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Biomedical subjects

B Poulton

Publications and source records attributed to B Poulton.

17 recordsLinked to original sources

Advances in the management of sepsis: the randomised controlled trials behind the Surviving Sepsis Campaign recommendations.

The Surviving Sepsis Campaign is the first international, multiorganisation, multidisciplinary attempt to reduce the appalling morbidity and mortality related to sepsis. Under the auspices of the campaign, guidelines have been published that cover more than 50 aspects of care of the septic patient. Campaign guidelines on antimicrobial therapy cover very general aspects of antibiotic policy and are mostly supported by expert opinion rather than randomised controlled trials. However, these 'common sense' recommendations on antibiotic therapy have been included in this review. The core areas of the Surviving Sepsis Campaign guidelines have been crystallised into resuscitation and management 'bundles'. This review focuses on the most important clinical trials that form the basis of these core guidelines.

Anti-Bacterial Agents↗

Variation in end-of-life decision making between critical care consultants.

Considerable variation in end-of-life decision making is reported between intensive care units in the United Kingdom, possibly because of differences in casemix. Senior medical staff within any one unit should, however, be consistent in such decision making. We reviewed the medical records for a 4-year period to establish if there was consistency in our own unit. This revealed considerable variation in the apparent willingness of consultants to make end-of-life decisions, emphasising the subjective nature of these decisions. Personality typing (Myers-Briggs Type Indicator) of consultants revealed that those who had made more than the expected number of decisions had scores towards the judging end of the judging/perceiving domain.

Attitude of Health Personnel↗

Epidural catheter migration: a comparison of tunnelling against a new technique of catheter fixation.

We investigated the efficacy of a new technique of epidural catheter fixation that relies on a strip of adhesive foam transfixed by a securing suture. We compared this technique to a tunnelled technique in a prospective, randomized trial (n = 25 in each group). Epidural catheter depth was recorded at the time of insertion and at the time of removal. Clinically significant catheter movement was considered as > 2 cm outward movement or > 1 cm inward movement. The mean duration of epidural analgesia was five days for both groups. Clinically significant movement was noted in eight patients (32%) in the tunnelled group and seven patients (28%) in the sutured group (P = 0.75). Movement of the epidural catheter did not correlate with analgesic failure. The sutured technique provided similar protection against migration to tunnelling but any potential advantages were offset by concerns about a significantly higher incidence of erythema around the catheter exist site in the sutured group (1 vs 6 patients, P = 0.04).

Adhesives↗

Relative risks.

Coronary heart disease is a major challenge for preventive health care. Although there is profuse evidence linking several risk factors with an increased incidence of the disease, much of this evidence is inconclusive and sometimes contradictory. New evidence is constantly generated often to be refuted at a later date. Community nurses, therefore, need to be informed of current research evidence and assist consumers in the interpretation of new facts and modifying lifestyles as necessary. At the end of the day, health promotion is about making informed choices. There are no right and wrong answers--only probabilities.

Causality↗

Radical overhaul.

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Community Health Nursing↗