T-Wave Morphology Changes as Surrogate for Blood Potassium Concentration in Hemodialysis Patients

End-stage renal disease (ESRD) patients undergoing hemodialysis (HD) are at high risk of arrhythmias and sudden cardiac death as a result of blood potassium concentration ([K+ ]) changes. The aim of this study is to investigate if dw, a time-warping-based electrocardiogram (ECG) biomarker of T-wave morphology changes, reflects [K+] evolution in HD patients, facilitating noninvasive [K+] monitoring and avoiding in-hospital blood tests analysis. 48-hour ECGs and a set of hourly-collected blood samples from 12 ESRD patients were acquired and analyzed. dw was calculated between a reference T-wave, measured at the end of the HD session, and the T-waves corresponding to each hour along the whole HD session, when [K+] was measured from blood samples. The values of dw correlated with the relative variations in [K+] with respect to the reference value (end of HD, ¿[K+ ]), with a median (interquartile) correlation coefficient of 0.90 (0.30), evidencing a strong relation between them. Our findings support the use of dw as a surrogate of ¿[K+], suggesting a potential use of dw for non-invasive hyperkalemia monitoring both in hospital and ambulatory settings

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Estudio de los cambios en la morfología de las ondas T como sustituto de la concentración de potasio en sangre en pacientes de hemodiálisis

Los pacientes con enfermedad renal crónica (en inglés end-stage renal disease .ESRD) que se someten a hemodiálisis (HD) tienen un alto riesgo de arritmias y muerte súbita cardiaca como resultado de los cambios en la concentración de potasio en la sangre ([K^+]). El objetivo de este estudio es investigar si d_w , un biomarcador derivado del análisis del electrocardiograma (ECG) utilizando el método de la deformación de la onda T (en inglés time-warping) para analizar los cambios en la morfología de la onda T, refleja la evolución de [K^+] en pacientes en HD. Esto facilitaría el control no invasivo de [K^+] evitando realizar análisis de sangre en el hospital. Para ello, se obtuvieron y analizaron ECGs de 48 horas y un conjunto de muestras de sangre de 12 pacientes en ESRD. d_w se calculó a partir de una onda T de referencia, medida al final de la sesión de HD, y las ondas T correspondientes a cada hora durante la sesión de HD, coincidiendo con los valores de [K^+] de las muestras de sangre. Los valores de d_w resultaron estar correlados con las variaciones relativas en [K^+] con respecto al valor de referencia (final de HD, ¿[K^+]), con un coeficiente de correlación de 0.90(0.30) (mediana(rango intercuartílico)), evidenciando una fuerte relación entre ellos. Nuestros hallazgos respaldan el uso de d_w para la monitorización no invasiva de hiperkalemia, tanto en el hospital como en entorno ambulatorios.Postprint (author's final draft