ObjeCtiveTo provide an overview of prediction models for risk of cardiovascular disease (CVD) in the general population.Design Systematic review. Data sOurCesMedline and Embase until June 2013.eligibility Criteria fOr stuDy seleCtiOn Studies describing the development or external validation of a multivariable model for predicting CVD risk in the general population. results 9965 references were screened, of which 212 articles were included in the review, describing the development of 363 prediction models and 473 external validations. Most models were developed in Europe (n=167, 46%), predicted risk of fatal or non-fatal coronary heart disease (n=118, 33%) over a 10 year period (n=209, 58%). The most common predictors were smoking (n=325, 90%) and age (n=321, 88%), and most models were sex specific (n=250, 69%). Substantial heterogeneity in predictor and outcome definitions was observed between models, and important clinical and methodological information were often missing. The prediction horizon was not specified for 49 models (13%), and for 92 (25%) crucial information was missing to enable the model to be used for individual risk prediction. Only 132 developed models (36%) were externally validated and only 70 (19%) by independent investigators. Model performance was heterogeneous and measures such as discrimination and calibration were reported for only 65% and 58% of the external validations, respectively. COnClusiOnsThere is an excess of models predicting incident CVD in the general population. The usefulness of most of the models remains unclear owing to methodological shortcomings, incomplete presentation, and lack of external validation and model impact studies. Rather than developing yet another similar CVD risk prediction model, in this era of large datasets, future research should focus on externally validating and comparing head-to-head promising CVD risk models that already exist, on tailoring or even combining these models to local settings, and investigating whether these models can be extended by addition of new predictors. IntroductionCardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide, 1 accounting for approximately one third of all deaths. 2 Prevention of CVD requires timely identification of people at increased risk to target effective dietary, lifestyle, or drug interventions. Over the past two decades, numerous prediction models have been developed, which mathematically combine multiple predictors to estimate the risk of developing CVD-for example, the Framingham, 3-5 SCORE, 6 and QRISK 7-9 models. Some of these prediction models are included in clinical guidelines for therapeutic management 10 11 and are increasingly advocated by health policymakers. In the United Kingdom, electronic health patient record systems now have QRISK2 embedded to calculate 10 year CVD risk.Several reviews have shown that there is an abundance of prediction models for a wide range of CVD outcomes. 12-14 However, the most comprehensive review 12 includes models published ...

Background: Severe pain after surgery remains a major problem, occurring in 20-40% of patients. Despite numerous published studies, the degree of pain following many types of surgery in everyday clinical practice is unknown. To improve postoperative pain therapy and develop procedurespecific, optimized pain-treatment protocols, types of surgery that may result in severe postoperative pain in everyday practice must first be identified. Methods: This study considered 115,775 patients from 578 surgical wards in 105 German hospitals. A total of 70,764 patients met the inclusion criteria. On the first postoperative day, patients were asked to rate their worst pain intensity since surgery (numeric rating scale, 0-10). All surgical procedures were assigned to 529 well-defined groups. When a group contained fewer than 20 patients, the data were excluded from analysis. Finally, 50,523 patients from 179 surgical groups were compared. Results: The 40 procedures with the highest pain scores (median numeric rating scale, 6-7) included 22 orthopedic/trauma procedures on the extremities. Patients reported high pain scores after many "minor" surgical procedures, including appendectomy, cholecystectomy, hemorrhoidectomy, and tonsillectomy, which ranked among the 25 procedures with highest pain intensities. A number of "major"

Only 11 putative risk factors for delirium are supported by either strong or moderate level of evidence. These factors should be considered when designing delirium prevention strategies or controlling for confounding in future etiologic studies.

Implementation of the WHO Surgical Checklist reduced in-hospital 30-day mortality. Although the impact on outcome was smaller than previously reported, the effect depended crucially upon checklist compliance.

Introduction The aim of this study was to investigate whether inhospital mortality was associated with the administered fraction of oxygen in inspired air (FiO 2 ) and achieved arterial partial pressure of oxygen (PaO 2 ).

Objective To identify existing prediction models for the risk of development of type 2 diabetes and to externally validate them in a large independent cohort. Data sources Systematic search of English, German, and Dutch literature in PubMed until February 2011 to identify prediction models for diabetes.Design Performance of the models was assessed in terms of discrimination (C statistic) and calibration (calibration plots and Hosmer-Lemeshow test).The validation study was a prospective cohort study, with a case cohort study in a random subcohort. Setting Models were applied to the Dutch cohort of the European Prospective Investigation into Cancer and Nutrition cohort study (EPIC-NL).Participants 38 379 people aged 20-70 with no diabetes at baseline, 2506 of whom made up the random subcohort.Outcome measure Incident type 2 diabetes. ResultsThe review identified 16 studies containing 25 prediction models. We considered 12 models as basic because they were based on variables that can be assessed non-invasively and 13 models as extended because they additionally included conventional biomarkers such as glucose concentration. During a median follow-up of 10.2 years there were 924 cases in the full EPIC-NL cohort and 79 in the random subcohort. The C statistic for the basic models ranged from 0.74 (95% confidence interval 0.73 to 0.75) to 0.84 (0.82 to 0.85) for risk at 7.5 years. For prediction models including biomarkers the C statistic ranged from 0.81 (0.80 to 0.83) to 0.93 (0.92 to 0.94). Most prediction models overestimated the observed risk of diabetes, particularly at higher observed risks. After adjustment for differences in incidence of diabetes, calibration improved considerably. ConclusionsMost basic prediction models can identify people at high risk of developing diabetes in a time frame of five to 10 years. Models including biomarkers classified cases slightly better than basic ones. Most models overestimated the actual risk of diabetes. Existing prediction models therefore perform well to identify those at high risk, but cannot sufficiently quantify actual risk of future diabetes.

Children undergoing urologic surgery at age less than 24 months showed more behavioral disturbances than children in whom surgery was performed after age 2 yr, although the results were not statistically significant. To confirm or refute an effect of anesthesia on cognitive development, at least 2,268 children need to be studied. With retrospective study designs, residual confounding remains an issue that can only be solved in prospective randomized studies.

Background: Postoperative stroke is a rare but major complication after surgery. The most often proposed mechanism is an embolus originating from the heart or great vessels. The role of intraoperative hypotension in the occurrence and evolution of postoperative stroke is largely unknown. Methods: A case-control study was conducted among 48,241 patients who underwent noncardiac and nonneurosurgical procedures in the period from January 2002 to June 2009. A total of 42 stroke cases (0.09%) were matched on age and type of surgery to 252 control patients. Conditional logistic regression analysis was used to estimate the effect of the duration of intraoperative hypotension (defined according to a range of blood pressure thresholds) on the occurrence of an ischemic stroke within 10 days after surgery, adjusted for potential confounding factors. Results: After correction for potential confounders and multiple testing, the duration that the mean blood pressure was decreased more than 30% from baseline remained statistically significantly associated with the occurrence of a postoperative stroke.