Appropriateness of inpatient intravenous iron therapy in a Swiss tertiary care hospital.

INTRODUCTION: Intravenous (IV) iron replacement is an established treatment for iron deficiency and is recommended in various medical guidelines, but cheaper oral iron formulations remain first-line therapy in several instances. Data on adherence to current prescription standards are lacking in Switzerland. METHODS: Retrospective single center quality control study evaluating the appropriateness of IV iron replacement in 400 inpatients during 2019 and 2021 at a Swiss tertiary care hospital. Appropriateness of IV iron was assessed by expert chart review according to national and international guidelines. RESULTS: IV iron prescriptions were assessed as inappropriate in 147 (37%) of cases (indication lacking in 13%, oral route preferred in 24%). Inappropriate prescribing was more common (p < .001) in surgical wards (66%) compared to medical units (48%) and the gynecologic ward (19%). Iron studies were lacking in 29% of inappropriate IV administrations. Insufficient replacement dosages were chosen in 38% of patients with appropriate prescription. CONCLUSION: Based on current guidelines, inappropriate in-hospital prescription of IV iron was frequently observed. Considerable differences exist between hospital units, which are consistent with conflicting recommendations of professional societies. We recommend increased attention toward the prescription quality to avoid unnecessary, expensive, and potentially harmful use of IV iron.

Marine mammal conservation in the 21st century: A plea for a paradigm shift towards mindful conservation.

Marine mammals are regarded in high esteem by the general public, and are recognized as flagship species for conservation, while at the same time they suffer from anthropogenic impacts on a global scale, and often in extreme ways. It seems there is a huge discrepancy between how we humans think about our fellow creatures in the sea, and how we behave to impact and/or conserve them. Here, I examine why the purely scientific and thus intellectual approach to marine mammal conservation has had limited success over the past decades. While there are some obvious success stories in cetacean conservation, the situation today is, for many species and populations, more dire than it has ever been. The idea of 'we need to know more'-a credo of the scientific community-often is politically misrepresented to postpone necessary conservation decisions. To adapt our path towards more profound and, importantly, more effective marine conservation, as conservationists we need to go deeper and change the narrative of separation, i.e., the concept of humans being set apart from the rest of nature. Instead, there is a need to create a narrative of connectedness, i.e., the consciousness of humans being an integral part of the planetary system. Rather than telling horror stories about the plight of marine mammals, conservationists also need to trigger positive emotions about them in ourselves. More holistic aspects of conservation need to be incorporated in our future efforts, including the fuller integration of traditional knowledge and indigenous wisdom, recognizing ecosystem functions of marine life and protecting the processes they sustain, respecting 'holiness' of nature while focusing on the animals' individuality, personhood and the cultural identity of distinct communities. Effective marine mammal conservation will be possible only on the basis of a profound change of our own values and a fundamental change of the societal system we are living in.

Gout Arthritis During Admission for Decompensated Heart Failure-A Descriptive Analysis of Risk Factors, Treatment and Prognosis.

BACKGROUND: Chronic heart failure and hospital admissions are well-known risk factors for acute gouty arthritis. However, in-depth analyses of patients admitted for decompensated heart failure (DHF) who subsequently developed a gout attack are sparse. This study aims to characterize DHF patients who developed a gout attack during their inpatient treatment and describe potential risk factors, its consequences, and its management in the setting of heart failure exacerbation. METHODS: Retrospective chart review of 50 patients with an admission diagnosis of DHF who subsequently experienced a gout attack during admission at a Swiss tertiary care hospital between 2018 and 2020. Patients with a refusal of the general research consent were excluded (n = 10). RESULTS: A gout attack developed in 66/1,832 (3.6%) DHF admissions of whom 50 individual patients were analyzed. Patients were predominately male (76%), of advanced age (median 80.5 years), with several comorbidities including chronic kidney disease (74%), comorbid gout (70%, only 43% on urate lowering therapy) and hyperuricemia (median 547 µmol/l, IQR 434-667 µmol/l). Diuretics were intensified in all patients. Acute gout presented as polyarticular arthritis (62%) and was often accompanied by fever (30%). Joint aspiration was performed in 32%, and intra-articular steroid injections administered in 20% of patients. Median length of stay and 6-month mortality were 16 days (IQR 12-25) and 32%, respectively, compared to 9 days (IQR 6-14) and 16% for DHF patients without a gout attack. CONCLUSION: Our study highlights features of gout attacks in the context of DHF including the absence of comorbid gout in a significant proportion of patients, the presence of polyarticular disease during the flare, and a poor prognosis. The present study identifies the necessity to better address gout as a comorbidity in DHF patients and may assist clinicians in identifying DHF patients at risk for a gout attack.

Large-scale movements of common bottlenose dolphins in the Atlantic: dolphins with an international courtyard.

Wide-ranging connectivity patterns of common bottlenose dolphins (Tursiops truncatus) are generally poorly known worldwide and more so within the oceanic archipelagos of Macaronesia in the North East (NE) Atlantic. This study aimed to identify long-range movements between the archipelagos of Macaronesia that lie between 500 and 1,500 km apart, and between Madeira archipelago and the Portuguese continental shelf, through the compilation and comparison of bottlenose dolphin's photo-identification catalogues from different regions: one from Madeira (n = 363 individuals), two from different areas in the Azores (n = 495 and 176), and four from different islands of the Canary Islands (n = 182, 110, 142 and 281), summing up 1791 photographs. An additional comparison was made between the Madeira catalogue and one catalogue from Sagres, on the southwest tip of the Iberian Peninsula (n = 359). Results showed 26 individual matches, mostly between Madeira and the Canary Islands (n = 23), and between Azores and Madeira (n = 3). No matches were found between the Canary Islands and the Azores, nor between Madeira and Sagres. There were no individuals identified in all three archipelagos. The minimum time recorded between sightings in two different archipelagos (≈ 460 km apart) was 62 days. Association patterns revealed that the individuals moving between archipelagos were connected to resident, migrant and transient individuals in Madeira. The higher number of individuals that were re-sighted between Madeira and the Canary Islands can be explained by the relative proximity of these two archipelagos. This study shows the first inter-archipelago movements of bottlenose dolphins in the Macaronesia region, emphasizing the high mobility of this species and supporting the high gene flow described for oceanic dolphins inhabiting the North Atlantic. The dynamics of these long-range movements strongly denotes the need to review marine protected areas established for this species in each archipelago, calling for joint resolutions from three autonomous regions belonging to two EU countries.

Robust intraocular acquisition of the accommodation demand using eyeball movements.

The Artificial Accommodation System is a mechatronic lens implant that will restore the ability of the human eye to accommodate. Therefore, the accommodation demand has to be acquired. One possibility is to measure the vergence angle of the eyeballs in reference to an external field. Using the earth magnetic field as reference the proof of this measuring principle was possible. Still there are drawbacks like high responsivity to interferences and limitations of the measuring range. The new approach is to use the gravity field as reference and thus reduce the responsivity to interferences. The measuring range can be expanded by combining both sensing principles.