Guideline-Concordant vs. Routinely Measured Predialysis Blood Pressure (BP), and Home BP in Prevalent Hemodialysis (HD) Patients
Notice bibliographique
Résumé
Background: Pre-HD blood pressure is a pivotal vital sign in clinical decision-making. Yet, obtaining accurate measurements remains challenging. Pre-HD BP has been reported to poorly correlate with home BP. In this study, we investigated whether guideline-concordant measured pre-HD BP taken by the research team is better correlated to home BP than routine BP measurements taken by HD nurses. Methods: Three automated and three manual BP measurements were obtained pre-HD by the research team strictly following Hypertension Canada guidelines. BP was also measured by the HD nurses as per program routines using the HD machine. Patients measured BP at home at 4 occasions. We observed and recorded whether nurses followed the 10 quality guidelines. Data are mean+sd. Results: The 37 patients were 61+15 years of age, 49/51% female/male. HD vintage was 1 year and 7 months (2 months-8 years). Automated BP was 136/71+31/17 mmHg and manual BP was 135/69+31/17 mmHg (NS) as assessed by the research team. Routine nurse measured BPs averaged 140/63+29/19 mmHg. Pulse pressures were 60+18 by the research team, 77+26 by the nurses and 60+19 mmHg by patients at home (P<0.01, home vs. nurses). There was a significant correlation between SBP, DBP, and PP between measurements taken by the research team and nurses, but not between those and home BPs. A strong discrepancy was observed between research and nurse measurements, as assessed by the level of agreement for DBP, SBP, and PP (Bland Altman). None of the 36 observed BP measurements by 22 nurses were fully concordant with the guidelines. The time of resting before the measurement was highly variable (0-15 minutes). None of the patients were asked whether food, drinks, or caffeine were consumed, or if people had smoked within 30 minutes prior to the measurement. No more than 1 pre-HD BP measurement was conducted in any of the cases. Nurses did not refrain from talking to patients during BP readings in 92% of the cases, which is known to potentially elevate readings by 25-40% within the first 30 sec of talking. Conclusion: This study failed to show that not following guidelines for BP measurements could explain the previously reported discrepancy between home and pre-HD BPs, despite that guideline-concordant BP assessment in the HD unit was poor. Measuring BP accurately is essential in directing care for our HD patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».