Timing of drotrecogin alfa (activated) initiation in treatment of severe sepsis: a database cohort study of hospital mortality, length of stay, and costs.

INTRODUCTION: For patients with critical conditions including severe sepsis, minimizing the time from presentation to treatment is important to improving outcomes. Understanding the factors influencing high hospital mortality and resource utilization in severe sepsis continues to interest clinicians and researchers. This study examined the associations between timing of drotrecogin alfa (activated) (DrotAA) initiation and hospital mortality, length-of-stay, and costs. METHODS: We conducted a cohort study of adult patients (N = 1179) with intensive care unit stays from November 2001 to June 2003 who received DrotAA in US hospitals with data in the Solucient ACTracker database. We defined evident severe sepsis (ESS) as concurrent antibiotic plus ventilator and/or vasopressor use. We characterized the interval between ESS and DrotAA initiation as Same-day, Next-day, or Day 2+. We compared group characteristics and created multivariate models of hospital mortality, length-of-stay, and costs. RESULTS: Forty-three percent of patients received Same-day DrotAA, 30% Next-day, and 27% Day 2+. Same-day and Next-day patients had more organ dysfunctions at ICU admission than Day 2+ patients (1.1 +/- 0.9 and 1.2 +/- 0.8 vs. 1.0 +/- 0.8; p = 0.021 and p < 0.001, respectively), but from ESS to DrotAA initiation, organ dysfunctions for Day 2+ patients had increased more (+0.0 and +0.4 vs. +0.6, respectively; all p < 0.0001). Increased mortality was observed with administration later than Same-day, although only for the Day 2+ group did the association remain significant (p < 0.05) after adjusting for clinical and demographic factors. Only Next-day initiation was associated with significantly decreased costs (p = 0.0145). CONCLUSIONS: Timing of DrotAA initiation is associated with clinical and economic outcomes in severe sepsis. The potential impact of this timing on hospital mortality, length-of-stay, and costs deserves further study.

Combined supercritical fluid extraction/solid-phase extraction with octadecylsilane cartridges as a sample preparation technique for the ultratrace analysis of a drug metabolite in plasma.

Supercritical fluid extraction was coupled with solid-phase extraction using octadecylsilane cartridges for the selective isolation of ultratrace levels of a drug metabolite, mebeverine alcohol, from plasma. Plasma was directly applied to the extraction cartridge, the cartridge was washed to remove protein and then extracted under supercritical conditions using CO2/5% methanol. The effluent from the extraction cell was bubbled through a small volume of 2-propanol to trap the extracted mebeverine alcohol. The effects of extraction pressure and temperature on analyte recovery were examined. The absolute recovery, selectivity, precision, and accuracy of the combined supercritical fluid extraction/solid-phase extraction approach were compared to those of conventional solid-phase extraction using gas chromatography/mass spectrometry in the selected-ion monitoring mode. Mebeverine alcohol was used as a model compound, and dog plasma was employed as the biological matrix for these studies.

Pupil response: a psychophysiological measure of fear during analogue desensitization.

15 highly aroused snake phobics individually constructed fear hierarchies by selecting colored photographs of snakes. Subjects either imagined fear scenes based on their photographs or were exposed to duplicate projected slides during desensitization. Pupillary responses of the Slide Group were also recorded before, during, and after desensitization. Fear of snakes was significantly reduced for both groups within five or fewer desensitization sessions. Changes in pupil size of the Slide Group appear to reflect arousal of fear as well as reduction of fear after treatment. Current technology makes pupillary response a viable psychophysiological measure of fear.

Achievement motivation, socialization, and hypnotic susceptibility among youths from four Israeli subcultures.

Based on London's theoretical model, results of a developmental study of Israeli children from four subcultures are reported. The impact of child-rearing practices on achievement motivation, hypnotic susceptibility, and brain wave patterns of subjects from Eastern European, Kurdish, Yemenite, and Moroccan backgrounds was tested and compared according to age level. Subjects were 15 children from each subcultural group. Five in each subcultural group were between 7 and 9 years old, five between 9 and 11, and five between 11 and 13. Instruments included a combined EEG-hypnotic scale, six measures of achievement and nAch, and the Winterbottom questionnaire. Subjects of European background, presumably with the highest nAch, had the lowest mean score in hypnotic susceptibility, while children of Moroccan descent, presumably the lowest achievement group, had the highest mean susceptibility score among the four subgroups as expected. It was also found, consistent with previous developmental studies of American children, that hypnotic susceptibility increases significantly with age regardless of subcultural grouping. While the four subgroups differed significantly in their school performance as expected, they did not differ in their need achievement scores. Findings in regard to EEG data are presently not reported because of technical difficulties encountered during recording. Implications for future research pertaining to methodological and theoretical issues involved in testing the model cross-culturally are discussed.