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Table 1.

Demographic and Clinical Characteristics of Patients by Antibacterial Risk Group

Abbreviations: DRG, diagnosis-related group; HIV, human immunodeficiency virus; HMO, health maintenance organization.

Table 1 does not include 39576 (0.3%) patients whose antibiotic exposure did not meet the criteria for the predefined exposure groups.

Severe sepsis/septic shock was defined as a hospital stay within 90 days of the index stay that included an () discharge diagnosis of severe sepsis ( code 995.92) or septic shock (785.52), identified in any position on the hospital discharge bill.

Secondary outcome, sepsis used a published definition for hospital administrative data, the “Angus definition,” which requires codes for both infection and acute organ dysfunction within the same hospitalization or a sepsis-specific diagnosis [23].

Characteristic based on information in the record for the index stay.

View Large
Table 1.

Demographic and Clinical Characteristics of Patients by Antibacterial Risk Group

Abbreviations: DRG, diagnosis-related group; HIV, human immunodeficiency virus; HMO, health maintenance organization.

Table 1 does not include 39576 (0.3%) patients whose antibiotic exposure did not meet the criteria for the predefined exposure groups.

Severe sepsis/septic shock was defined as a hospital stay within 90 days of the index stay that included an () discharge diagnosis of severe sepsis ( code 995.92) or septic shock (785.52), identified in any position on the hospital discharge bill.

Secondary outcome, sepsis used a published definition for hospital administrative data, the “Angus definition,” which requires codes for both infection and acute organ dysfunction within the same hospitalization or a sepsis-specific diagnosis [23].

Characteristic based on information in the record for the index stay.

View Large

Because both facility-level and patient-level data in the HDD are nonidentifiable, it was determined this work did not constitute research involving human subjects. All data were analyzed using SAS software, version 9.3 (SAS Institute).

Among 516 hospitals, we identified 14120553 randomly selected index stays among adults. Of those patients, 1205226 (8.5%) experienced sepsis either during or before the index stay, and 305428 (2.2%) died during the index stay or within 90 days of discharge; these patients were excluded. Of the remaining 12746135 patients with index stays, 21247 (0.17%) had severe sepsis or septic shock identified within 90 days of their index stay using our primary outcome, and 92467 (0.7%) had sepsis identified within 90 days using our secondary outcome ( Table 1 ).

2) Large clinical studies that test the superiority of management in a dedicated syncope facility vs. conventional management

BP recording is crucial for the majority of clinical TLOC situations and will yield important information for the treatment of syncope. Unfortunately, current long-term BP (or surrogate) recording systems are not optimal for diagnostic use in the syncope evaluation setting.

3) Development and validation of new diagnostic multiparametric devices that can record heart rhythm and BP (and possibly other physiological parameters such as cerebral saturation or EEG) at the time of a syncopal event.

Only a few small RCTs have been conducted on treatment of syncope. In addition, syncopal recurrences are unpredictable and often decrease spontaneously after medical assessment, even in the absence of a specific therapy. The consequence of the spontaneous decrease is that any therapy for syncope prevention appears to be more effective than it actually is, making the results of observational data on therapy questionable in the absence of a control group. No therapy can be effective for all patients. Any therapy should be assessed in homogeneous subgroups.

Therefore, there is strong urgent need for RCTs on the efficacy of:

4) Pharmacological therapies targeted to specific subgroups of reflex syncope.

5) Pacemaker therapy targeted to specific subgroups of cardioinhibitory reflex syncope.

6) Pharmacological therapies of OH-mediated syncope.

7) ICD therapy targeted to specific subgroups of patients with unexplained syncope at risk of SCD.

There is a need to move towards personalized medicine. Improving our knowledge of the biochemical mechanisms underlying specific forms of reflex syncope will allow the development of new therapies in such specific settings. For example, a low adenosine phenotype and a low norepinephrine phenotype have been recently identified.

8) Randomized clinical trials on the efficacy of theophylline (and other xantine antagonists) for low adenosine syncope and norepinephrine transport inhibitors for low epinephrine syncope.

Syncope is a transient phenomenon. The ideal therapy should be one that is administered only when needed.

9) Randomized clinical trials of on-demand administration of specific therapy based on specific sensors similar to adrenalin injectors in asthma or nasal spray for paroxysmal SVT.

AF = atrial fibrillation; AV = atrioventricular; BBB = bundle branch block; BP = blood pressure; b.p.m. = beats per minute; CSM = carotid sinus massage; CSS = carotid sinus syndrome; ECG = electrocardiogram; ED = emergency department; EPS = electrophysiological study; ESC = European Society of Cardiology; HR = heart rate; ICD = implantable cardioverter defibrillator; ILR = implantable loop recorder; LVEF = left ventricular ejection fraction; NYHA = New York Heart Association; OH = orthostatic hypotension; SCD = sudden cardiac death; SVT = supraventricular tachycardia; VA = ventricular arrhythmia; VT = ventricular tachycardia; VVS = vasovagal syncope.

AF = atrial fibrillation; AV = atrioventricular; BBB = bundle branch block; BP = blood pressure; b.p.m. = beats per minute; CSM = carotid sinus massage; CSS = carotid sinus syndrome; ECG = electrocardiogram; ED = emergency department; EPS = electrophysiological study; ESC = European Society of Cardiology; HR = heart rate; ICD = implantable cardioverter defibrillator; ILR = implantable loop recorder; LVEF = left ventricular ejection fraction; NYHA = New York Heart Association; OH = orthostatic hypotension; SCD = sudden cardiac death; SVT = supraventricular tachycardia; VA = ventricular arrhythmia; VT = ventricular tachycardia; VVS = vasovagal syncope.

Supplementary Data with additional Web Tables complementing the full text, and an additional free shipping newest sale clearance Camper Beetle 18648 Brown Blue Mens Lo Leather Trainers Shoes Boots from china low shipping fee free shipping 2015 new best store to get cheap online 04qpj
document—with a glossary containing definitions of syncope and related concepts with tracings, videos, flow charts, and checklists—are available on the European Heart Journal website and via the ESC Website at www.escardio.org/guidelines .

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