The results of our study suggest that the use of invasive procedu

The results of our study suggest that the use of invasive procedures, limitation of life support measures and ICU mortality appear to vary according to Intensivists’ base specialty of training.While our results should only be viewed as hypothesis-generating given the retrospective design of the study, there are a number of factors that make the results plausible. useful handbook The first is that this is not a new phenomenon. Previous reports have suggested that physicians with training in a specific area of medicine tend to have more favorable outcomes with conditions that fall into their area of expertise than do generalists [8-12]. Since over 30% of the admitting diagnoses in our ICUs are related to the pulmonary system, the Pulmonary Medicine group may have an intrinsic advantage over the Internal Medicine and AGSEM groups.

In addition, extra years spent as a trainee may provide Intensivists with Pulmonary Medicine backgrounds valuable clinical experience that helps them diagnose and manage complex ICU patients more effectively than those with Internal Medicine backgrounds.The second is that we observed a significant difference in the propensity to limit life-sustaining therapy between the three groups. While many factors play into a decision to limit life support, it has previously been shown that the identity of the individual physician is one of the most, if not the most, important determinants [13]. Different practice patterns for limitation of life support based on Intensivist’s base specialty of training have not previously been described, but should now be further evaluated.

A third factor that helps explain our results is that because the Pulmonary group performed significantly less invasive procedures than the other two groups, their patients may have been at less risk to develop potential life-threatening complications [14-16]. While we had initially hypothesized that the decrease in the number of procedures was due to members of the Pulmonary group having more years of clinical experience and their greater comfort level in diagnosing and managing patients based on clinical examination and non-invasive tests alone, this turned out not to be the case according to our statistical models because we adjusted for number of years in practice. However, the lower number of procedures performed may still be a surrogate for an overall more conservative practice pattern that may benefit their patients, but that is not easily measured by a single variable such as years in practice. Future research should explore other areas of Drug_discovery potential practice pattern variation based on Intensivist base specialty of training beyond the two variables that we elected to measure in this study.

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