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Background: Electronic cigarettes (e-cigarettes) are the most used form of tobacco products among adolescents and young adults, and Vuse is one of the most popular brands of e-cigarettes among US adolescents. In October 2021, Vuse Solo became the first e-cigarette brand to receive marketing granted orders (MGOs) from the US Food and Drug Administration (FDA), authorizing its marketing and their tobacco-flavored pods. Vuse Ciro and Vuse Vibe, and their tobacco-only ("original") e-liquids, were authorized for marketing in May 2022 and Vuse Alto tobacco-flavored devices were authorized in July 2024. These marketing authorizations are contingent upon the company adhering to the MGOs' stated marketing restrictions, including reducing exposure and appeal to youth via digital, radio, television, print, and point-of-sale advertising., Objective: In this study, we analyzed the official social media channels of Vuse (Instagram and Facebook) to examine how Vuse marketed its products on social media and whether these marketing posts contain potentially youth-appealing themes., Methods: We conducted content analysis of the official RJ Reynolds Vapor Company Instagram and Facebook accounts. We collected all posts from October 10, 2019, when RJ Reynolds Vapor Company submitted its premarket tobacco product application to the FDA, to February 21, 2022, to cover the first winter holiday season after the MGO. Two coders developed the codebook with 17 themes based on the Content Appealing to Youth index to capture the posts' characteristics and potentially youth-appealing content. We calculated the percentage of posts in which each code was present., Results: A total of 439 unique posts were identified. During this study's period, there were no posts on Instagram or Facebook marketing Vuse Solo (the authorized product at that time). Instead, Vuse Alto (unauthorized to date of study) was heavily marketed, with 59.5% (n=261) of the posts specifically mentioning the product name. Further, "Vuse" more generally was marketed on social media without differentiating between the authorized and unauthorized products (n=182, 41.5%). The marketing messages contained several potentially youth-appealing themes including creativity or innovation (n=189, 43.1%), individuality or freedom (n=106, 24.2%), and themes related to art (n=150, 34.2%), music (n=77, 17.5%), sports (n=125, 28.5%), nature (with n=49, 11.2% of the posts containing flora imageries), alcohol imagery (n=10, 2.3%), and technology (n=6, 1.4%)., Conclusions: Although Vuse Alto e-cigarettes had not yet obtained FDA marketing authorization during the 28 months of data collection, they were the primary Vuse e-cigarette devices marketed on social media. Vuse social media posts use themes that are appealing to and likely promote youth use, including creativity and innovation, individuality or freedom, arts and music, nature, technology, and alcohol imagery. The FDA should (1) prohibit companies from comarketing unauthorized products alongside authorized products, and (2) exercise enforcement against even authorized products that are marketed using youth-appealing features., (© Eileen Han, Lauren K Lempert, Francesca Vescia, Bonnie Halpern-Felsher. Originally published in JMIR Formative Research (https://formative.jmir.org).)

The introduction of hybrid diagnosis-related groups (DRG) presents new challenges for healthcare providers and health insurances. The same applied in 2023 to the institute designated by the Federal Ministry of Health (BMG) to extract medical procedures and calculate remuneration levels for the first hybrid DRGs. A responsible calculation methodology and a realistic data basis are required as the result of the calculation can lead to controversy, even to a splitting among specialist groups and constructs. There is also the threat of mismanagement with subsequent supply problems. In this context, a loss of quality can occur due to the use of simple surgical procedures that are less complex and not expensive with respect to material costs and are economical but not state of the art and thus directly worsen the medical care of patients in the statutory health insurance (GKV). Furthermore, it is already becoming apparent that procedures that are uneconomical due to the miscalculation are partially no longer being comprehensively rendered by healthcare providers due to adjustment of the service portfolio. An appropriate compensation of procedures is only possible based on a remuneration that adequately covers the costs. In this respect, this article is not intended to be understood as a "solution to the problem of the internal distribution of the remuneration in hybrid DRGs" but more to offer suggestions for solutions for the required further development of the hybrid DRG compensation level calculation to prevent a threat to the treatment of GKV patients due to mismanagement. As required in § 115f of the Sozialgesetzbuch V (SGB V), the recalculation of an economic remuneration must be carried out urgently and promptly using an empirical calculation basis and methodology and this must be regularly adapted., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: T. Kisch, R. Müller-Rath, S. Gregor, R. Lorenz, A. Neumann, S. Dittrich, M. Müller, R. Lippert, J. Henniger, B. Lembeck, E.-M. Baur, J. Karst, F. Vescia und R. Schmitz geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Nearly 3 million U.S. adolescents use e-cigarettes. E-cigarette marketing is associated with adolescent e-cigarette use; however, studies have not asked adolescents their perceptions about whether and which e-cigarette marketing in retail stores influences purchase and use., Methods: Eleven 90-minute focus groups with 12-19-year-olds (mean age 15.7, 46.6 % female) from 11 U.S. states (n = 58) recruited through Instagram and schools (May 2021-Aug 2022). Photographs of e-cigarette marketing in and around retail stores were used to aid discussion. Thematic analysis identified themes related to appealing marketing characteristics., Results: Adolescents indicated that e-cigarette marketing in and around retail stores arouses their curiosity, reminds them to buy, and normalizes using e-cigarettes. Adolescents identified specific e-cigarette marketing characteristics that they believed influence their decision to purchase and use e-cigarettes including the Tobacco Power Wall, free samples and flavor smelling samples, price incentives such as discounts and starter-kits, e-cigarette displays near checkout encouraging grab-and-go, displays near food, snacks or candy, and e-cigarette advertising through posters on store windows and stickers at checkout. Adolescents reported combining online and social media strategies to bypass age verification in retail stores (e.g., buying gift cards online and using them in stores). Adolescents suggested adding warning images on negative health effects of e-cigarettes, increasing prominence of minimum-age-of-tobacco-sale signs, and developing marketing education as counter-marketing strategies., Conclusions: Adolescents indicate that specific e-cigarette marketing characteristics in retail stores influence their purchase and use decisions. Addressing such e-cigarette marketing exposures in retail stores through counter-marketing messages may bolster adolescent e-cigarette prevention efforts., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Bonnie Halpern-Felsher is a paid expert scientist in some litigation against the e-cigarette industry and an unpaid scientific advisor and expert regarding some tobacco-related policies. No other authors have any conflicts to disclose., (© 2024 The Author(s).)

Legislation, regulations and rules must be complied with when conducting ambulant surgeries and administering ambulant anesthesia. Additionally, there are social welfare legislation and regulations, as well as technical guidelines and standards that must be complied with, for instance, regarding the management of medical products or the disposal of waste and sewage in medical practices. At a country level, many of these regulatory areas are managed differently by each German state, and in some instances management differs significantly from one state to another. Social and employment legislation, as well as regulations for ambulant operating physicians and business operators have to be observed. In order to prevent nosocomial infections, there is a focus on maintaining compliance with hygiene regulations and the Infection Protection Act. There are a variety of possible operational models and ways to organize ambulant operating rooms. The particular model that is best for a specific practice will depend on the local circumstances. That being said, particular attention should be given to patient-centered, stress free surgical patient care, which should be prioritized over the business. Ambulant surgery can be performed in private practices, as well as hospitals, and the two usually differ significantly from one another. On the one hand there are the well-organized, high performing, private practices, which have a focus on ambulant surgeries, where the participating physicians contribute to the success of the practice. On the other hand, there are the often large and cumbersomely organized hospitals, where ambulant surgeries are viewed as more of a burden than as an additional source of income., Competing Interests: Interessenkonflikt: Die Autoren erklären, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

The number of operations carried out on an outpatient basis is increasing in Germany. This trend has been observed for years. The prerequisite is an infrastructure that is in line with guidelines. The competence of the anesthetist must not be restricted to that of a standard specialist anesthetist, but the physician should have experience in ambulatory anesthesia. Well-adjusted comorbidities of the patient are generally not a contraindication for an outpatient procedure. The heavily overweight patient can also be operated on an outpatient basis if he is compliant, comorbidities are well adjusted and intensive postoperative care is ensured. Obstructive sleep apnea syndrome is per se not a contraindication for carrying out a surgical intervention on an outpatient basis. The intensive postoperative care and the presence of a CPAP device are also important in the recovery room. An important decision criterion in cardiac patients is the determination of the metabolic equivalent (MET). A MET value > 4 is considered sufficient for outpatient procedures. Postoperatively, the patient can be discharged home when the surgeon and the anesthetist are convinced that the condition of the patient is stable. A sensible companion and instruction to the patient that he is not allowed to actively participate in road traffic are essential for discharge after surgery. The decision on outpatient or inpatient care must always be taken individually. It is not possible to make a general statement as to the manner in which an intervention should be carried., Competing Interests: Interessenkonflikt: Die Autoren erklären, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Outpatient anaesthesia has increased considerably in recent years. More complex procedures are performed on an outpatient basis and patients suffer from more co-morbidities. A patient- and procedure-centred risk management system includes guidelines for patient-selection and -evaluation, selection of adequate anaesthetic drugs, structured post-anaesthesia care and discharge-procedures, and a critical incident management plan. Risk management for ambulatory anaesthesia is supposed to reduce malpractice and prevent complications. Ultimately, procedure related cost will decrease and confidence as well as satisfaction of patients, surgeons and anaesthesia team members will increase., (© Georg Thieme Verlag Stuttgart · New York.)

This brief review traces the evolution of hospitals from their origins to the present.

Enlargements of the thyroid gland known as goiters appear in artworks and artifacts of many cultures. They are represented in sculptures, bas-reliefs, masks, waxes, mosaics, bronzes, stained glass windows, paintings and drawings of the last two millennia. These are described in several monographs and in Merke's scholarly History and Iconography of Endemic Goitre and Cretinism (Barbieri 1993, Gianpalmo and Fulcheri 1988, Gianpalmo 1992, Medvei 1982, Merke 1984). Most numerous among these works are the portrayals of goiters in paintings and drawings of the Renaissance. This essay lists eleven additional Renaissance artworks in which goiters are represented, as well as reviewing reasons for this occurrence and examines the unusual case of Piero della Francesca.

Objective: Isoflurane is a suitable agent to produce sedation in the intensive care unit (ICU). However, data concerning occupational exposure to isoflurane during long-term sedation are not yet available. The purpose of this study was to evaluate occupational exposure to isoflurane in the ICU., Design: Trace concentrations of isoflurane were measured directly by means of photoacustic infrared spectrometry during isoflurane sedation in ten cases over a period of 24 hours. Values were obtained at four personnel-related and two leakage-related locations in an ICU chamber., Results: All measured values were low, the majority under 3 ppm isoflurane at the personnel-related points. Peak concentrations up to 40 ppm were recorded for several minutes during nursing interventions. At measurement point "nearby patient's mouth" values up to 5 ppm were recorded, at location "anaesthesia machine" values ranged from 2 to 69 ppm isoflurane., Conclusion: We conclude that an effective high flow scavenging system, a low-leakage anaesthesia machine and an airconditioning equipment without recirculation could keep occupational exposure low. The majority of the measured values was below the NIOSH recommendation (2 ppm). All values was lower than a national state recommendation (10 ppm). Under other circumstances (e.g. without scavenging system) air pollution will be higher and therefore measurements at the working place are needed.