Guideline-Concordant vs. Routinely Measured Predialysis Blood Pressure (BP), and Home BP in Prevalent Hemodialysis (HD) Patients
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".