the courses online in like 1 month but I guess we will see what happens. Khan Academy is probably the most useful thing for me
Owen Cox
Just don't give up after your first try. There could be an influx of top tier asians that year that pushed the requirements way up that year, and you didn't make the cut. Or budget cuts kicked in and you drew the short end of the straw. The interviewers can see the effort you've put in, and eventually, you will get in.
Andrew Reyes
Thanks I'll keep that in mind. Any suggestions on how to boost my application in general? I've been volunteering in this clinic for 3 years. It's fine, nothing special, the nurses are insufferable. Planning on starting volunteering in a hospital soon. I want to get some research experience/become a research assistant but not entirely sure where to start. Since I am a non science major I don't know what sort of relevant research experience I could get for medical school. There are a bunch of psychology labs I could apply to but I'd probably end up doing research on stuff like mental disorders or cognitive development, etc.
Also at what point should I consider going overseas? I am 22, turning 23 soon. I'd like to be finished medical school and in a residency by 30.
Alexander Morris
Also if it makes a difference I have EU citizenship. I would probably go to Ireland if anywhere
Juan Cook
You've pretty much got everything you need, good gpa, soon-to-be good mcat, volunteer clinical hours. See if you can go to the hospital, as that's where you'll likely be doing residency. The only thing that could break you would be the interview/poorly written application. Overseas is weird. I really don't know.
Also, take this all with a grain of salt. I was an engineer student who lived in a house full of premed/med students, so this is all just second hand shit they told me back then.
Camden Brown
No unless youre african american/hispanic
Probably not and I dont know try calling one and asking
Isaiah Johnson
What kind of "research experience" is good for medical schools? Does it have to be something in the biomedical sciences or a type of clinical research, or is doing something related to your major (like chem or physics) is fine?
Juan Russell
Ok thanks
Samuel Peterson
Dude I'm an arts major can I be a "research" assistant for like a humanities prof or something?
Austin Turner
Why are you so mean? I need help here
but i guess ill always be worth less than you huh
Robert James
A heart murmur the specific nature of which is as yet unknown. It has its own diagnostic code ffs. Learn your trade, mechanic.
Owen Walker
Any research exp is good. A lot of misconceptions on this thread btw. Go to SDN you chucklefucks.