You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
lauralyn mcintyre and colleagues   have neatly used a septic shock scenario - based survey to highlight considerable variations within canadian critical care practice .
they acknowledge the potential pitfalls of translating survey results into ' real life ' ; however , my own experience of the diversities within uk practice suggest this would be representative of at least one other industrialized country , albeit with some variation in the detail ( for example , use of gelatin as a plasma expander is much commoner in europe ) .
they found decisions regarding treatment strategy ( choice of fluid , use of inotropes and transfusion triggers ) to be highly variable .
however , they did demonstrate consistency in a continuing reliance on ' basic ' monitoring ( blood pressure , heart rate , central venous pressure , urine output , pulse oximetry ) .
this was to the relative exclusion of other , more sophisticated techniques ( cardiac output , central venous saturation ) whose use has been linked with outcome improvements in specific situations , such as the scenario on which their survey was based .
is this heterogeneity a triumph of uncertainty and/or natural conservatism and/or arrogance and/or sloth over heavily promoted , multiple society - endorsed guidelines   based primarily on the important yet limited rivers study ?
why are n't we all practising homogenized medicine ? what does it take to standardize our approach to care of the critically ill ?
the institute of healthcare improvement 's surviving sepsis campaign website   boldly states that a bundle  a group of interventions related to a disease process  "
when executed together will result in better outcomes than when implemented individually " and that " the science behind the elements of a bundle is so well - established ( my italics ) that their implementation should be considered a generally accepted practice . "
yet three of the major planks upon which the two sepsis bundles are based , namely the use of corticosteroids , activated protein c and early goal - directed therapy are currently being questioned via , respectively , the corticus study findings , the european agency for the evaluation of medicinal products ( emea ) , and the national institutes of health ( through their recent $ 8.4 m funding of the process study ) . these new challenges
will , i believe , serve to increase uncertainty still further in the short - term and , thus , affect participation in an approach that is worthy but , in my opinion , critically flawed through a lack of prospective validation .
medics are a naturally conservative bunch  the avid uptake of new technologies by a rapid responder minority is rarely translated into standard practice , often because the initial enthusiasm for a drug , device or strategy fails to pass muster when more rigorously scrutinised or trialled .
it was not that many years ago that we were being exhorted to use high doses of dobutamine to achieve ' supranormal ' cardiorespiratory goals in the critically ill , as an extrapolation of findings from a high - risk surgical patient cohort .
when subsequent randomised trials made it painfully clear that the intensive care unit ( icu ) patient outcomes did not match up to expectation , the concept was generally discarded , even from the surgical patient population in whom the benefit was repeatedly seen .
i 've yet to meet a self - confessed mediocre intensivist so we all need to take a critical and regular look at our own individual performance .
we do require a healthy degree of self - confidence to support our decision - making ability , but are we ready to accept that our icu is perhaps offering an inferior level of care to the hospital down the road ? or if we do acknowledge poor performance , is this from someone / everyone / anyone else but me ?
anonymised audit should , in a non - threatening manner , facilitate recognition and , hopefully , correction of our shortcomings .
the dutch offer external peer review ' visitations ' that can be initiated either by the icu or their hospital administration .
how widespread is this practice ? finally , it is also a deficiency of ourselves as a community that we still can not answer many fundamental questions . for an individual patient ,
what constitutes optimal targets , for example , for blood pressure and tissue perfusion , or ' best ' treatment , such as the optimal duration of a course of antibiotics ?
altruistic , multi - centre , generalisable research addressing simple questions is evolving . the canadians and australasians have clearly led the way while european and other countries are catching up . perhaps these studies could ( should ) be better coordinated to complement each other .
perhaps this spirit of cooperation could ( should ) also be extended to open access , anonymised patient databases as a means of comparing models of care and for future hypothesis generation .
why is the practice of intensive care so heterogenous ? 
 uncertainty as to ' best practice ' , conservatism , and complacency may all contribute to our divergent management strategies . 
 the need for further generalisable research , anonymised audit , external peer review and open access databases is discussed .