SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions

Aims The aim of this study was to derive and validate the SCORE2-Older Persons (SCORE2-OP) risk model to estimate 5- and 10-year risk of cardiovascular disease (CVD) in individuals aged over 70 years in four geographical risk regions.Methods and results Sex-specific competing risk-adjusted models for estimating CVD risk (CVD mortality, myocardial infarction, or stroke) were derived in individuals aged over 65 without pre-existing atherosclerotic CVD from the Cohort of Norway (28 503 individuals, 10 089 CVD events). Models included age, smoking status, diabetes, systolic blood pressure, and total- and high-density lipoprotein cholesterol. Four geographical risk regions were defined based on country-specific CVD mortality rates. Models were recalibrated to each region using region-specific estimated CVD incidence rates and risk factor distributions. For external validation, we analysed data from 6 additional study populations {338 615 individuals, 33 219 CVD validation cohorts, C-indices ranged between 0.63 [95% confidence interval (CI) 0.61-0.65] and 0.67 (0.64-0.69)}. Regional calibration of expected-vs.-observed risks was satisfactory. For given risk factor profiles, there was substantial variation across the four risk regions in the estimated 10-year CVD event risk.Conclusions The competing risk-adjusted SCORE2-OP model was derived, recalibrated, and externally validated to estimate 5- and 10-year CVD risk in older adults (aged 70 years or older) in four geographical risk regions. These models can be used for communicating the risk of CVD and potential benefit from risk factor treatment and may facilitate shared decision-making between clinicians and patients in CVD risk management in older persons.Cardiolog

Difficulty and discrimination capacity of examinations estimated on the basis of repeated student failure

This paper examines the difficulty and discrimination capacity of several subjects for problematic students, i.e., those failing repeatedly (re‐examined four or more times) in at least one subject. Four hundred and six problematic students were analysed. The difficulty in passing thirty‐one mandatory subjects was assessed in two ways: on the basis of the attrition rate of the students due to pass the subject, on the basis of the percentage of number of failures over the number of examinations. The discrimination capacity of the same subjects was assessed on the basis of ‘false positive’ and ‘false negative’ results. The result of the evaluation of one subject was considered a false positive if it gave an excellent mark to a problematic student; it was considered a false negative if a student had to be reexamined four or more times before passing, although he had at least one excellent passing mark in one or more subjects. There were 157 excellent marks given to 114 problematic students. The two ways to assess difficulty ranked the thirty‐one subjects in a very significantly‐similar way. The subjects of the first, second and sixth years of study were considerably more difficult than the other years. A high proportion of false‐negative results in a subject did not imply necessarily increased difficulty and vice versa. Thus, only two of the five subjects with the highest proportion of false‐negative results belonged to the group of the five most difficult subjects. Also, three of the five subjects with the highest proportion of false‐positive results belonged to the group of the five easiest subjects. Finally, only one of the five subjects with the lowest proportion of false (positive plus negative) results belonged to the group of the five most difficult subjects. Examination systems involving oral examinations either alone or in conjunction with written ones were more difficult for the problematic students than those involving purely written examinations, while their discrimination capacity was not significantly different. The discrimination capacity of the subjects involving practical examinations as part of their evaluation system was significantly better than that of those not involving practical examinations. It is concluded that a very permissive examination system presents the problem of repeatedly‐failing students. A quasi‐open admission system, as in Athens University, associated with a very permissive examination system, leads to a pattern of difficulty, the peaks of which appear, mainly, in the first and last year of studies. 1983 Blackwell Publishin

Admission process and final qualification of medical students

Several ways of admission are compared as to their effect on the final drop‐out rate under an unlimited system of examinations within the Medical School. Out of 8260 students admitted during 10 years via several admission systems, 5927 graduated within 16 years from enrolment. A larger drop‐out rate (as well as a longer delay in graduating) was observed with students admitted without entrance examinations. An important number of students entering after examinations (45%) were also late in graduating. Among the admission systems used the findings point to the fact that a closed system provides the school with a majority of competent students but excludes a number of students who proved capable of graduating when enrolled in the same school. The findings also point to the need of improvement of the admission process in the closed system or the need for strict first‐ or second‐year evaluation of students in the open system. 1983 Blackwell Publishin

The growing role of echocardiography in interventional cardiology: The present and the future

As structural heart disease interventions continue to evolve to a sophisticated level, accurate and reliable imaging is required for pre-procedural selection of cases, intra-procedural guidance, post-procedural evaluation, and long-term follow-up of patients.Traditionally, cardiovascular procedures in the catheterization laboratory are guided by fluoroscopy and angiography. Advances in echocardiography can overcome most limitations of conventional imaging modalities and provide successful completion of each step of any catheter–based treatment. Echocardiography's unique characteristics rendered it the ideal technique for percutaneous catheter-based procedures.The purpose of this review is to demonstrate the use of the most common and up-to-date echocardiographic techniques in recent non-coronary percutaneous interventional procedures, underlining its inevitable and growing role, as well as illustrating areas of weakness and limitations, and to provide future perspectives. Keywords: Transesophageal, 3D echocardiography, Catheterization laboratory, Interventiona