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The DNRfK (German Network for Tobacco-Free Hospitals & Health-Care Services) is based on the Code of the ENSH-Global Network for Tobacco-Free Health-Care Services. To evaluate the project, a total survey of network members using an online questionnaire (78 items) was carried out (n=181; 67.4% response rate). At the time of the recording period, 17% achieved the silver level of certification, 43% the bronze level and 40% had not been certified. Various smoking cessation methods are offered (motivational interviewing, 47%; brief interventions, 45%; individual counselling, 45%). Smokers received pharmacological support in 63% of the hospitals. Smoking cessation services are mainly carried out by physicians (63%), nursing staff (51%) and psychologists (51%). Guideline-oriented smoking cessation is offered by 36% of participants (69% silver level, 33% bronze level, and 32% in clinics without certification). The Code has been widely accepted and, consequently, well implemented by members. The quality of the tobacco control measures and evidence-based smoking cessation treatments increases with duration of membership and certification level or is validated through this. Some deficiencies were found with respect to training-the-trainer qualifications and follow-up measurements., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background and Objective: The prevalence of difficult or prolonged weaning from mechanical ventilation is increasing because of a growing number of elderly patients with multiple diseases and pulmonary problems requiring mechanical ventilation. Intensive care units (ICU) are inclined to refer to specialized unit those patients who are difficult to wean. A nationwide survey of German facilities was conducted and this article reports the current state of weaning centers staffed by chest physicians., Patients and Methods: 38 centers participated in the survey, which was divided into 10 items, covering characteristics of the hospital, weaning strategies, patients and outcomes during 2006. The survey included 2718 patients in whom weaning was difficult or prolonged. Almost three quarters of patients were transferred to one of the weaning centers from the ICU of another hospital., Results: The weaning success rate was 66.4%. In 31,9 % of patients home mechanical ventilation was started after they had been weaned. The overall hospital mortality rate was 20.8%. There were major differences between individual centres concerning the number of patients, organization of the weaning unit and weaning strategies., Conclusions: Weaning was successful in two thirds of patients who had been on prolonged mechanical ventilation and had then been transferred to weaning facilities staffed by chest physicians. These centres effectively improved the quality of care of patients on prolonged mechanical ventilation by avoiding long-term invasive ventilation and sparing cost-intensive ICU resources. The problems that still exist may be overcome by a network of weaning facilities.

When the sanatorium "Heidehaus" was founded on June 1, 1907 in the northern countryside of Hannover with Dr. Otto Ziegler as head about 120 beds for patients with tuberculosis were available. By 1914 about 200 patients were being treated by 4 physicians and 10 nurses. An operating theatre and a modern radiology unit were added in 1927. Shortly after the 2nd World War 400 patients with tuberculosis were hospitalised simultaneously. With the introduction of antituberculous triple drug treatment the number of patients dropped significantly. During this period many traditional facilities, used to care for patients with tuberculosis lost their financial basis and closed. However in the 1960s Prof. Schindler, the head of Heidehaus, widened the spectrum of the hospital into a modern chest hospital, focused on lung and airway diseases. In particular in the 1980s and 1990s this trend continued and 2 independent departments, i. e., pneumology and thoracic surgery were founded. In 2005 due to restructuring by the community of Hannover the "Heidehaus" moved completely and merged with another traditional hospital to become the new "Oststadt-Heidehaus". In its new surroundings both departments for pulmonary medicine and thoracic surgery offer a broad spectrum of modern thoracic medicine in cooperation with other disciplines.

23% of a nonselected group of patients showed wedge shaped defects (9-10 of them per person). The number of teeth with these cervical erosions increases with age. Small accumulation of plaque was found. 65% of the patients with wedge shaped defects had parafunctions and 70% had a chronic pain. A complex of causes underlies the wedge shaped defects. A causal relation appears to exist between wedge shaped defects, occlusal disharmony, parafunctions and strong psychological tension of patients.

The effects of the oxygen radical generating system hypoxanthine (HX)/xanthine oxidase (XO) on the [3 H]--dopamine uptake, the TBARS- and thiol content in striatal synaptosomes of adult rats were examined. Preincubation of synaptosomes with 20 mU XO/0.25 mM HX diminished the dopamine uptake and oxidized thiol groups of synaptosomes. Under these conditions no increase of TBARS, an indicator of lipid peroxidation, was observed. We concluded that in the used hypoxia model free radical mediated damage does not occur.