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For data analysis, the study period was divided: in semesters, in order ROCK inhibitor cost to assess the progression of learning process and in two periods, before and after June 2006, in order to assess the impact of 'sepsis team' on patient outcome. Students' t-test, chi-squared, Fisher's exact test, and analysis of variance single-factor analysis were used when appropriate. Univariate and multivariate logistic regression were performed, with hospital mortality as dependent variable and individual interventions, bundles and sepsis team admission as independent variables. Variables with P < 0.20 from univariate analysis were included in the backward logistic regression model that was also corrected for possible confounders such as age, SOFA and SAPS II scores, the presence of shock, lactate blood concentration (first data after study inclusion) and sepsis team period.

The goodness of fit was assessed by the Hosmer-Lemeshow test. A value of P < 0.05 was considered significant. The statistical software package SPSS 15.0 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis.ResultsFrom January 2005 to June 2007, 87 patients met criteria for study inclusion, but 20 patients were clearly excluded because they were affected by chronic decompensated cirrhosis and were on the waiting list for liver transplantation. Comparing the five semesters of the study period, no differences were observed in the number of patients, age, gender, type of admission (i.e. surgical and emergency department), primary site of infection, SAPS II and hospital length of stay.

Percentage of septic shock patients, SOFA score, ICU length of stay and in-hospital mortality decreased (P > 0.05) during Lenvatinib (E7080) the study period (Table (Table11).Table 1Number, age, sex, primary site of infection, grade of sepsis, severity scores, length of stay and mortality of patients subdivided for semestersThe interventions compliance increased (P < 0.05) from January 2005 to June 2007 for all but the glycaemia control and adequate fluid resuscitation. In the same way, the compliance with 6-hour resuscitation and 24-hour management bundles as well as with all interventions increased (P < 0.01) (Table (Table2).2). The implementation of bundles was associated (P < 0.01) with a decrease of in-hospital mortality (Figure (Figure1).1).

The characteristics of patients with and without all interventions compliance were similar, except for age (55 �� 12 vs 65 �� 13 years), sex (60 vs 27% female) and SAPS II (44 �� 13 vs 56 �� 21; P < 0.05). Nevertheless, the differences between observed mortalities and expected mortalities by SAPS II were favourable (P < 0.05) in patients with bundles and all interventions compliance (Figure (Figure11).Figure 1Mortality of patients with (black column) and without (white column) implementation of 6-hours bundle, 24-hours bundle and all interventions.