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Biomedical subjects

A V Pollock

Publications and source records attributed to A V Pollock.

At least 19 recordsLinked to original sources
PubMed1998

Guidelines for the correct conduct of clinical research in surgery.

Clinical research may be either epidemiological or experimental. Epidemiological (observational) research includes cross-sectional, case-control, and cohort studies and draws attention to associations, which may or may not denote cause and effect. Experimental research may be explanatory, the purpose of which is to advance our knowledge of physiological or pathological events; or it may be pragmatic, the purpose of which is to influence our treatment of patients. All these types of clinical research have their own rules, but underlying the detailed rules are the universal ones of telling the truth and doing no harm.

Case-Control Studies↗
PubMed1997

Ten years of improvement in the standard of randomised controlled clinical trials in four international journals.

One hundred reports of randomised controlled clinical trials in BMJ, Lancet, N Engl J Med, and Br J Surg in 1996 were compared with 100 reports published worldwide in 1979 to 1984 in terms of design and conduct, analysis, and presentation. In all these respects the recently published trials were significantly better than those of 12 to 17 years ago. There is, however, room for further improvement.

Evaluation Studies as Topic↗
PubMed1996

What is audit and how to start it?

The verb "to audit" dates from the sixteenth century when it meant "to make an official systematic examination of accounts". If we substitute "diseases and medical interventions" for "accounts", that is what clinical audit means. It is more than merely quality assurance, although that comes into it. It embraces also a great deal of clinical research. It certainly entails the complete, accurate, and honest recording of a doctor's practice. How to start it? That depends on whether you are going to audit the work of your own unit only, or whether you are going to include the work of the whole hospital, region, or country. Whatever you do you must compare the results that you find with those that have been published. Many departments find it impossible to record the outcome of every intervention in a way that allows sensible conclusions to be drawn. To these departments the reporting of critical incidents is a most welcome substitute. Whatever way you go, remember that audit must be interesting and it must produce results that help you to improve your practice.

Belgium↗
PubMed1996

Duration of antibiotic treatment in surgical infections of the abdomen. At what point is infection cured but inflammation persists?

While infection is a consequence of invasion of microorganisms, sepsis is a phenomenon of the host. Systemic inflammatory response syndrome (SIRS), "severe sepsis", and "septic shock" may occur without infection, or persist, and lead to multiple organ dysfunction syndrome (MODS) after infection has been eradicated with antibiotics and surgery. The mechanisms responsible for these phenomena are increasingly being elucidated, but we cannot yet define when infective sepsis merges into non-infective sepsis. What do we know is they are just as lethal as each other.

Bacterial Infections↗
PubMed1993

Surgical evaluation at the crossroads.

Surgeons have lagged behind physicians and oncologists in embracing randomized controlled clinical trials. This paper suggests that a complete, accurate and objective comparison of the outcome of a novel intervention with that of a traditional intervention in previous years, or in another surgical group, can yield valuable information and can lead surgeons to improve their practice. There has recently been a decline in the number of randomized controlled trials published in The British Journal of Surgery; this may reflect the unwillingness of many patients to allow their surgical treatment to be decided by chance.

Decision Making↗
PubMed1989

Early infective complications and late recurrent cancer in stapled colonic anastomoses.

Between 1978 and 1981, 73 patients with colonic or rectal cancer were randomized to have their anastomoses made by either a single interrupted layer of braided polyester sutures, or by a circular stapling instrument. Of these operations, 20 were considered to have been palliative, the remaining 53 being potentially curative. The incidence of local recurrence in the latter group was analyzed in relation to initial septic and anastomotic complications. The 53 patients were followed for a median of 36 months (range, 1 to 87); 24 were alive and well and 22 had died of disseminated cancer or unrelated causes. Seven patients died with local recurrent disease proved at laparotomy or autopsy after a median of 33 months (range, 3 to 72). Thirty anastomoses were stapled and 23 sutured; of the seven patients who died with local recurrent disease, six had stapled anastomoses (Fisher's exact probability F2 = 0.12; log rank chi-square = 3.53, 0.05 less than P less than 0.10). Two patients who died with locally recurrent disease had had clinically apparent anastomotic leaks and one other patient had had a radiologically demonstrated leak. This compares with a total of seven leaks (clinical or radiologic) in the remaining group of 46 patients with no recurrence (Fisher's exact probability F2 = 0.11). These results tend to support the hypothesis that anastomotic leaks may lead to locally recurrent disease, particularly after stapled anastomoses.

Colorectal Neoplasms↗
PubMed1989

Preincisional intraparietal Augmentin in abdominal operations.

A total of 624 consecutive eligible patients undergoing abdominal operations received a single preoperative dose of amoxycillin/clavulanic acid (1.2 g Augmentin) for the prophylaxis of surgical wound infection. They were randomised to have the antibiotic injected intravenously at induction of anaesthesia (n = 328) or infiltrated subcutaneously along the line of the proposed incision (n = 296). The incidence of wound infections was considerably lower in the group given the antibiotic into the abdominal wall (8.4% compared with 15.9%--chi 2 = 7.90, P = 0.005). No significant differences were found in the incidence of other major or minor infective or non-infective postoperative complications between the groups. It is concluded that preincisional intraparietal injection is more effective than intravenous injection of Augmentin for the prophylaxis of surgical wound infection.

Abdomen↗
PubMed1988

Antimicrobial bowel preparation. Oral, parenteral, or both?

It has been suggested that wound infection rates after colorectal operations are influenced more by the presence of adequate tissue levels of antimicrobials at the time of contamination than by the extent of bacterial colonization of the intestinal lumen. There are, however, theoretical grounds for the belief that both levels are important. The authors therefore conducted a random control trial in 119 consecutive patients undergoing elective colorectal operations, comparing the results in a group receiving purely parenteral antimicrobial prophylaxis with those in one having a combined oral and parenteral regimen. The results in 83 contemporary nonrandomized patients, all of whom had the combined prophylactic regimen, are also reported. Oral bowel preparation resulted in a significantly smaller number of operation cultures showing growth of fecal gram-negative aerobes and anaerobes than did the purely parenteral regimen. There were more isolations of enterococci in the combined group but the excess did not achieve statistical significance. The rates of infective complications were higher in the parenteral than in the combined group, the difference in wound infection rates being statistically significant; the figures were 27.6 percent and 13.9 percent, respectively (P = .04). It is concluded that, in colorectal operations, it is advisable not only to ensure adequate tissue levels of antimicrobials but also to reduce the risk of endogenous bacterial infection by partially decontaminating the bowel.

Administration, Oral↗