Multilateralismus im Hohen Norden: Die Ukrainekrise droht, die Arktisdiplomatie zu versicherheitlichen

Im April dieses Jahres übergab Kanada den Vorsitz des Arktischen Rates an die USA; in der Arktis waren diese bislang kein starker Akteur. Doch gerade jetzt gefährdet die Ukrainekrise die bisher gut funktionierende internationale Zusammenarbeit mit Russland in der Arktis. Gleichzeitig ist angesichts signifikanter umweltpolitischer Herausforderungen und der steigenden wirtschaftlichen Relevanz des Hohen Nordens multilaterale Zusammenarbeit in der Region wichtiger denn je - es gilt sicherzustellen, dass diplomatische Lösungen auch in Zukunft möglich sein werden

A year-long quality improvement project on fluid management using blood volume monitoring during hemodialysis

<p>Inadequate removal of extracellular volume markedly increases blood pressure and contributes to high morbidity and mortality in hemodialysis patients. Advances in fluid management are needed to improve clinical outcomes. The aim of this quality improvement project was to examine the advantages of using a hematocrit-based, blood volume monitor (Crit-Line<a href="#FN0001" target="_blank"></a>) for 12 months, as part of a clinic-wide, fluid management program in one dialysis facility.</p> <p>Forty-five individuals were receiving hemodialysis at one facility at project initiation and are included in this analysis. Monthly averaged clinical parameters (dialysis treatment information, blood pressures, blood volume, and laboratory data) were compared from Months 1–12. Analyses were conducted overall and according to the presence/absence of hypertension at Month 1 (Baseline). Antihypertensive medication changes were assessed for patients with hypertension at Month 1.</p> <p>Average hemodialysis treatment time (+10.6 minutes, <i>p</i> = 0.002), eKt/V (+0.25, <i>p</i> < 0.001) and online clearance (+0.21, <i>p</i> < 0.0001) increased significantly in Month 12 versus Month 1. Average albumin levels and normalized protein catabolic rate increased from Month 1 to 12. Post-dialysis systolic blood pressure (SBP) decreased by Month 12 (<i>p</i> = 0.003). In hypertensive patients (SBP ≥ 140 mmHg in Month 1), there were significant differences in pre- and post-dialysis SBP between Month 1 and Month 12 (pre-hemodialysis: <i>p</i> = 0.02; post-hemodialysis: <i>p</i> = 0.0003), and antihypertensive medication use decreased in 29% of patients, while only 11% increased use. Treatment time in hypertensive patients increased by 15.4 minutes (<i>p</i> = 0.0005).</p> <p>This was a single, clinic-wide, quality improvement project with no control group. All data analyzed were from existing clinical records, so only routinely measured clinical variables were available and missing data were possible.</p> <p>During this year-long fluid management quality improvement project, decreases in post-dialysis SBP and increases in adequacy and treatment time were observed. Patients with hypertension at Month 1 experienced reductions in pre-dialysis SBP and antihypertensive medications.</p

Additional file 3: Table S8. of The dynamics of the metabolism of acetate and bicarbonate associated with use of hemodialysates in the ABChD trial: a phase IV, prospective, single center, single blind, randomized, cross-over, two week investigation

Estimating the Difference between Bicarbonate Dialysate Inflow and Arterial Blood Bicarbonate (mEq/L) at Any Time Point during 240 Minute Dialysis Treatment - Excluding Subjects S010, S015, S017. (DOCX 12 kb

Additional file 1: of Effects of dialysate to serum sodium (Na+) alignment in chronic hemodialysis (HD) patients: retrospective cohort study from a quality improvement project

Figure S1. Quantile-quantile plot visually comparing the probability distribution of the quantiles of the study cohort and the propensity score-matched control cohort in the intention-to-treat analysis. Figure S2. Quantile-quantile plot visually comparing the probability distribution of the quantiles of the study cohort and the propensity score-matched control cohort in the as-treated analysis. (PPTX 470 kb

Additional file 2: of Effects of dialysate to serum sodium (Na+) alignment in chronic hemodialysis (HD) patients: retrospective cohort study from a quality improvement project

Table S1 a). Subset Analysis in those with a GNa+ > 1 mEq/L: Treatment effect of dialysate to serum sodium alignment in in those patients part to this quality initiative (intention-to-treat cohort; N = 66) and the propensity score matched control cohort (N = 64). Table S1b). Subset Analysis in those with a GNa+ > 1 mEq/L: Treatment effect of dialysate to serum sodium alignment in in those patients part to this quality initiative (as-treated cohort; N = 52) and the propensity score matched control cohort (N = 64). Table S2a). Subset Analysis in those with a pre HD SBP > 150 mmHg: Treatment effect of dialysate to serum sodium alignment in in those patients part to this quality initiative (intention-to-treat cohort; N = 50) and the propensity score matched control cohort (N = 78). Table S2b. Subset Analysis in those with a pre HD SBP > 150 mmHg: Treatment effect of dialysate to serum sodium alignment in in those patients part to this quality initiative (as-treated cohort; N = 72) and the propensity score matched control cohort (N = 73). (DOCX 25 kb

Additional file 1: of Effects of dialysate to serum sodium (Na+) alignment in chronic hemodialysis (HD) patients: retrospective cohort study from a quality improvement project

Figure S1. Quantile-quantile plot visually comparing the probability distribution of the quantiles of the study cohort and the propensity score-matched control cohort in the intention-to-treat analysis. Figure S2. Quantile-quantile plot visually comparing the probability distribution of the quantiles of the study cohort and the propensity score-matched control cohort in the as-treated analysis. (PPTX 470 kb