Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Dividing intensive care specialists according to their backgrounds is not useful to improve quality in intensive care. | Braun and Spies Critical Care 2010 14 409 http content 14 2 409 CRITICAL CARE LETTER L_ Dividing intensive care specialists according to their backgrounds is not useful to improve quality in intensive care Jan-Peter Braun and Claudia Spies See related research by Billington etal. http content 13 6 R209 We have some strong concerns regarding the principle message in Billington and colleagues article 1 - namely that intensivists base speciality of training may be associated with variations in practice patterns and outcome in critical care patients. We caution against propagating the concept of dividing intensive care specialists according to their backgrounds. Some methodological weaknesses in the paper are as follows. First the impact of nursing factors was not considered. Specifically the standardised mortality rate was higher in intensive care units ICUs with lower numbers of nurses per bed 2 . The quality of invasive procedures will also be greatly impacted by nursing practices. Second there was very significant variation in size between the three ICUs involved in the study. There is good evidence demonstrating that cost efficiency is better in ICUs with more than about 12 beds 3 . Third the median years since critical care medicine certification and the mean weeks of service per year as well as the absolute numbers of physicians were significantly lower in intensivists with base specialty training in anaesthesia general surgery and emergency medicine. Fourth there is no information regarding variation in surgical versus nonsurgical patients the times to stabilisation in the emergency room and finally procedural or structural differences between the various institutions involved. Finally the authors observed no differences in patients length of ICU stay or in hospital mortality or hospital length of stay. Without information regarding scores at discharge we consider drawing conclusions based simply on ICU mortality figures to be .
