Risk assessment for major adverse cardiovascular events after noncardiac surgery using self-reported functional capacity: international prospective cohort study.

BACKGROUND: Guidelines endorse self-reported functional capacity for preoperative cardiovascular assessment, although evidence for its predictive value is inconsistent. We hypothesised that self-reported effort tolerance improves prediction of major adverse cardiovascular events (MACEs) after noncardiac surgery. METHODS: This is an international prospective cohort study (June 2017 to April 2020) in patients undergoing elective noncardiac surgery at elevated cardiovascular risk. Exposures were (i) questionnaire-estimated effort tolerance in metabolic equivalents (METs), (ii) number of floors climbed without resting, (iii) self-perceived cardiopulmonary fitness compared with peers, and (iv) level of regularly performed physical activity. The primary endpoint was in-hospital MACE consisting of cardiovascular mortality, non-fatal cardiac arrest, acute myocardial infarction, stroke, and congestive heart failure requiring transfer to a higher unit of care or resulting in a prolongation of stay on ICU/intermediate care (≥24 h). Mixed-effects logistic regression models were calculated. RESULTS: In this study, 274 (1.8%) of 15 406 patients experienced MACE. Loss of follow-up was 2%. All self-reported functional capacity measures were independently associated with MACE but did not improve discrimination (area under the curve of receiver operating characteristic [ROC AUC]) over an internal clinical risk model (ROC AUCbaseline 0.74 [0.71-0.77], ROC AUCbaseline+4METs 0.74 [0.71-0.77], ROC AUCbaseline+floors climbed 0.75 [0.71-0.78], AUCbaseline+fitnessvspeers 0.74 [0.71-0.77], and AUCbaseline+physical activity 0.75 [0.72-0.78]). CONCLUSIONS: Assessment of self-reported functional capacity expressed in METs or using the other measures assessed here did not improve prognostic accuracy compared with clinical risk factors. Caution is needed in the use of self-reported functional capacity to guide clinical decisions resulting from risk assessment in patients undergoing noncardiac surgery. CLINICAL TRIAL REGISTRATION: NCT03016936.

[Tools for junior scientists support from medical societies: survey amongst members organized in the Association of the Scientific Medical Societies (AWMF)]. / Förderung des wissenschaftlichen Nachwuchses durch medizinische Fachgesellschaften - Umfrage unter den Mitgliedsgesellschaften der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. (AWMF).

INTRODUCTION: A decreasing number of young physicians go for an academic career. The most frequently cited reasons are deficient structures and a lack of perspectives. The German Research Foundation warned against supply gaps in the medical sciences and in 2010 published recommendations for the improvement of professional development at all levels of medical education. A systematic survey of existing support tools and their dissemination among the medical societies has not yet been conducted. METHOD: Network members of the AWMF were contacted by e-mail and asked to answer 59 questions regarding the support of junior scientists in their respective societies. RESULTS: 28 out of 147 societies replied to the questionnaire. Most of the societies offer at least one of the following tools (multiple responses; selective topics): award for oral presentations (n=27), free attendance at conferences (n=15), financial research funding (n=19), assessment of any funding application (n=10), mentoring (n=6), support of students working on their doctoral thesis (n=26), support of studies abroad (n=16), training course on statistics/ laboratory methods (n=17), support with clinical studies (n=22). DISCUSSION: Here, we present our survey findings on established support tools for junior scientists for the first time. Apart from the medical schools, several medical-scientific societies have also started to provide tools of support for their junior scientists. However, to ensure that long-term perspectives and attractive conditions are provided in the field of medical science for junior scientists, broader support and interdisciplinary exchange of established tools are needed.

[Risk management for ambulatory anaesthesia]. / Ambulante Anästhesie--Risikomanagement in der ambulanten Anästhesie.

Outpatient anaesthesia has increased considerably in recent years. More complex procedures are performed on an outpatient basis and patients suffer from more co-morbidities. A patient- and procedure-centred risk management system includes guidelines for patient-selection and -evaluation, selection of adequate anaesthetic drugs, structured post-anaesthesia care and discharge-procedures, and a critical incident management plan. Risk management for ambulatory anaesthesia is supposed to reduce malpractice and prevent complications. Ultimately, procedure related cost will decrease and confidence as well as satisfaction of patients, surgeons and anaesthesia team members will increase.