Effects of acupuncture on pain and inflammation in pediatric appendicitis

A paper [full text here] from The Journal of Alternative and Complementary Medicine says that "acupuncture may be a feasible and effective treatment modality for decreasing subjective pain and inflammation" in pediatric patients with appendicitis.

They studied six adolescents with appendicitis and administered acupuncture for pain control prior to surgery. Pain was assessed using three analog scales, and inflammation was measured using serial white blood cell (WBC) counts and C-reactive protein levels (CRP). CRP is a nonspecific indicator of inflammation in the body.

Figure 2 from the paper summarizes the results.

You can see that after 20 minutes of acupuncture, all three pain scores and WBCs declined. However, CRP continued to rise. Conspicuously absent from the figure and the text of the paper are any statistical analyses. This is due to the lack of a significant difference in any of these values because of the limited number of subjects studied.

The authors were undeterred and concluded "Although CRP as a general marker of inflammation stayed roughly the same on sequential blood draws, the median WBC showed a modest and noticeable drop. The implication of this finding is that the effectiveness of acupuncture may have a biophysiological basis." Look at the figure and decide for yourself if the WBC drop is really more noticeable than the CRP rise.

While the authors did mention some limitations of the study including the lack of statistics, they didnt discuss impediments to using acupuncture in patients who present to an emergency department. Whether patients were given antibiotics before or during the acupuncture session was not stated.

Even if the technique actually works [which is certainly not proven by this paper], how practical would it be to have an acupuncturist on call? Would she take in-house call? If not, how long would it take for her to get to the hospital? Would insurance pay for acupuncture? Would the acupuncturist be subject to work hours limitations?

The authors are not proposing acupuncture as a definitive treatment for appendicitis. So what is the clinical value of reducing inflammation? An even better way to reduce inflammation [and pain] is to remove the diseased appendix.

I know how difficult it is to publish papers and continue to do all the clinical and administrative work of an academic physician. As I have said on several occasions, many of my published papers were simply not very good.

But acupuncture to decrease inflammation in appendicitis patients? I doubt youll be seeing an on-call acupuncturist any time soon.

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What are the chances of international medical grads matching in surgery

Anyone considering attending a Caribbean or any foreign medical school should do due diligence. An Internet search is step one. If the school does not list residency match statistics, that could be a red flag. It would not be easy to accomplish, but try to speak with some current students or recent graduates of any schools you are thinking about.

If the school wont give you any names, use caution, and remember, they are not likely to give you the names of dissatisfied students or alumni.

If a school does not require Medical College Admission Test (MCAT) scores, I would advise extreme caution. That suggests they probably take all comers.
Heres a look at some match data from offshore schools. The list of schools is by no means comprehensive as there are about 25 med schools in the Caribbean area. I attempted to find results from the 2015 match for the following schools: Ross, St. Georges, American University of the Caribbean, Caribbean Medical University, St. James University, University of Medicine and Health Sciences, and American Global University.

I used the word "placed" because that term is what one of the schools used, and I believe students who obtained positions in the Supplemental Offer and Acceptance Program (SOAP) after the main match are included.

The orthopedic results are shown to give you an idea of the chances to find a surgical position in any surgical specialty other than general.

For all of the schools that published lists, the overwhelming majority of students obtained positions in family medicine and internal medicine.

The number of unmatched students is not stated, but US schools dont publish that information either.

It is not completely hopeless because if you look at the NRMPs Advance Data for the 2015 match, you can see that 243 (20%) of the general surgery positions and 40 (5.7%) of the positions in orthopedics were filled by non-US grads.

Finally, heres a portion of an email I received last week.

I am a US-IMG who recently matched into a categorical surgery residency at a university program. I graduate in a few weeks from a school in the Middle East. I rotated in my 4th year at some really prominent institutions that many foreign grads dont have access to, and I believe this helped tremendously.

I was definitely on the high end for a foreign grad in terms of interviews in my class. I was very lucky. A lot of people told me I would have to look into other things or didnt believe in me, but in the end, I took a risk for something I love.

Unless you want to be an internist or a family doctor, you will have to decide if you want to risk not being the lucky one.

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