scholarly journals A simple modification of dialysate potassium: its impact on plasma potassium concentrations and the electrocardiogram

2019 ◽  
Author(s):  
Pierre Delanaye ◽  
François Krzesinski ◽  
Bernard E Dubois ◽  
Alexandre Delcour ◽  
Sébastien Robinet ◽  
...  
Keyword(s):  
Sudden Death ◽  
Qt Interval ◽  
Lower Risk ◽  
Plasma Potassium ◽  
Qt Dispersion ◽  
Dialysis Session ◽  
Simple Modification ◽  
Before And After ◽  
Electrocardiogram Ecg ◽  
The Impact

Abstract Background Sudden death is frequent in haemodialysis (HD) patients. Both hyperkalaemia and change of plasma potassium (K) concentrations induced by HD could explain this. The impact of increasing dialysate K by 1 mEq/L on plasma K concentrations and electrocardiogram (ECG) results before and after HD sessions was studied. Methods Patients with pre-dialysis K >5.5 mEq/L were excluded. ECG and K measurements were obtained before and after the first session of the week for 2 weeks. Then, K in the dialysate was increased (from 1 or 3 to 2 or 4 mEq/L, respectively). Blood and ECG measurements were repeated after 2 weeks of this change. Results Twenty-seven prevalent HD patients were included. As expected, a significant decrease in K concentrations was observed after the dialysis session, but this decrease was significantly lower after the switch to an increased dialysate K. The pre-dialysis K concentrations were not different after changing, but post-dialysis K concentrations were higher after switching (P < 0.0001), with a lower incidence of post-dialysis hypokalaemia. Regarding ECG, before switching, the QT interval (QT) dispersion increased during the session, whereas no difference was observed after switching. One week after switching, post-dialysis QT dispersion [38 (34–42) ms] was lower than post-dialysis QT dispersion 2 weeks and 1 week before switching [42 (38–57) ms, P = 0.0004; and 40 (35–50) ms, P = 0.0002]. Conclusions A simple increase of 1 mEq/L of K in the dialysate is associated with a lower risk of hypokalaemia and a lower QT dispersion after the dialysis session. Further study is needed to determine if such a strategy is associated with a lower risk of sudden death.

scholarly journals Evaluation of a mandatory phishing training program for high-risk employees at a US healthcare system

2019 ◽  
Vol 26 (6) ◽  
pp. 547-552 ◽  
Author(s):  
William J Gordon ◽  
Adam Wright ◽  
Robert J Glynn ◽  
Jigar Kadakia ◽  
Christina Mazzone ◽  
...  
Keyword(s):  
High Risk ◽  
Training Program ◽  
Lower Risk ◽  
Healthcare Systems ◽  
Intervention Period ◽  
Substantial Impact ◽  
Hospital Employees ◽  
Mandatory Training ◽  
Before And After ◽  
The Impact

Abstract Objective The study sought to understand the impact of a phishing training program on phishing click rates for employees at a single, anonymous US healthcare institution. Materials and Methods We stratified our population into 2 groups: offenders and nonoffenders. Offenders were defined as those that had clicked on at least 5 simulated phishing emails and nonoffenders were those that had not. We calculated click rates for offenders and nonoffenders, before and after a mandatory training program for offenders was implemented. Results A total of 5416 unique employees received all 20 campaigns during the intervention period; 772 clicked on at least 5 emails and were labeled offenders. Only 975 (17.9%) of our set clicked on 0 phishing emails over the course of the 20 campaigns; 3565 (65.3%) clicked on at least 2 emails. There was a decrease in click rates for each group over the 20 campaigns. The mandatory training program, initiated after campaign 15, did not have a substantial impact on click rates, and the offenders remained more likely to click on a phishing simulation. Discussion Phishing is a common threat vector against hospital employees and an important cybersecurity risk to healthcare systems. Our work suggests that, under simulation, employee click rates decrease with repeated simulation, but a mandatory training program targeted at high-risk employees did not meaningfully decrease the click rates of this population. Conclusions Employee phishing click rates decrease over time, but a mandatory training program for the highest-risk employees did not decrease click rates when compared with lower-risk employees.

scholarly journals Short-term beat-to-beat variability of the QT interval is increased and correlates with parameters of left ventricular hypertrophy in patients with hypertrophic cardiomyopathy

2015 ◽  
Vol 93 (9) ◽  
pp. 765-772 ◽  
Author(s):  
Andrea Orosz ◽  
István Baczkó ◽  
Viktória Nagy ◽  
Henriette Gavallér ◽  
Miklós Csanády ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Qt Interval ◽  
Qt Dispersion ◽  
Relative Increase ◽  
Left Ventricular ◽  
Short Term ◽  
Lv Mass ◽  
Proarrhythmic Risk ◽  
Electrocardiogram Ecg ◽  
Qt Interval Variability

Stratification models for the prediction of sudden cardiac death (SCD) are inappropriate in patients with hypertrophic cardiomyopathy (HCM). We investigated conventional electrocardiogram (ECG) repolarization parameters and the beat-to-beat short-term QT interval variability (QT-STV), a new parameter of proarrhythmic risk, in 37 patients with HCM (21 males, average age 48 ± 15 years). Resting ECGs were recorded for 5 min and the frequency corrected QT interval (QTc), QT dispersion (QTd), beat-to-beat short-term variability of QT interval (QT-STV), and the duration of terminal part of T waves (Tpeak–Tend) were calculated. While all repolarization parameters were significantly increased in patients with HCM compared with the controls (QTc, 488 ± 61 vs. 434 ± 23 ms, p < 0.0001; QT-STV, 4.5 ± 2 vs. 3.2 ± 1 ms, p = 0.0002; Tpeak–Tend duration, 107 ± 27 vs. 91 ± 10 ms, p = 0.0015; QTd, 47 ± 17 vs. 34 ± 9 ms, p = 0.0002), QT-STV had the highest relative increase (+41%). QT-STV also showed the best correlation with indices of left ventricular (LV) hypertrophy, i.e., maximal LV wall thickness normalized for body surface area (BSA; r = 0.461, p = 0.004) or LV mass (determined by cardiac magnetic resonance imaging) normalized for BSA (r = 0.455, p = 0.015). In summary, beat-to-beat QT-STV showed the most marked increase in patients with HCM and may represent a novel marker that merits further testing for increased SCD risk in HCM.

QT Interval and QT Dispersion Before and After Diet Therapy in Patients with Simple Obesity

1999 ◽  
Vol 220 (3) ◽  
pp. 133-138 ◽  
Author(s):  
MERLYN E. MSHIU ◽  
TETSUNORI SAIKAWA ◽  
KENICHIRO ITO ◽  
MASAHIDE HARA ◽  
TOSHIIE SAKATA
Keyword(s):  
Qt Interval ◽  
Qt Dispersion ◽  
Diet Therapy ◽  
Before And After ◽  
Simple Obesity

Potassium dynamics are attenuated in hyperkalemia and a determinant of QT adaptation in exercising hemodialysis patients

2013 ◽  
Vol 115 (4) ◽  
pp. 498-504 ◽  
Author(s):  
Cao Thach Tran ◽  
Henning Bundgaard ◽  
Søren Daustrand Ladefoged ◽  
Stig Haunsø ◽  
Keld Kjeldsen
Keyword(s):  
Qt Interval ◽  
Potassium Concentration ◽  
Plasma Potassium ◽  
Work Load ◽  
Hemodialysis Patients ◽  
Cycle Ergometer ◽  
Potassium Dynamics ◽  
Before And After ◽  
Stage Renal Disease ◽  
End Stage

Disturbances in plasma potassium concentration (pK) are well known risk factors for the development of cardiac arrhythmia. The aims of the present study were to evaluate the effect of hemodialysis on exercise pK dynamics and QT hysteresis, and whether QT hysteresis is associated with the pK decrease following exercise. Twenty-two end-stage renal disease patients exercised on a cycle ergometer with incremental work load before and after hemodialysis. ECG was recorded and pK was measured during exercise and recovery. During exercise, pK increased from 5.1 ± 0.2 to 6.1 ± 0.2 mM (mean ± SE; P < 0.0001) before hemodialysis and from 3.8 ± 0.1 to 5.1 ± 0.1 mM ( P < 0.0001) after hemodialysis. After 2 min of recovery, pK had decreased to 5.0 ± 0.2 mM and 4.1 ± 0.1 mM ( P < 0.0001) before and after hemodialysis, respectively. pK increase during exercise was accentuated after hemodialysis. The pK increase was negatively linearly correlated with pK before exercise (β = −0.21, R2 = 0.23, P = 0.001). QT hysteresis was negatively linearly correlated with the decrease in pK during recovery (β = −28 ms/mM, R2 = 0.36, P = 0.006). Thus, during recovery, low pK was associated with relatively longer QT interval. In conclusion, new major findings are an accentuated increase in pK during exercise after hemodialysis, an attenuated increase in pK in hyperkalemia, and an association between pK and QT interval adaptation during recovery. The acute pK shift after exercise may modulate QT interval adaptation and trigger cardiac arrhythmias.

scholarly journals Effect of n-3 fatty acids from fish on electrocardiographic characteristics in patients with frequent premature ventricular complexes

2005 ◽  
Vol 93 (6) ◽  
pp. 787-790 ◽  
Author(s):  
Anouk Geelen ◽  
Peter L. Zock ◽  
Ingeborg A. Brouwer ◽  
Martijn B. Katan ◽  
Jan A. Kors ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Qt Interval ◽  
Cardiac Electrophysiology ◽  
Heart Cell ◽  
Premature Ventricular Complexes ◽  
Disease Mortality ◽  
Before And After ◽  
Additional Support ◽  
Electrocardiogram Ecg ◽  
Insight Into

n-3 Fatty acids may protect against heart disease mortality by preventing fatal arrhythmias. Underlying effects on cardiac electrophysiology may be demonstrable in the standard electrocardiogram (ECG) and provide insight into the mechanism. Therefore, we investigated the effect of dietary n-3 fatty acids on heart-rate-corrected QT interval, T-loop width, spatial QRS-T angle and spatial U-wave amplitude in patients with frequent premature ventricular complexes. Seventy-four patients received either capsules providing 1·5 g n-3 fatty acids daily or placebo for approximately 14 weeks. ECG were recorded before and after intervention. None of the ECG characteristics was significantly affected by treatment. The present results do not provide additional support for the hypothesis that n-3 fatty acids prevent cardiac arrhythmia through generic electrophysiologic effects on heart cell membranes. However, we cannot exclude effects of n-3 fatty acids on clinical relevant endpoints that are not easily detected by prior changes in the ECG.

scholarly journals ECG Changes in Melanoma Patients Undergoing Cancer Therapy—Data from the ECoR Registry

2020 ◽  
Vol 9 (7) ◽  
pp. 2060
Author(s):  
Julia Pohl ◽  
Raluca-Ileana Mincu ◽  
Simone Maria Mrotzek ◽  
Lena Hinrichs ◽  
Lars Michel ◽  
...  
Keyword(s):  
Heart Rate ◽  
Checkpoint Inhibitors ◽  
Qt Dispersion ◽  
Qtc Interval ◽  
Programmed Death ◽  
Before And After ◽  
Programmed Death 1 ◽  
Qrs Duration ◽  
Melanoma Patients ◽  
Electrocardiogram Ecg

We aimed to evaluate whether therapy with immune checkpoint inhibitors (ICI) leads to changes in electrocardiogram (ECG) parameters in melanoma patients. We retrospectively examined 41 patients (46% women, age 61 ± 12years) with advanced melanoma (stage III/IV) before and during ICI treatment from our “Essen Cardio-oncology Registry” (ECoR). ECGs were analyzed before and 4–12 weeks after therapy started (follow-up, 90 ± 51 days). Heart rate, PR time, QRS duration and duration of the corrected QT (QTc) interval were recorded. QT dispersion (QTd) was calculated. Heart rate, PR time, QRS and QTc did not differ when comparing values before and after therapy started. QTd was prolonged after therapy started (32 ± 16 ms vs. 47 ± 19 ms, n = 41, p < 0.0001). Subgroup analyses revealed prolonged QTd in patients that received a combination immunotherapy with ipilimumab and nivolumab (31 ± 14 ms vs. 50 ± 14 ms, n = 21, p < 0.0001), while QTd in patients with anti–programmed death 1 (PD-1) inhibitor monotherapy did not change after therapy started. QTd is prolonged in patients under ICI combination therapy, potentially signaling an increased susceptibility to ventricular arrhythmias.

scholarly journals Electrocardiographic Changes Associated With Ibrutinib Exposure

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482093180
Author(s):  
Michael G. Fradley ◽  
Allan Welter-Frost ◽  
Matthew Gliksman ◽  
Josephine Emole ◽  
Federico Viganego ◽  
...  
Keyword(s):  
Qt Interval ◽  
Ventricular Arrhythmias ◽  
Qt Dispersion ◽  
Corrected Qt Interval ◽  
Qt Intervals ◽  
Electrocardiographic Changes ◽  
The Absolute ◽  
Significant Change ◽  
Electrocardiographic Parameters ◽  
Electrocardiogram Ecg

Although ibrutinib-associated atrial and ventricular arrhythmias have been well described, there is little information about ibrutinib’s effects on other electrocardiographic parameters, particularly the QT interval. Using our database of 137 patients treated with ibrutinib, we retrospectively identified 21 patients in whom an electrocardiogram (ECG) was obtained both prior to and after ibrutinib exposure. All traditional ECG parameters as well as QT dispersion were manually measured by an electrophysiologist. Compared to baseline ECGs, post ibrutinib ECGs demonstrated QT interval shortening from 386 ms to 356 ms ( P = .007), corrected QT interval shortening using Bazett’s formula from 446 ms to 437 ms ( P = .04), and corrected QT interval shortening using Fridericia’s formula from 425 ms to 407 ms ( P = .003). QT dispersion also increased post ibrutinib exposure compared to baseline (39.8 ms vs 57.3 ms, P = .002). There was no significant change in other ECG parameters. In conclusion, both the absolute and corrected QT intervals significantly shortened after ibrutinib exposure, while there was a significant increase in QT dispersion. These findings may point to a common underlying electrophysiologic mechanism of ibrutinib-associated arrhythmias.

scholarly journals Sudden Death Associated With Sickle Cell Trait Before and After Mandatory Screening

2020 ◽  
Vol 12 (3) ◽  
pp. 241-245 ◽  
Author(s):  
Benjamin K. Buchanan ◽  
David M. Siebert ◽  
Monica L. Zigman Suchsland ◽  
Jonathan A. Drezner ◽  
Irfan M. Asif ◽  
...  
Keyword(s):  
Sudden Death ◽  
Sickle Cell ◽  
National Collegiate Athletic Association ◽  
Sickle Cell Trait ◽  
Strenuous Exercise ◽  
Level Of Evidence ◽  
Increased Risk ◽  
Ncaa Athletes ◽  
Before And After ◽  
The Impact

Background: Sickle cell trait (SCT) has been associated with an increased risk of sudden death in athletes during strenuous exercise. In August 2010, the National Collegiate Athletic Association (NCAA) began requiring athletes to be screened for SCT, provide proof of SCT status, or sign a waiver and launched an educational campaign for athletes, coaches, and medical staff. The impact of this program is unknown. The purpose of this study was to determine the incidence of death associated with sickle cell trait (daSCT) in NCAA athletes before and after legislation. Hypothesis: NCAA SCT legislation will decrease the incidence of daSCT. Study Design: Observational study. Level of Evidence: Level 2. Methods: A database of NCAA athlete deaths from 2000 to 2019 was reviewed for daSCT. A total of 8,309,050 athlete-years (AY) were included. Incidence of death was calculated before and after legislation. Results: The incidence of daSCT in Division I (DI) football athletes before legislation (n = 9) was 1:28,145 AY and after legislation (n = 1) was 1:250,468 AY (relative risk [RR], 0.112; 95% CI, 0.003-0.811; P = 0.022), an 89% reduction in risk after legislation was enacted. The incidence of daSCT in African American DI football athletes before legislation (n = 9) was 1:12,519 AY and after legislation (n = 1) was 1:118,464 AY (RR, 0.106; 95% CI, 0.002-0.763; P = 0.017), also an 89% risk reduction after legislation was enacted. For all NCAA athletes, the incidence of daSCT was 1:489,749 AY before legislation (n = 10) and 1:1,705,780 AY after legislation (n = 2) (RR, 0.288; 95% CI, 0.031-1.347; P = 0.146). Conclusion: The incidence of daSCT in DI football athletes has decreased significantly since legislation was enacted. Cases of daSCT outside of football are rare. It is unclear whether the decrease is related to screening for SCT, education, or both. Clinical Relevance: This is the first evidence that NCAA SCT legislation may save lives.

QT Interval and QT Dispersion Before and After Diet Therapy in Patients with Simple Obesity

1999 ◽  
Vol 220 (3) ◽  
pp. 133-138 ◽  
Author(s):  
M. E. Mshui ◽  
T. Saikawa ◽  
K. Ito ◽  
M. Hara ◽  
T. Sakata
Keyword(s):  
Qt Interval ◽  
Qt Dispersion ◽  
Diet Therapy ◽  
Before And After ◽  
Simple Obesity

Strategic Role of Zakat in Multidimensional Quality of Life in Sijunjung, Indonesia

2018 ◽  
Vol 15 (1) ◽  
pp. 55-72
Author(s):  
Herlin Hamimi ◽  
Abdul Ghafar Ismail ◽  
Muhammad Hasbi Zaenal
Keyword(s):  
Quality Of Life ◽  
Positive Impact ◽  
Wealth Distribution ◽  
Absolute Poverty ◽  
Before And After ◽  
The Status ◽  
Being There ◽  
The Impact

Zakat is one of the five pillars of Islam which has a function of faith, social and economic functions. Muslims who can pay zakat are required to give at least 2.5 per cent of their wealth. The problem of poverty prevalent in disadvantaged regions because of the difficulty of access to information and communication led to a gap that is so high in wealth and resources. The instrument of zakat provides a paradigm in the achievement of equitable wealth distribution and healthy circulation. Zakat potentially offers a better life and improves the quality of human being. There is a human quality improvement not only in economic terms but also in spiritual terms such as improving religiousity. This study aims to examine the role of zakat to alleviate humanitarian issues in disadvantaged regions such as Sijunjung, one of zakat beneficiaries and impoverished areas in Indonesia. The researcher attempted a Cibest method to capture the impact of zakat beneficiaries before and after becoming a member of Zakat Community Development (ZCD) Program in material and spiritual value. The overall analysis shows that zakat has a positive impact on disadvantaged regions development and enhance the quality of life of the community. There is an improvement in the average of mustahik household incomes after becoming a member of ZCD Program. Cibest model demonstrates that material, spiritual, and absolute poverty index decreased by 10, 5, and 6 per cent. Meanwhile, the welfare index is increased by 21 per cent. These findings have significant implications for developing the quality of life in disadvantaged regions in Sijunjung. Therefore, zakat is one of the instruments to change the status of disadvantaged areas to be equivalent to other areas.

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