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#Endocardite #Epidemiologie #Metabolomique #These
Endocarditis remains a highly morbid disease with an overall mortality rate of 20% at 30 days despite a growing armamen- tarium of antimicrobial therapy and improved techniques for surgical intervention [1••].
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#Endocardite #Epidemiologie #Metabolomique #These
Clinical risk factors for endocarditis include the growing num- ber of patients with need for prolonged vascular access, the epidemic of intravenous drug use (IVDU), and the increasing number of patients with implanted intracardiac devices, prosthetic valves, and/or other prosthetic material [3, 4••]
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#Endocardite #Epidemiologie #Metabolomique #These
Several other comorbidities are associated with an increased risk of endocarditis (Table 1) including chronic kidney disease, can- cer, human immunodeficiency virus (HIV), and advanced age (ages 58–77) [1••, 3, 5, 6].
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[unknown IMAGE 7081348959500]
[THESE] Vincent et Otto - 2018 - Infective Endocarditis Update on Epidemiology.pdf
#Endocardite #Epidemiologie #Metabolomique #These #has-images
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#Endocardite #Epidemiologie #Metabolomique #These
Device patients who suffer from endocarditis are predomi- nantly male with an average age in their 60s. Longitudinal comparison of rates and proportion of device-related endo- carditis demonstrate that between 4 and 8% of total endo- carditis cases (depending on the population) investigated have intracardiac devices [1••, 5, 6•, 8]
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#Endocardite #Epidemiologie #Metabolomique #These
Prosthetic valve endocarditis now ac- counts for approximately 20% of all endocarditis cases, with an increasing prevalence over the past two decades [5, 6•]
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#Endocardite #Epidemiologie #Metabolomique #These
In high-income countries, patients with a prosthetic valve have a 50 times higher risk of suffering an episode of endocarditis than those without a prosthetic valve [4••]
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#Endocardite #Epidemiologie #Metabolomique #These
Early prosthetic valve endocarditis, occurring with 60 days of valve implanta- tion, is almost always healthcare-associated, meaning that a different spectrum of bacteria compared to infection remote from valve implantation must be considered when managing this diagnosis [5]
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#Endocardite #Epidemiologie #Metabolomique #These
Population-based studies that look exclusively at the USA have demonstrated an in- crease in Staphylococcus aureus and enterococcal endocardi- tis concurrent with the decrease in Streptococcus viridans in- fection [3, 9–11]
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#Endocardite #Epidemiologie #Metabolomique #These
There have been no significant changes in frequency of fungal endocarditis [10]. Fungal infective endocarditis is a high-risk infection, particularly because they a re the most likely form of endocarditis to have embolic complica ti ons
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#Endocardite #Epidemiologie #Metabolomique #These
The mortality rate for infective endocarditis is approximately 20% within the first 30 days, though exact rates vary between population-based studies [1••]
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#Endocardite #Epidemiologie #Metabolomique #These
Another analysis of endocarditis in the USA over several decades found that in-hospital mor- tality decreased after the 1960s (when it was approximately 30%) and subsequently stabilized around 20% [10].
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#Endocardite #Epidemiologie #Metabolomique #These
Factors found to be associated with in-hospital death include prosthetic valve infection (OR 1.47), advanced age (OR 1.30), pulmonary edema (OR 1.79), S. aureus endocarditis (OR 1.54), coagulase-negative staphy- lococcus infection (OR 1.50), mitral valve vegetation (OR 1.34), and paravalvular complications (OR 2.25) [7]
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#Endocardite #Epidemiologie #Metabolomique #These
A small study of octogenarians found a higher 1-year mor- tality (37.3%) compared to those under age 65 years (13%) [13•].
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#Endocardite #Epidemiologie #Metabolomique #These
Factorsthathavebeenassociatedwithimprovedin-hospital mortality include receiving surgical valve treatment and infec- tion with Streptococcus viridans [14]
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#Endocardite #Epidemiologie #Metabolomique #These
Right-sided endocarditis, affecting only the tricuspid or pulmonic valve, is seen in 5–10% of cases and has a lower early mortality rate (approximately 7%), although late mortal- ity may be high if IVDU is the underlying risk factor [6•]
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#Endocardite #Epidemiologie #Metabolomique #These
The 2007 update in guideline recommendations for preven- tion of endocarditis using antibiotic prophylaxis before dental procedures continues to be controversial
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#Endocardite #Epidemiologie #Metabolomique #These
Studies investi- gating rates of Streptococcal endocarditis following changes in pro phylaxis have shown conflicting data. Some have shown increasing incidence since 2007, while others have not [5, 9]. We conclude that there is not sufficient evidence to support returning to the old prophyl axis guidelines and support the 2007 recommendations. This opinion is supported by a meta-analysis indicating that it is not clear that prophy- laxis actually reduces rates of infective endocarditis or wheth- er prophylaxis simply reduces rates of post-procedural bacter- emia [16]
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#Endocardite #Epidemiologie #Metabolomique #These
The most common presenting symptom of endocarditis is fe- ver and vague symptoms of systemic illness.
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#Endocardite #Epidemiologie #Metabolomique #These
Blood cultures are the foundation for making the diag- nosis of endocarditis, and are recommended for patients with 48 h of otherwise unexplained fever, a new or changed mur- mur on auscultation, or echocardiographic evidence of new valve dysfunction [4••, 6•]
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#Endocardite #Epidemiologie #Metabolomique #These
Up to 25% of patients with infec- tive endocarditis present with embolic events
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#Endocardite #Epidemiologie #Metabolomique #These
Even when the TTE demonstrates findings consis- tent with endocarditis, TEE is recommended to evaluate po- tential local complications of endocarditis including intracar- diac abscess [4••, 20]
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#Endocardite #Epidemiologie #Metabolomique #These
Unfortunately, in pa- tients with underlying valve disease, echocardiography cannot exclude endocarditis with certainty because valve degenera- tion and calcification can be difficult to differentiate from vegetation, and shadowing from prosthetic valves can mask underlying vegetation [21, 22]
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[unknown IMAGE 7081382251788]
[THESE] Vincent et Otto - 2018 - Infective Endocarditis Update on Epidemiology.pdf
#Endocardite #Epidemiologie #Metabolomique #These #has-images
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#Endocardite #Epidemiologie #Metabolomique #These
The combination of 18 F- FDG positron emission tomography (PET) and computed to- mographic (CT) imaging/angiography may be useful in pa- tients with possible endocarditis of a native valve, prosthetic valve, prosthetic conduit (congenital heart disease correction), or intracardiac device [20]
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#Endocardite #Epidemiologie #Metabolomique #These
Some studies suggest that PET is more sensitive than echocardiography for diagnosis of endo- carditis, specifically in patients with prost hetic material (Table 2)[22, 23]. Another advantage of this approach is that distant emboli (including to the spleen, kidneys, and lungs) can be identified simultaneously with the investigation of in- tracardiac infections [20]
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#Endocardite #Epidemiologie #Metabolomique #These
Radiolabel ed leukocyte scint igraphy, also known as white-blood-cell SPECT imaging, has a higher specificity for diagnosis of endocarditis compared to 18 F- FDG/PET CT and can also identify embolic complications. However, sensitivity and spatial resolution are inferior to that of 18 F- FDG/PET CT [6•, 24]
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#Endocardite #Epidemiologie #Metabolomique #These
Cardiac computed tom ography angiography (CCTA) is thought to be most helpful in the cases of possible right- sided infections because it can simultaneously identify the intracardiac infection and pulmonary septic embolic conse- quences.
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#Endocardite #Epidemiologie #Metabolomique #These
CCTA is useful for identification and localization of paravalvular extension of infection, such as abscesses, peri- cardial involvement, and spread to the coronary sinus.
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#Endocardite #Epidemiologie #Metabolomique #These
Specifically, CCTA sensitivity for detection of paravalvular abscess and pseudoaneurysms is higher than that of echocar- diography, and improved spatial resolution offered by CCTA is particularly beneficial when valvular calcification or pros- thetic valve material produces shadowing on echocardiogra- phy. On the other hand, lacking Doppler data, CCTA is not useful for evaluation of valve function.
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#Endocardite #Epidemiologie #Metabolomique #These
Guidelines for when to utilize PET-CT, nuclear imaging, CCTA, and MRI are not yet available and will depend on additional research to validate the accuracy, clinical utility, and cost-effectiveness of these approaches
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#Endocardite #Epidemiologie #Metabolomique #These
If anticoagulation cannot be interrupted safely, and the patient has no neurologic sequelae of their infection, treatment can be continued with close monitoring for possible cerebrovascular or other bleeding complications
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#Endocardite #Epidemiologie #Metabolomique #These
Neuroimaging with brain MRI should be considered even in the absence of symptoms in patients to be continued on therapeutic anticoagulation to detect occult disease because patients with active endocarditis have multiple reasons to develop central nervous system bleeds, including hemorrhagic conversion of an embolic stroke, rupture of a mycotic cerebrovascular aneurysm, or di- rect septic vascular erosion in the brain [4••].
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#Endocardite #Epidemiologie #Metabolomique #These
In the 2017 AHA/AHA Valvular Heart Disease Guidelines up- date, early surgery (during the initial hospitalization) is rec- ommended for (a) aortic or mitral valve infections with severe valvular dysfunction or fistula leading to heart failure; (b) paravalvular fungal infection; (c) heart block, abscess, or de- structive lesion such as a perforated leaflet; (d) endocarditis secondary to fungi, multidrug-resistant organisms, infections not responding to antibiotic therapy after 5 to 7 days of treat- ment, or prosthetic valve endocarditis due to staphylococcus or non-HACEK gram negative rods; (e) large vegetations with embolic complications or severe valvular stenosis; or (f) very large vegetations (> 10 mm) (Fig. 1)[4••, 6•].
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#Endocardite #Epidemiologie #Metabolomique #These
Patients with intracardiac pacing leads nearly always re- quire procedural intervention in addition to antibiotic therapy to treat the infection (Fig. 1). The pacing leads and device must be extracted and replaced in most cases to eradicate the source of infection [4••, 13•]
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#Endocardite #Epidemiologie #Metabolomique #These
After device re- moval, patients require at least 2 weeks of parenteral antibiotic therapy [6•].
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#Endocardite #Epidemiologie #Metabolomique #These
Symptoms and signs of infection must be resolved with negative blood cultures for at least 72 h prior to device reimplantation
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#Endocardite #Epidemiologie #Metabolomique #These
If there is simul- taneous valvular infection, 14 days should pass between de- vice extraction and reimplantation [6•, 30]
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#Endocardite #Epidemiologie #Metabolomique #These
Patients with intracerebral hemorrhage (ICH) should not undergo sur- gery within the fir st 7 days of this event due to the risk of further intracranial bleeding during cardiopulmonary bypass and current guidelines recommend waiting at least 4 weeks when possible [4••, 35]
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#Endocardite #Epidemiologie #Metabolomique #These
However, early surgery (within 2 weeks) in patients with ischemic cerebral embol- ic infarction without hemorrhage may be safe as highlight- ed in the recent 2017 ACC/AHA Valvular Heart D isease Guideline update when surgical indications are present, although waiting 4 weeks should be considered in hemo- dynamically stable patients (Fig. 1)[4••, 34]
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#Endocardite #Epidemiologie #Metabolomique #These
Systemic embolic events occur in 20–50% of infect iv e en- docarditis pati ents overall, alt hough this risk is significant- ly reduced within 2 weeks of starting antimicrobial therapy [6•]
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#Endocardite #Epidemiologie #Metabolomique #These
Neurological complications secondary to embolic events o ccur in 15 –40 % of p atients depending on the population evaluated, and this often occurs prior to diag- nosis of endocarditis (can be the presenting symptoms) [6•, 34]
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#Endocardite #Epidemiologie #Metabolomique #These
Endocarditis lesions on the mitral valve, large lesions (> 1 cm), and highly mobile lesions are the most likely to embolize [6•].
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[unknown IMAGE 7081489206540]
[THESE] BEH Prévalence EI France 2013.pdf
#Endocardite #Epidemiologie #Metabolomique #These #has-images
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#Endocardite #Epidemiologie #Metabolomique #These
Dans l’étude 2008, 497 patients présentant une EI certaine ont été analysés : 369 hommes (74,2%) et 128 femmes (25,8%). L’âge moyen était de 62,3 ans (de 18 à 96 ans), plus élevé chez les femmes (moyenne : 65 ans) que chez les hommes (moyenne : 61,4 ans) (p<,05). L’incidence globale de l’EI était de 32,4 cas par mil- lion d’habitants (intervalle de confiance (IC) 95% : [29,6-35,4]). Elle était plus élevée chez les hommes (50,7 cas par million d’habitants, IC95%:[45,6-56,1]) que chez les femmes (15,9 cas par million d’habi- tants, IC95%:[13,3-18,9]) et augmentait avec l’âge (incidence maximale de 194 cas par million d’habi- tants chez les hommes entre 75 et 79 ans) (figure 1)
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#Endocardite #Epidemiologie #Metabolomique #These
Il n’a pas été retrouvé de pathologie cardiaque sous- jacente pour 52,7% des patients.
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#Endocardite #Epidemiologie #Metabolomique #These
La fièvre était présente dans 86% des cas. Durant l’évolution, 33,8% des patients ont présenté une insuffisance cardiaque, 4,2% des troubles de la conscience (Glasgow <) et 11,9% des manifesta- tions immunologiques (glomérulonéphrite, nodules d’Osler, taches de Roth, facteurs rhumatoïdes posi- tifs).
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[unknown IMAGE 7081497333004]
[THESE] BEH Prévalence EI France 2013.pdf
#Endocardite #Epidemiologie #Metabolomique #These #has-images
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[unknown IMAGE 7081500740876]
[THESE] BEH Prévalence EI France 2013.pdf
#Endocardite #Epidemiologie #Metabolomique #These #has-images
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#Endocardite #Epidemiologie #Metabolomique #These
Tous les patients ont eu une échocardiographie par voie transthoracique et 87,9% par voie transœso- phagienne. Un critère majeur échographique était présent chez 92,6% : végétations (87,5%), abcès (16,1%) et, parmi les 104 patients porteurs de prothèse valvulaire, 19 (18,3%) désinsertions de prothèse
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#Endocardite #Epidemiologie #Metabolomique #These
Plus de 90% (451/497) des hémocultures étaient positives et les cas d’EI non microbiologiquement documentés représentaient seulement 5,25% des EI
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#Endocardite #Epidemiologie #Metabolomique #These
Les streptocoques représentaient 36,2% et les sta- phylocoques 26,6% de l’ensemble des germes isolés, mais les streptocoques oraux seulement 18,7%. Les streptocoques du groupe D étaient isolés dans 12,5% des cas
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#Endocardite #Epidemiologie #Metabolomique #These
Une chirurgie cardiaque a été réalisée chez 44,8% des patients (tableau 1), âgés en moyenne de 58,2 ans.
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[unknown IMAGE 7081510440204]
[THESE] BEH Prévalence EI France 2013.pdf
#Endocardite #Epidemiologie #Metabolomique #These #has-images
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[unknown IMAGE 7081512537356]
[THESE] BEH Prévalence EI France 2013.pdf
#Endocardite #Epidemiologie #Metabolomique #These #has-images
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#Endocardite #Epidemiologie #Metabolomique #These
La mortalité hospitalière était de 22,7% (tableau 1), plus élevée en cas d’infection liée aux soins (31,1%) que dans les endocardites communautaires (20,3%), (p<,01). Pour ces dernières, quatre facteurs de risque de mortalité ont été identifiés en analyse multivariée : l’âge avancé ( hazard ratio (HR) de 1,03 par année en plus, IC95%:[1,01-1,04]), S. aureus comme agent causal (HR=2,71 ; IC95%:[1,87-3,63]), l’existence d’une complication intracérébrale (HR=2,11 ; IC95%:[1,45-3,09], p<,0001) et l’insuf- fisance cardiaque (HR=1,47 ; IC95%:[1,01-2,13]), tandis que pour les endocardites liées aux soins, S. aureus était le seul facteur associé à un haut risque de mortalité (HR=2,54 ; IC95%:[1,33-4,85]) (tableau 4)
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#Endocardite #Epidemiologie #Metabolomique #These
L’incidence des EI à streptocoques était stable, avec respectivement, en cas par million d’habitants et en 1991, 1999 et 2008 : 14,5, 14,8 et 10,4 pour l’ensemble des streptocoques, 8,1, 6,3 et 6,5 pour les strepto- coques oraux, et 6,4, 8,5 et 3,9 pour les streptocoques du groupe D. Pour l’ensemble des staphylocoques, l’incidence était respectivement, en 1991, 1999 et 2008 de : 6,7, 8,9 et 11,6 cas d’EI à ces germes par million d’habitants. Cette incidence augmentait de façon significative pour S. aureus (1,6, 3,7 et 4,1 ; p<,05) et les staphylocoques à coagulase négative (0,6, 0,8 et 1,9 ; p<,05) chez les patients sans car- diopathie sous-jacente. S. aureus est devenu, en 2008, le microorganisme pour lequel l’incidence de l’EI est la plus élevée, avec un taux chez l’ensemble des patients à 8,2 cas par million d’habitants
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#Endocardite #Epidemiologie #Metabolomique #These
IE is a highly morbid disease; hospital mortality is reported to be approximately 10 – 20% and hospi- talization in intensive care units (ICUs) is frequent [1,3,8,9]. In the 2008 French study, 44.9% of patients with IE underwent valvular surgery [1]
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#Endocardite #Epidemiologie #Metabolomique #These
For these reasons, outpatient treatment is diffi cult to consider, and in the rare cases where it is possible, it is recommended to wait until after 14 days of hospitalization
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#Endocardite #Epidemiologie #Metabolomique #These
All the medical records of these patients were reviewed by an infectious diseases specialist. These stays corresponded to 198 patients. According to the Duke criteria, 173 patients had IE, giving a positive predictive value (PPV) of 87.4% (95% confi dence interval (CI) ⫽ 82.8 – 92.0%) for the case defi nition
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#Endocardite #Epidemiologie #Metabolomique #These
In all, 128 of these 173 IE were classifi ed ‘ defi nite ’ and 44 as ‘ possible ’ (one patient could not be classifi ed because of insuffi cient data). The frequency of defi nite IE was thus 74.4% (95% CI ⫽ 67.9 – 80.9%)
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#Endocardite #Epidemiologie #Metabolomique #These
Variables used in the epidemiological analysis included: age (mean, median, and categorized into 10-year age groups), sex, comorbidities, causative pathogens, valve status of patients (native valve, pros- thetic valve, presence of pacemaker or defi brillator), ICU stays, valve surgery, and in-hospital mortality
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#Endocardite #Epidemiologie #Metabolomique #These
Between 2007 and 2009, 807 HDs met the criteria for IE according to the case defi nition. These HDs involved 578 patients (194 in 2007, 185 in 2008, and 199 in 2009)
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#Endocardite #Epidemiologie #Metabolomique #These
During the period 2007 – 2009, the mean annual incidence of IE in the Centre region, standardized for age and sex, adjusted for PPV and frequency of defi nite IE was 45.8 cases per million inhabitants (65 per million inhabitants for males and 27 per million inhabitants for females)
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#Endocardite #Epidemiologie #Metabolomique #These
A substantial proportion of the population was affected by comorbidities, the most frequent being chronic cardiac insuffi ciency (19.6%), diabetes (16.1%), and cancer (12.1%)
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[unknown IMAGE 7081532984588]
[THESE] Sunder et al. - 2015 - Clinical and economic outcomes of infective endoca.pdf
#Endocardite #Epidemiologie #Metabolomique #These #has-images
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#Endocardite #Epidemiologie #Metabolomique #These
The mean duration of hospitalization was 30 days (median 22.4 days). During their stay, 29.6% of patients were admitted to an ICU. The average cost of hospital stays was € 15 281 ( $ 20 429) per patient, representing a mean annual cost for the region of € 2 944 279 ( $ 3 936 202). It increased by ⫹ 34.3% between 2007 ( € 12 938 ⫽ $ 17 613) and 2009 ( € 17 735 ⫽ $ 23 654).
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#Endocardite #Epidemiologie #Metabolomique #These
During the 3 years studied, the global in-hospital mortality rate was 17.6% (102/578)
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#Endocardite #Epidemiologie #Metabolomique #These
In this epidemiological study conducted in one representative French region, an elevated annual incidence of IE was estimated (45.8 cases per million inhabitants). The frequency of valvular surgery was low (20%) and the in-hospital mortality was 17%. The average cost of hospital stays was € 15 281 ( $ 20 429), resulting in a signifi cant burden of IE for society
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#Endocardite #Epidemiologie #Metabolomique #These
The frequency of defi nite IE was 74.4%, lower than in previous published studies [12]
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#Endocardite #Epidemiologie #Metabolomique #These
In contrast, the present study, which was based on HD algorithm, could have overestimated the diagnosis of IE, but our population-based study could be more representative of the reality.
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#Endocardite #Epidemiologie #Metabolomique #These
Multivariate analysis identifi ed fi ve factors as being associated with mortality: age, chronic renal insuffi ciency, staphylococcal infection, and ischemic and hemorrhagic stroke. These factors have repeatedly been reported in previous studies [9,23 – 26]
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#Endocardite #Epidemiologie #Metabolomique #These
The economic analysis confi rmed that the costs of IE for society are large. During the 3 years studied, the average cost of a stay for IE increased by 34%, so our analysis probably underestimates the true cost of IE. If surgery had been more frequent than we observed in our study, and indeed as reported by Selton-Suty et al. [1], the global cost would have been even higher than we estimate here.
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Flashcard 7081802468620

Question
Using table , you can achieve the desktop layout easily, but cannot make it responsive
Answer
[default - edit me]

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

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Article 7081806138636

1.1 Begriffe und Definitionen

Eine allgemeingültige oder als Arbeitsdefinition vom größten Teil der damit befassten Wissenschaftler anerkannte und konsistent verwendete Konvention darüber, was genau mit „Change Management“ gemeint sein soll, existiert nicht. Die Abgrenzungen dessen, was mit „Change“ genau gemeint ist, welche Abgrenzungen und Ausprägungen, Anlässe, Abläufe und Konsequenzen er hat, ob er gemanagt werden kann und, wenn ja, ob es dabei nur um die Anpassungsprozesse oder gar das Managen des Wandels selbst gehen soll, ist vom Wissenschaftshintergrund des Autors und meist einer pragmatischen situativen Verwendung der Nomenklatur abhängig. „Change Management“ ist zudem einer der typischen Begriffe der neueren Managementtheorie, in der hochkomplexe Realitäten zwangsläufig simplifiziert und operationalisierbar gemacht werden müssen. Dabei gehen regelmäßig Feinheiten und Genre-Spezifika verloren, was die kritisch reflektierte wissenschaftliche Diskussion im Gegensatz zur eigentlichen Intention dann doch wieder verkompliziert. J



dete Konvention darüber, was genau mit „Change Management“ gemeint sein soll, existiert nicht. Die Abgrenzungen dessen, was mit „Change“ genau
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1.1 Begriffe und Definitionen
Eine allgemeingültige oder als Arbeitsdefinition vom größten Teil der damit befassten Wissenschaftler anerkannte und konsistent verwendete Konvention darüber, was genau mit „Change Management“ gemeint sein soll, existiert nicht. Die Abgrenzungen dessen, was mit „Change“ genau gemeint ist, welche Abgrenzungen und Ausprägungen, Anlässe, Abläufe und Konsequenzen er hat, ob er gemanagt werden kann und, wenn ja, ob es dabei nur um die Anpassungsprozesse oder gar