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Surgical cap attire plays an important role in creating a safe and sterile environment in procedural suites, thus the choice of reusable versus disposable caps has become an issue of much debate. Given the lack of evidence for differences in surgical site infection (SSI) risk between the two, selecting the cap option with a lower carbon footprint may reduce the environmental impact of surgical procedures. However, many institutions continue to recommend the use of disposable bouffant caps. ISO-14044 guidelines were used to complete a process-based life cycle assessment to compare the environmental impact of disposable bouffant caps and reusable cotton caps, specifically focusing on CO 2 equivalent (CO 2 e) emissions, water use and health impacts. Reusable cotton caps reduced CO 2 e emissions by 79% when compared to disposable bouffant caps (10 kg versus 49 kg CO 2 e) under the base model scenario with a similar reduction seen in disability-adjusted life years. However, cotton caps were found to be more water intensive than bouffant caps (67.56 L versus 12.66 L) with the majority of water use secondary to production or manufacturing. Reusable cotton caps have lower total lifetime CO 2 e emissions compared to disposable bouffant caps across multiple use scenarios. Given the lack of evidence suggesting a superior choice for surgical site infection prevention, guidelines should recommend reusable cotton caps to reduce the environmental impact of surgical procedures. • Disposable surgical cap use is more carbon-intensive than reusable cap use. • Reusable surgical cap use has fewer impacts on population health. • Life cycle assessments have a place in value-based surgical care. [ABSTRACT FROM AUTHOR]

To conduct a comparative cost analysis between single-use and reusable cystoscopes from a national healthcare system perspective and assess the environmental footprint. Single-center micro-cost analysis of reusable vs single-use cystoscopes used institutional data. The cost breakdown included capital, reprocessing, repair, procedure, and environmental impact expenses. Data collection occurred in 2022, utilizing registered data, observations, and expert opinions. Depreciation was applied over 5 years for reusable cystoscopes and 8 years for the automated endoscope reprocessor. Deterministic sensitivity analyses gauged result robustness to input variations. Lastly, an assessment of the environmental footprint, focusing on water consumption and waste generation, was conducted. Per-procedure cost associated with reusable cystoscopes was €332.46 vs €220.19 associated with single-use, resulting in savings of €112.27. When projecting these costs per procedure with the number of procedures performed in 2022 (1186), comparing the costs of procedures performed in 1 year with reusable endoscopes (€394,295.86) to the costs of the exact number of procedures performed with disposable endoscopes (€261,149.37), a saving of €133,146.49 could be achieved. Additionally, after continuous use of single-use endoscopes, procedures were scheduled every 20 minutes instead of every 30 minutes. This adjustment allowed for 15 daily procedures instead of 10 while maintaining the same shift. This suggests potential advantages in terms of improved organizational impact and reduced waiting lists. Ultimately, the decreased environmental impact favored the adoption of single-use cystoscopes. Our study presents an opportunity for organizational development in response to the evolving external environment, considering user needs, market dynamics, and competition with other facilities. [ABSTRACT FROM AUTHOR]

Background and Aims: In response to documented duodenoscope-related infectious outbreaks of multidrug-resistant organisms, the Food and Drug Administration has recommended a transition to duodenoscopes with innovative designs, including duodenoscopes with disposable components or fully disposable duodenoscopes. We aim to characterize the learning curve (LC) for a single-use disposable duodenoscope. Methods: We performed a retrospective analysis of a prospectively collected database from 31 patients who underwent ERCP by a single, experienced operator using the EXALT Model D® (Boston Scientific, Marlborough) disposable duodenoscope at a single tertiary referral center. The LC for this device was described by the number of cases needed to achieve proficiency using cumulative sum (CUSUM) analysis. Number of attempts to cannulate and time to cannulate the desired duct were assessed as separate endpoints. The overall mean number of attempts and overall mean time to cannulation were used as the target values in the respective CUSUM analyses. Proficiency was defined as the number of procedures where an inflection point was reached in the CUSUM graph. This observation indicates improving operator performance as shown by a decrease in the number of attempts and shortening of cannulation time after the defined number of procedures. Results: Overall, 31 patients underwent ERCP using the EXALT Model D disposable duodenoscope by a single experienced endoscopist. 6 (19%) patients had a native papilla and the majority of these procedures were classified as ASGE complexity level 2 or above. The procedure was completed using solely the disposable duodenoscope in 27 patients (87%), while a reusable duodenoscope was required for procedure completion in 4 patients (13%). The cross-overs were distributed evenly across the performance period. Procedure-related adverse events included: post-ERCP pancreatitis (3%), bleeding (3%) and no perforations. In the analyses of both endpoints, an inflection of the CUSUM curves is achieved at 10 cases, indicating sustained reduction of cannulation attempts and time to cannulation. Conclusion: Among experienced pancreaticobiliary endoscopists, approximately 10 ERCPs is the threshold whereby procedure-related factors including cannulation success and procedural time improves. Procedure-related adverse events are consistent with those expected with reusable duodenoscopes. The need to cross-over from single-use duodenoscope to reusable duodenoscope did not appear to be related to the learning curve, as they were evenly distributed across the study period. These results can be used to guide adoption of single-use duodenoscopes into clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Disposable duodenoscopes and duodenoscopes with disposable endcaps are being used in clinical practice to reduce or eliminate the risk of transmitting infections. The study aim was to assess perceptions and experiences regarding the use of these duodenoscopes among advanced endoscopy fellows in a nationally representative sample. Methods: A 17-item electronic survey was sent to 74 advanced endoscopy training programs. The survey was completed by 50 participants and their responses were included for analysis. Results: Most participants were from academic training programs (82.7%) and identified as being in their 7th year of post graduate training (92%; PGY-7). Participants performed an average of 414 ERCPs. 29% reported difficulty with cannulation using disposable duodenoscopes versus 15.7% with duodenoscopes with disposable endcaps (vs. standard duodenoscope). 96% of trainees perceived disposable duodenoscopes as not cost effective and 92% stated they would not use this device during independent practice. 100% of trainees stated that they would use duodenoscopes with disposable endcaps during independent practice. For their most challenging cases, 90% of trainees preferred using standard reprocessable duodenoscopes while no trainee indicated they would prefer using a disposable duodenoscope in this scenario. 82% of participants stated that disposable duodenoscopes and disposable endcaps should be used exclusively or preferentially for high-risk patients citing cost, functionality, and concerns regarding environmental impact. Discussion: Advanced endoscopy fellows perceive disposable duodenoscopes as impacting technical maneuverability. Concerns about functionality, cost effectiveness and environmental impact are barriers to adoption. [ABSTRACT FROM AUTHOR]

Background: Climate change is the greatest threat to human health. Cardiothoracic patients suffer direct consequences from poor environmental health and we have a vested interest to address this in our practice. As leaders of complex high‐end surgery, we are uniquely positioned to effect practical and immediate changes to significantly pare down emissions within the operating theatre, outside the operating theatre and beyond the confines of the hospital. Methods: We aim to spotlight this pressing issue, take stock of our current efforts, and encourage fellow specialists to drive this agenda. Results: Sustainability in healthcare needs to be formalized as part of the core curriculum in surgical training and awareness generated via carbon audits and life cycle analyses. Practical actions such as reducing unnecessary equipment usage, choosing reusable equipment over single use disposables, judicious use of investigations rooted in clinical reasoning and sharing of resources across services and health systems help reduce the carbon output of our specialty. Conclusion: The 'Triple Bottom Line' serves as a good template to calibrate efforts that balance quality against environmental costs. More can be done to advocate for and find solutions for sustainable healthcare with cardiothoracic surgery. [ABSTRACT FROM AUTHOR]

Introduction: Video laryngoscope (VL) technology improves first‐pass success. The novel i‐view VL device is inexpensive and disposable. We sought to determine the first‐pass intubation success with the i‐view VL device versus the standard reusable VL systems in routine use at each site. Methods: We performed a prospective, pragmatic study at two major emergency departments (EDs) when VL was used. We rotated i‐view versus reusable VL as the preferred device of the month based on an a priori schedule. An investigator‐initiated interim analysis was performed. Our primary outcome was a first‐pass success with a non‐inferiority margin of 10% based on the per‐protocol analysis. Results: There were 93 intubations using the reusable VL devices and 81 intubations using the i‐view. Our study was stopped early due to futility in reaching our predetermined non‐inferiority margin. Operator and patient characteristics were similar between the two groups. The first‐pass success rate for the i‐view group was 69.1% compared to 84.3% for the reusable VL group. A non‐inferiority analysis indicated that the difference (−15.1%) and corresponding 90% confidence limits (−25.3% to −5.0%) did not fall within the predetermined 10% non‐inferiority margin. Conclusions: The i‐view device failed to meet our predetermined non‐inferiority margin when compared to the reusable VL systems with the study stopping early due to futility. Significant crossover occurred at the discretion of the intubating operator during the i‐view month. [ABSTRACT FROM AUTHOR]

A laboratory-based lateral flow (LF) test that utilizes up-converting reporter particles (UCP) for ultrasensitive quantification of Schistosoma circulating anodic antigen (CAA) in urine is a well-accepted test to identify active infection. However, this UCP-LF CAA test requires sample pre-treatment steps not compatible with field applications. Flow, a new low-cost disposable, allows integration of large-volume pre-concentration of urine analytes and LF detection into a single field-deployable device. We assessed a prototype Flow-Schistosoma (Flow-S) device with an integrated UCP-LF CAA test strip, omitting all laboratory-based steps, to enable diagnosis of active Schistosoma infection in the field using urine. Flow-S is designed for large-volume (5–20 mL) urine, applying passive paper-based filtration and antibody-based CAA concentration. Samples tested for schistosome infection were collected from women of reproductive age living in a Tanzania region where S. haematobium infection is endemic. Fifteen negative and fifteen positive urine samples, selected based on CAA levels quantified in paired serum, were analyzed with the prototype Flow-S. The current Flow-S prototype, with an analytical lower detection limit of 1 pg CAA/mL, produced results correlated with the laboratory-based UCP-LF CAA test. Urine precipitates occurred in frozen banked samples and affected accurate quantification; however, this should not occur in fresh urine. Based on the findings of this study, Flow-S appears suitable to replace the urine pre-treatment required for the laboratory-based UCP-LF CAA test, thus allowing true field-based applications with fresh urine samples. The urine precipitates observed with frozen samples, though less important given the goal of testing fresh urines, warrant additional investigation to evaluate methods for mitigation. Flow-S devices permit testing of pooled urine samples with applications for population stratified testing. A field test with fresh urine samples, a further optimized Flow-S device, and larger statistical power has been scheduled. [ABSTRACT FROM AUTHOR]

The Medical Device Regulation 2017/745 (MDR) enables the development of a wide range of innovative products. With respect to Directive 93/42, the MDR explicitly identifies the so-called "medical devices made of substances" (MDMS) through specific requirements. In addition, the MDR expands the definition of medical device (MD) by including the "modification of a physiological or pathological state" as a medical purpose specific to devices. This clarifies that materials interacting with the human body in such a way as to modify its "state" are medical devices. Natural materials, such as vegetal matrices, are characterized by the presence of both functional and structural interactions between their components; they can thus be described as "network/s" and interact with the human body in a coordinated, complex way. Since the "state" of the human body is a network of biological functions, the "network/s over a network" interaction between the naturalmaterial and the human body is likely to modify the "state" of the human body. Thus, therapeutic products consisting of natural materials, such as vegetal matrices, seem to fit perfectly into the definition of a medical device. Here we analyze the main characteristics of medicinal products, of medical devices made of substances and of medical devices consisting of natural materials. We see that medicinal products and medical devices made of substances have the common characteristic of being based on substances, either synthetic or derivatives of natural materials, but differ in their mechanism of action. On the other hand, medical devices constituted of natural materials relate to the general category of medical devices and cannot be characterized by any single component, identified as an active component. We also discuss how these characteristics relate to the mechanism of action of each type of product. This analysis should allow to identify the most appropriate path for each product, a necessary step to promote research and development of innovative therapies for a large number of unmet medical needs. [ABSTRACT FROM AUTHOR]

The article focuses on the environmental impact of orthopaedic surgery and emphasizes the need for sustainable practices in the operating room. Topics discussed include the large carbon footprint of surgical procedures, the primary sources of greenhouse gas emissions in operating rooms, and strategies for reducing energy consumption and waste generation.

Introduction Epoxy-based resin formulations are a frequent cause of allergic and irritant contact dermatitis in the construction and painting industries. Cases of epoxy resin contact dermatitis continue to persist across many sectors and are likely attributable to the growing use of epoxy products, including epoxy-based anti-corrosion coatings and inadequate skin protection. There are no published performance data against epoxy resins for garment materials and gloves to guide proper material selection in the workplace. Objectives The objective of this study was to evaluate the resistance of 5 protective garment materials against permeation and penetration by bisphenol A diglycidyl ether and its higher oligomers found commonly in epoxy-based anti-corrosion coatings. Methods Five disposable garment materials were evaluated for resistance to bisphenol A diglycidyl ether monomers and oligomers during contact with epoxy-based anti-corrosion coatings, including latex gloves, nitrile gloves, Tyvek coveralls, polypropylene/polyethylene (PP/PE) coveralls, and a cotton T-shirt. A permeation test cell system was used to evaluate each garment material against an epoxy-based zinc-rich primer and an epoxy-based intermediate coating using a realistic application method. Glass fiber filters were used to collect permeating and penetrating epoxy resin during a 120-min test period. Bisphenol A diglycidyl ether quantification was performed with high-performance liquid chromatography–electrospray ionization-tandem mass spectrometry. Paint loading, coating thickness, and homogeneity were assessed on polytetrafluoroethylene filters sprayed in series in permeation test cells. Results Latex gloves provided the least resistance to permeation by BADGE in coating formulations, with a maximum cumulative permeation over the 2-h test interval of 21.7 ng cm−2 with the primer and 513.8 ng cm−2 with the intermediate coating product. Nitrile gloves were not permeated by either coating formulation. The Tyvek coveralls provided greater protection as compared to the PP/PE coveralls. The cotton T-shirt was penetrated by bisphenol A diglycidyl ether more frequently than any of the tested garment materials and resulted in a maximum cumulative penetration of 128 ng cm−2 with the primer and 28.0 ng cm−2 with the intermediate coating. Conclusion Although all the garment materials evaluated during this study provided sufficient protection to prevent cumulative permeation in excess of the established acceptable permeation thresholds, the use of nitrile gloves and Tyvek coverall is highly recommended to minimize skin exposure to bisphenol A diglycidyl ether. We recommend cotton T-shirts to be used under Tyvek coveralls as a secondary layer of skin protection and for added comfort, but not as a primary protection layer. [ABSTRACT FROM AUTHOR]

Fogging and staining of a laparoscope lens negatively impact surgical visualization. We hypothesized that the disposable hot pack could not only warm but also clean laparoscopes. Hence, this study verified and developed the disposable hot pack with anti-fogging and cleaning function. The laparoscope was inserted into a swine abdominal cavity for five minutes. Then, the laparoscopic tip was heated with 65 °C saline or the folded disposable hot pack with nonwoven fabric coated surfactant for ten seconds (n = 15). Also, a laparoscopic tip with dirt was wiped with the prototype or conventional gauze for 10 s (n = 10). The dirt, fogging, and temperature of the laparoscopic tip were respectively evaluated after the laparoscope was inserted into the abdominal cavity. The laparoscopic tip temperature five minutes after insertion into the abdominal cavity was similar (31.1 °C vs 31.2 °C, p = 0.748) and there was no fogging in both methods. The conventional gauze had significantly less temperature of the laparoscopic tip after cleaning and higher fogging occurrence than the prototype (29.5 °C vs 34.0 °C, p < 0.001, 30% vs 0%, p = 0.030, respectively), although there was no dirt left after both methods. The disposable hot pack has a strong potential as an anti-fogging and cleaning device for use during laparoscopic surgery. [ABSTRACT FROM AUTHOR]

The article identifies deceptive terms and proposes potential terminologies to better convey the risk of nicotine addiction and its consequence for health. Topics discussed include response of transnational tobacco corporations to a steady decline in cigarette sales, tobacco industry reduced-harm marketing slogans and suggested alternative descriptors, and recommendations.

Background and objectives: Disposable electronic cigarettes (e-cigarettes) are widely used by adolescents and young adults (AYAs). Whether using disposable devices is associated with future e-cigarette use patterns is unknown but important for informing e-cigarette regulation. Methods: Prospective longitudinal study combining data from adolescent (14-17 years) and young adult (21-24 years) cohorts from Southern California surveyed at baseline and approximately 8-month follow-up during 2021 to 2022. The analyses included AYAs who used e-cigarettes in the past 30 days at baseline and had exposure and outcome data (N = 403; adolescent n = 124, young adult n = 279). Results: In the pooled sample of AYAs who used e-cigarettes at baseline (57.2% cis-gender female, 56.2% Hispanic), 278 (69.0%) reported past 30-day disposable e-cigarette use, and 125 (31.0%) used only nondisposable e-cigarettes. Baseline use of disposable (versus only nondisposable) devices was associated with higher odds of continued e-cigarette use (adjusted odds ratio = 1.92; 95% confidence interval = 1.09-3.42) and a greater number of times used e-cigarettes per day at follow-up (adjusted incidence rate ratio = 1.29; 95% confidence interval = 1.02-1.63). In supplemental analyses, disposable e-cigarette use was associated with greater odds of no changes (versus reductions) in e-cigarette use frequency and puffs per episode from baseline to follow-up but was not associated with increases in use frequency and intensity. No differences in e-cigarette use outcomes were found between those with poly-device (disposable and nondisposable) versus only disposable device use. Conclusions: Use of disposable e-cigarette devices among AYAs may be associated with higher risks for persistent e-cigarette use patterns, which should be considered in tobacco product regulation designed to protect AYAs. [ABSTRACT FROM AUTHOR]

Background: Unsafe injection practices pose significant risks to both patients and healthcare providers, constituting a critical issue in global healthcare ensuring the safety and appropriateness of injection practices is imperative. Aim & Objective: This study aimed to comprehensively assess the safety of injection practices across various healthcare facilities. Methodology: A Descriptive survey was conducted during March to December-2021. Non random Purposive sampling technique was adopted to select health care facilities. Total 26 healthcare facilities were selected from Government & private sectors. The study areas were OPDs and indoor wards. An observational checklist used to collect data. Data analysis was done using SPSS-28. Results: A comprehensive assessment revealed commendable adherence to injection safety practices. No deficiencies were found in the availability of resources and materials necessary for injection practices in hospitals. However, certain areas for improvement were identified. Interestingly, the practice of using a fresh pair of gloves for injections was unnoticed in 33% of government facilities and 45% of private facilities, suggesting a possible lapse in infection control protocols. Conclusion: While the healthcare facilities of Surat exhibit commendable adherences to certain aspects of injection safety, there remain opportunities for enhancement. Addressing implementing regular training programs for healthcare providers are crucial steps toward optimizing injection safety practices and ensuring the well-being of both patients and providers. [ABSTRACT FROM AUTHOR]

Glucose is an important biomarker for diagnosing and prognosing various diseases, including diabetes and hypoglycemia, which can have severe side effects, symptoms, and even lead to death in patients. As a result, there is a need for quick and economical glucose level measurements to help identify those at potential risk. With the increase in smartphone users, portable smartphone glucose sensors are becoming popular. In this paper, we present a disposable microfluidic glucose sensor that accurately and rapidly quantifies glucose levels in human urine using a combination of colorimetric analysis and computer vision. This glucose sensor implements a disposable microfluidic device based on medical-grade tapes and glucose analysis strips on a glass slide integrated with a custom-made polydimethylsiloxane (PDMS) micropump that accelerates capillary flow, making it economical, convenient, rapid, and equipment-free. After absorbing the target solution, the disposable device is slid into the 3D-printed main chassis and illuminated exclusively with Light Emitting Diode (LED) illumination, which is pivotal to color-sensitive experiments. After collecting images, the images are imported into the algorithm to measure the glucose levels using computer vision and average RGB values measurements. This article illustrates the impressive accuracy and consistency of the glucose sensor in quantifying glucose in sucrose water. This is evidenced by the close agreement between the computer vision method used by the sensor and the traditional method of measuring in the biology field, as well as the small variation observed between different sensor performances. The exponential regression curve used in the study further confirms the strong relationship between glucose concentrations and average RGB values, with an R-square value of 0.997 indicating a high degree of correlation between these variables. The article also emphasizes the potential transferability of the solution described to other types of assays and smartphone-based sensors. [ABSTRACT FROM AUTHOR]

Recent studies have shown that astronauts experience altered immune response behavior during spaceflight, resulting in heightened susceptibility to illness. Resources and resupply shuttles will become scarcer with longer duration spaceflight, limiting access to potentially necessary medical treatment and facilities. Thus, there is a need for preventative health countermeasures that can exploit in situ resource utilization technologies during spaceflight, such as additive manufacturing (i.e., 3D printing). The purpose of the current study was to test and validate recyclable antimicrobial materials compatible with additive manufacturing. Antimicrobial poly(lactic acid)- and polyurethane-based materials compatible with 3D printing were assessed for antimicrobial, mechanical, and chemical characteristics before and after one closed-loop recycling cycle. Our results show high biocidal efficacy (>90%) of both poly(lactic acid) and polyurethane materials while retaining efficacy post recycling, except for recycled-state polyurethane which dropped from 98.91% to 0% efficacy post 1-year accelerated aging. Significant differences in tensile and compression characteristics were observed post recycling, although no significant changes to functional chemical groups were found. Proof-of-concept medical devices developed show the potential for the on-demand manufacturing and recyclability of typically single-use medical devices using antimicrobial materials that could serve as preventative health countermeasures for immunocompromised populations, such as astronauts during spaceflight. [ABSTRACT FROM AUTHOR]

Patients benefit from the use of check valves when drugs with a particularly short half-life (e.g., catecholamines) are continually administered through a one-way valve or when an accidental retrograde bolus application must be prevented, as in the event of a rapid sequence induction and intubation. The lack of a check valve can prevent the administered drug from working in the intended manner resulting in potentially insufficient treatment and negative consequences for the patient. In order to ensure the highest level of patient safety while using check valves appropriate training of medical personnel is essential. In contrast, preventable dangers (e.g., infections, awareness) exist when safety measures are disregarded, including the re-use of medications, syringes or disposable materials in successive patients after having only exchanged the check valves. It is not clear how often this is practiced in German-speaking areas. [ABSTRACT FROM AUTHOR]

The UK government is consulting on banning disposable e-cigarettes. This study aimed to describe trends in disposable e-cigarette use among adults in Great Britain since 2021 and establish who would currently be affected by a ban on disposables. Nationally-representative monthly cross-sectional survey. We analysed data from 69,973 adults surveyed between January 2021 and August 2023. We estimated monthly time trends in the weighted prevalence of current disposable e-cigarette use among adults and by sociodemographic characteristics and smoking status. From January 2021 to August 2023, the prevalence of disposable e-cigarette use grew from 0.1 % to 4.9 %. This rise was observed across all population subgroups but was most pronounced among younger adults (e.g. reaching 15.9 % of 18-year-olds compared with 1.3 % of 65-year-olds), those who currently smoke (16.3 %), and those who stopped smoking in the past year (18.2 %). Use among never smokers remained relatively rare (1.5 %), except among 18- to 24-year-olds (7.1 %). Use was significantly higher in England than Wales or Scotland (5.3 % vs. 2.0 % and 2.8 %) and among less (vs. more) advantaged social grades (6.1 % vs. 4.0 %), those with (vs. without) children (6.4 % vs. 4.4 %), and those with (vs. without) a history of mental health conditions (9.3 % vs. 3.1 %). A ban on disposable e-cigarettes would currently affect one in 20 adults in Great Britain (approximately 2.6 million people). The proportion who would be affected would be greatest among young people, including the 316,000 18-24 year-olds who currently use disposables but who have never regularly smoked tobacco, which may discourage uptake of vaping in this group. However, a ban would also affect 1.2 million people who currently smoke and a further 744,000 who previously smoked. It would also have a disproportionate impact on disadvantaged groups that have higher rates of smoking and typically find it harder to quit. [ABSTRACT FROM AUTHOR]

Background: Marketing and sales of e-cigarettes are unregulated in Malaysia. We analyzed content displayed on e-cigarette retailer websites to identify marketing claims, promotional strategies, and product details in the year 2022. Methods: We analyzed 30 Malaysia-based retailer websites using a mixed methods approach. Data were extracted as the frequency of occurrences of marketing claims, presence of regulatory information, product types, and flavors of e-juice as per a predefined codebook based on published literature. We also extracted textual details published on the websites about marketing claims, and slogans. Results: Most retailer websites provided contact information and physical store addresses (83%) but only half had 'click through' age verification (57%) that seldom needed any identification proof for age (3%). Marketing claims were related to health (47%), smoking cessation (37%), and modernity/trend (37%) and none had health warnings. Promotional strategies were discounts (80%). starter kits (57%) and email subscriptions (53%). Product types displayed were rechargeable (97%) and disposable (87%) devices and e-liquids (90%) of an array of flavors (> 100). Nicotine presence, its concentration, and "nicotine is an addictive chemical" were displayed in 93%, 53%, and 23% of websites respectively. Conclusion: Surveillance of content displayed online on e-cigarette retailer websites and regulation of online marketing and sales should be implemented by the Ministry of Health, Malaysia. Such measures are needed to prevent access to, and initiation of e-cigarette use among the youth and adults who do not smoke. [ABSTRACT FROM AUTHOR]

FebriDx is a rapid point-of-care test combining qualitative measurements of C-reactive protein (CRP) and Myxovirus Resistance Protein A (MxA) using a disposable test device to detect and differentiate acute bacterial from viral respiratory tract infections. The goal of this study was to investigate the diagnostic accuracy of FebriDx in patients with suspected respiratory tract infections in the emergency department (ED). This was an observational cohort study, performed in the ED of an academic hospital. Patients were included if they had a suspected infection. The primary outcome was the presence of a bacterial or viral infection, determined by clinical adjudication by an expert panel. The sensitivity, specificity, and positive and negative predictive value of FebriDx for the presence of bacterial versus non-bacterial infections, and viral versus non-viral infections were calculated. Between March 2019 and November 2020, 244 patients were included. A bacterial infection was present in 41%, viral infection was present in 24%, and 4% of the patients had both viral and bacterial pathogens. FebriDx demonstrated high sensitivity in the detection of bacterial infection (87%), high NPV (91%) to rule out bacterial infection, and high specificity (94%) for viral infection in patients with a suspected infection in the ED. [ABSTRACT FROM AUTHOR]

Context: Surgical site infections (SSI) continue to be a major cause of morbidity, mortality, prolonged hospital stays and a major reason of financial burden to health-care providers and patients after major abdominal surgeries. Along with infection control practices and care bundles, additional use of devices which protect the wound from contamination is believed to decrease the burden of SSI. Aims: This study aims to assess the benefit of single-ring disposable wound protector in preventing SSI, overall complications, hospitals stay and morbidity data in laparoscopic colorectal resection. Settings and Design: The study design involves case--control study, retrospective. Subjects and Methods: A case--control study comparing single ring oval wound protector versus conventional wound protectors retrospectively between August 2019 and December 2021. The ease of use of the device, rate of SSI, overall complications, hospitals stay and morbidity data were analysed. Statistical Analysis Used: The statistical analysis was performed by IBM SPSS Statistics 20 version. All Categorical Variables will be described as frequency and percentage. Continuous variables will be described as mean ± standard deviation. Continuous variables were analysed using t-test and categorical parameters using Fisher's exact test. Results: Of the 110 patients studied, wound Protecting devices were used in 58 patients Wound Protector Group (WPG group) and 62 patients did not use such devices (no WPG). The groups were comparable in demographic features, risk features, systemic illness, type of surgeries undertaken and the specimen extraction wound used. There was a significant decrease in the incidence of SSI (1.7% vs. 16% P ≤ 0.008) and the hospital stay (P ≤ 0.03) when WPG was used compared to the group in which it was not used. Conclusions: Apart from the use of infection control practices and care bundles, the use of oval-shaped single-ring wound protector is likely to reduce SSI. [ABSTRACT FROM AUTHOR]

Spinal endoscopy has evolved significantly since its inception, offering minimally invasive solutions for various spinal pathologies. This study introduces a promising innovation in spinal endoscopy—a single-use digital endoscope designed to overcome the drawbacks of traditional optic endoscopes. Traditional endoscopes, despite their utility, present challenges such as fragility, complex disinfection processes, weight issues, and susceptibility to mechanical malfunctions. The digital endoscope, with its disposable nature, lighter weight, and improved image quality, aims to enhance surgical procedures and patient safety. The digital endoscope system comprises a 30-degree 1000 × 1000 pixel resolution camera sensor with a 4.3 mm working channel, and LED light sources replacing optical fibers. The all-in-one touch screen tablet serves as the host computer, providing portability and simplified operation. Image comparisons between the digital and optic endoscopes revealed advantages in the form of increased field of view, lesser distortion, greater close-range resolution, and enhanced luminance. The single-use digital endoscope demonstrates great potential for revolutionizing spine endoscopic surgeries, offering convenience, safety, and superior imaging capabilities compared to traditional optic endoscopes. [ABSTRACT FROM AUTHOR]

Introduction: Single-use medical devices (SUDs) are labeled for single use only, but rising health care costs along with the absence of visible deterioration in the quality of SUDs after one use have led to their reprocessing and reuse. In the past, SUDs mainly consisted of equipment such as guidewires and catheters. However, SUDs have now expanded to flexible endoscopes and energy devices that are much more expensive. Reuse of such devices raises concerns of infection transmission, safety, and lack of effectiveness. We reviewed the disinfection process, cost benefits, potential harms, and legal status of the reuse of SUDs in endourology. Materials and Methods: PUBMED, Embase, and the Cochrane Library databases were searched for articles published between 1970 and March 2023 that reported the reuse of SUDs using the search terms "reuse"; "single-use device"; "disposable medical devices"; "reprocessing of single-use device"; "endourology"; and keywords related to cost, safety, sterilization, and legal status. Online resources were found using Google search engines. Articles on cost savings, device malfunction, disinfection, or legal status in different countries were reviewed. Results and Conclusions: Reusing SUDs has financial, environmental, and practical advantages. The potential savings on medical expenses is the most compelling argument for reprocessing disposable devices. Reusing medical equipment also contributes to the reduction of toxic biodegradable waste. However, there is a scarcity of data on the safety and efficacy of reused SUDs. For patient safety and to avoid complications, the practice must be regulated with established reprocessing standards. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of frenulum protection technique of the disposable circumcision suture device (DCSD) in adult males. Materials and Methods: Atotal of 53 adult males were diagnosed with redundant prepuce and underwent circum- cision with DCSD using frenulum protection technique. The main preoperative and postoperative measure of the length of penile frenulum was evaluated. Other data such as edema rate, intraoperative blood loss, operation time, postoperative pain, staple falling off time, incision infection rate, and evaluation of satisfaction rate with penis appearance were documented in the study. Results: There was no significant difference in preoperative and postoperative frenulum length for each patient. The mean length of the penile frenulum before and after surgery was 2.25 ± 0.36 cm and 2.23 ± 0.39 cm, respectively (p = .31). The rate of frenulum length preservation was 100%. All the patients had no excessive resection of the frenulum and no serious complication happened after surgery. The satisfaction rate of postoperative penis appearance from patients’ evaluation was 98.1% (52/53). Conclusion: The frenulum protection technique was simple and operable, which could help the operator to accu- rately identify the most distal position of the frenulum and retain a sufficient length of frenulum during DCSD circumcision. [ABSTRACT FROM AUTHOR]

The article focuses on the utility of vulcanization accelerator-free nitrile rubber gloves (M-GEN2 [type B]), discussing their development, durability, chemical resistance, and a study evaluating their effectiveness in reducing hand eczema among individuals in various occupations. It showcases significant improvement in hand eczema severity after using M-GEN2 (type B) gloves, indicating high glove tolerance and potential benefits for individuals with hand eczema in occupational settings.

Introduction Airway compromise is the second leading cause of potentially preventable prehospital combat death. Endotracheal intubation (ETI) remains the most common role 1 airway intervention. Video laryngoscopy (VL) is superior to direct laryngoscopy (DL) for first-attempt intubation, especially in less-experienced providers and for trauma patients. The cost has been a major challenge in pushing VL technology far-forward; however, the cost of equipment continues to become more affordable. We conducted a market analysis of VL devices under $10,000 for possible options for role 1. Materials and Methods We searched Google, PubMed, and the Food and Drug Administration database from August 2022 to January 2023 with a combination of several keywords to identify current VL market options under $10,000. After identifying relevant manufacturers, we then reviewed individual manufacturer or distributor websites for pricing data and system specifications. We noted several characteristics regarding VL device design for comparison. These include monitor features, size, modularity, system durability, battery life, and reusability. When necessary, we requested formal price quotes from respective companies. Results We identified 17 VL options under $10,000 available for purchase, 14 of which were priced below $5,000 for individual units. Infium (n  = 3) and Vimed Medical (n  = 4) provided the largest number of unique models. VL options under $10,000 exist in both reusable and disposable modalities. These modalities included separate monitors as well as monitors attached to the VL handle. Disposable options, on a per-unit basis, cost less than reusable options. Conclusions Several VL options exist within our goal price point in both reusable and disposable options. Clinical studies assessing the technology performance of ETI and deliberate downselection are needed to identify the most cost-effective solution for role 1 dispersion. [ABSTRACT FROM AUTHOR]

Background: The removal of ureteral stent can be performed with disposable or reusable flexible cystoscopes, but limited comparative data are available on functionality, risk of infections, and costs. Methods: We performed a multicentric, prospective, observational study on patients undergoing in-office ureteral stent removal with Isiris-α® or a reusable Storz™ flexible cystoscope. Study endpoints were the functionality and effectiveness of the devices, the rate of postoperative bacteriuria and UTIs, and the costs of the procedure. Results: A total of 135 patients were included, 80 (59.2%) treated with reusable cystoscopes and 55 (40.8%) with Isiris-α®. No significant baseline differences between groups were detected. Isiris-α® outperformed the reusable device in terms of quality of vision (p 0.001), manoeuvrability (p 0.001), grasper functionality (p < 0.001), and quality of the procedure (p 0.01). Mean procedure time was shorter with Isiris-α® (p < 0.001) due to a shorter instrument preparation time (p < 0.001). No differences were found in terms of perceived patient pain (p 0.34), nor postoperative bacteriuria or symptomatic UTIs. According to our cost analysis, the in-office procedure performed with Isiris-α® was more expensive (+ 137.8€) but was independent from instrument turnover or disinfection. Among limitations of study we acknowledge the lack of randomization, the use of antibiotic prophylaxis in several patients, and the high rate of missing preoperative urine cultures. Conclusions: Isiris-α® outperforms reusable cystoscopes for in-office ureteral stent removal in terms of total operative time and quality of the procedure, at the cost of being more expensive. No significant differences in postoperative bacteriuria or symptomatic UTIs were found. [ABSTRACT FROM AUTHOR]

INTRODUCTION Electronic nicotine delivery system (ENDS) and liquid characteristics affect nicotine and toxicant exposure and use behaviors. Little is known about how adults who frequently use ENDS transition between ENDS device/liquid groupings. METHODS A total of 379 US adults (≥21 years) using ENDS frequently (≥5 days/ week) self-reported and uploaded photos of their most used ENDS device and liquid in three waves of online surveys (May 2020 -- November 2021). Device/ liquid grouping was defined by device (i.e. disposable/refillable tank/refillable pod or cartridge/disposable pod or cartridge, adjustable/no adjustable settings) and liquid (i.e. salt/freebase) characteristics. Participants using the same grouping across waves were considered stable users. RESULTS The most prevalent wave (W) 1 grouping was tank (freebase, adjustable settings; 36.8%). From W1 to W3, the number of disposable device (salt, no adjustable settings) users increased 156.4% and the number of disposable pod/cartridge (salt, no adjustable settings) users decreased 15.2%. In W2 and W3, compared to stable users, participants using tank (freebase, adjustable settings) in W1 and another grouping in W2 and/or W3 reported significantly higher nicotine concentrations (mg/mL) (W2: 15.1 vs 5.5, p<0.001; W3: 22.9 vs 5.6, p<0.001) and lower device power (watt) (W2: 46.8 vs 58.7, p=0.02; W3: 34.0 vs 57.2, p<0.001). CONCLUSIONS Over a 1.5-year period, a rapid growth in disposable device (salt, no adjustable settings) use and a decrease in disposable pod/cartridge (salt, no adjustable settings) use were observed. Participants who transitioned from tank (freebase, adjustable settings) to other groupings were more likely to increase liquid nicotine concentration and reduce device power compared to stable users. [ABSTRACT FROM AUTHOR]

Laparoscopic common bile duct exploration (LCBDE) remains underutilized in the management of common bile duct (CBD) stones. The exact cause of this under-utilization remains unclear; however, identified barriers to LCBDE implementation include lack of training and unavailability of dedicated instruments. LCBDE is an attractive alternative for stone retrieval in patients with Roux-en-Y gastric bypass given the anatomical difficulty in endoscopic retrograde cholangiopaneatography (ERCP). Direct visualization through choledochoscopy is the method of choice for LCBDE. However, dedicated choledoscopes are expensive and not widely available, which may lead surgeons to seek for alternatives at their particular environment. With the COVID-19 pandemic, disposable bronchoscopes have become widely accessible at our institution, raising the possibility of using one for direct vision of the biliary tract. We present the case of a 61-year-old male with past medical history of Roux-en-Y gastric bypass, who presented to the emergency department with a CBD stone. Successful LCBDE was achieved with the aid of a disposable bronchoscope for direct visualization of the biliary tract. [ABSTRACT FROM AUTHOR]

Introduction The electronic nicotine delivery systems (ENDS) market is highly heterogeneous and changing rapidly in the United States, making classification of devices complicated, especially for surveys. We assessed the percentage of concordant responses between self-reported device type and device type reported by manufacturer/retailer sites for three ENDS brands. Aims and Methods Population Assessment of Tobacco and Health Study wave 5 (2018–2019) asked adult ENDS users about their ENDS device type with the following multiple-choice question: "What kind of electronic nicotine product [is/was] it?" with response options: (1) A disposable device, (2) A device that uses replaceable prefilled cartridges, (3) A device with a tank that you refill with liquids (4) A mod system, and (5) Something else. Participants using only one ENDS device and reporting brands of JUUL (n = 579), Markten (n = 30), or Vuse (n = 47) were included. Responses were dichotomized as "concordant=1" (prefilled cartridge for these three brands) and "discordant = 0" (other responses) to assess the concordance. Results The overall concordance between self-reports and manufacturer/retail sites was 81.8% (n = 537). This percentage was 82.7% (n = 37) among Vuse users, 82.6% (n = 479) among JUUL users, and 69.1% (n = 21) among Markten users. Almost one in three people who use Markten did not indicate that their device uses replaceable prefilled cartridges. Conclusions While at least 70% concordance could be acceptable, collecting more information about device type (eg, liquid container (pod/cartridge/tank), refillability; and submitting pictures) may improve the accuracy of the information. Implications This study is particularly relevant for researchers analyzing smaller samples for example when examining disparities. Monitoring the characteristics of ENDS accurately in population-based studies is critical for regulatory authorities to understand ENDS toxicity, addiction, health effects, and use behaviors at the population level. There is evidence that higher concordance can be achieved with other questions- and methods. Adjusting survey questions about ENDS device type (eg, more descriptive response options, inclusion of separate questions asking about tank, pod, cartridge) and potentially including photos of participants' devices may help to classify ENDS device types more accurately. [ABSTRACT FROM AUTHOR]

Background: As the US healthcare sector contributes to 5–10% of national CO2 emissions, with a substantial contribution from surgical services, a collective effort is important to minimize the climate footprint of surgery. Solid plastic waste generated from single-use items in operating rooms is a major contributor to greenhouse gas emissions. To address this problem, we implemented a pilot study to replace single-use scrub caps with reusable caps. Methods: Ninety-two surgical trainees at the Massachusetts General Hospital, Boston, were provided reusable personalized scrub caps. Over 6 months, their use of the reusable cap was compared with corresponding use of disposable single-use caps. We then used the cost of raw materials, fabric and cap manufacturing, transportation, and end-of-life/waste treatment to perform an economic and environmental burden analysis. Results: After 6 months of reusable scrub cap use, 33 participants (51.6%) reported that due to their use of a reusable scrub cap, their utilization of disposable bouffant or caps had decreased by 76–100%. This was associated with a significant reduction in the use of single-use caps after adjusting for surgical case volume. The carbon footprint of single-use scrub caps was significantly higher than reusable caps during the study period. Reusable scrub cap usage also strongly correlated with substantial reductions in energy consumption and freshwater toxicity. Conclusions: Reusable personalized cloth scrub caps are cost-effective and can help reduce surgery's carbon footprint by reducing waste generated from disposable scrub cap use. More programs should consider replacing single-use polypropylene caps with reusable scrub caps for their operating room staff. [ABSTRACT FROM AUTHOR]

Background: While e-cigarettes have been identified as an effective means of tobacco harm reduction, the degree to which these devices will realise their harm reduction potential will be determined in large part by how available these products are to adults who smoke. One of the key factors determining that availability is the regulatory regime around these products. Within the US e-cigarettes have become the most commonly used tobacco product by middle and high school students, with disposable e-cigarettes now the most popular type of device used by youth. In this paper, we report data on the prevalence with which one of the most popular disposable e-cigarettes within the US is being used by youth (aged 13–17) and underage young adults (aged 18–20). Methods: A cross-sectional online survey of a probability-based sample of 1215 youth (13–17 years) recruited via Ipsos' KnowledgePanel and 3370 young adults aged 18–24, among whom 1125 were aged 18–20, recruited via Ipsos' KnowledgePanel and online consumer research panels. Results: Among youth, 3.50% (95% CI: 2.46–4.83) reported smoking combustible cigarettes in the past 30 days, and 6.73% (95% CI: 5.26–8.48) reported using an e-cigarette in the past 30 days. Among underage young adults, 7.22% (95% CI: 5.24–9.67) reported smoking combustible cigarettes every day or some days, and 15.90% (95% CI: 12.96–19.21) reported using e-cigarettes every day or some days. Despite the scale of e-cigarette use in general among the US youth, only 0.04% (95% CI: 0.00–0.38) of 13–17 years old reported using the BIDI® Stick disposable e-cigarette in the past 30 days. Conclusions: While disposable e-cigarettes have become the most popular type of e-cigarette used by the US youth, it is likely that the prevalence of use of individual devices varies significantly. There is a need to regularly monitor the use of e-cigarettes by type of device and brand, in order to determine which products have the greatest potential to reduce smoking-related harm among adults who smoke and which products are being used by youth and underage young adults. [ABSTRACT FROM AUTHOR]

Surgical drapes are frequently used in operating rooms and clinics where interventional procedures are performed. In hospitals, surgical drapes can be preferred as disposable or reusable. The choice of surgical drapes stands out as an important issue for hospitals, considering the costs. The objective of the study is to compare disposable and reusable surgical drapes in terms of their costs and benefits and choose the best alternative for the subject hospital. The study was carried out in a training and research hospital with more than 1000 patient beds in Ankara, Türkiye. Cost analysis of 27 reusable surgical drape sets was conducted using procurement, tailoring, sterilization, washing, and drying costs. Cost analysis of disposable surgical drape sets was conducted using purchase unit cost and waste disposal costs. The benefits of surgical drapes were compared using the Analytical Hierarchy Process method, weighted by field experts within the scope of some criteria. At last, the analysis was completed by taking the ratio of findings from both cost and benefit analysis for reusable and disposable surgical drapes. Reusable surgical drapes were found to be less costly and more beneficial when compared to disposables. However, it is not possible to reach a generally accepted conclusion as results may vary from hospital to hospital. Cost savings can be achieved by using reusables as primary surgical drapes in some, if not all surgeries. These results may be useful for decision-makers. [ABSTRACT FROM AUTHOR]

Objectives: The objectives are to compare lead blood concentrations in veterinary workers using lead shielding with concentrations in a control population, to measure hand surface lead before and after use of shielding, and to compare hand surface lead with and without the use of disposable gloves worn under hand shielding. Methods: Blood and hand wipe samples were analyzed for lead using inductively coupled plasma mass spectrometry. Results: There was no difference in blood lead between exposed and control groups. After lead glove use, 69% (18/26) of hand surface lead samples from workers not using disposable gloves were greater than 500 μg, 42% (11/26) were greater than 1000 μg, and 12% (3/26) were greater than 2000 μg. Conclusions: If lead shielding use is unavoidable, disposable gloves should be worn, and skin should be decontaminated after use. [ABSTRACT FROM AUTHOR]

Nowadays, the majority of the processes used to sterilize disposable medical devices have several drawbacks in terms of safety, energy consumption, and costs. In this work, a sterilization method based on an indirect nonthermal plasma treatment is presented. The main advantages of this method are low environmental impact, absence of harmful chemical compounds' storage, and backward compatibility relative to production, sterilization, and shipping chain. The sterilization of disposable devices, enclosed inside their protective packaging, is achieved by exploiting reactive species produced by a Dielectric Barrier Discharge plasma reactor. Various devices have been subjected to a 2‐h treatment, achieving complete sterilization based on USP and EU‐PHARMA protocols. Pretreatment of carton packaging has been necessary to guarantee a complete sterilization process. [ABSTRACT FROM AUTHOR]

Background: This study primarily assessed ENT surgical trainees' preferences for the qualities of disposable and reusable fibre-optic nasendoscopes. Secondary aims included eliciting trainees' views on ENT surgery and climate change, and creating a single-centre per-use cost analysis for disposable and reusable fibre-optic nasendoscopes. Methods: A cross-sectional study was formulated. An online survey consisting of multiple-choice and Likert-scale questions was distributed nationally. Cost analysis was performed using 2021–2022 data from the host institution. Results: Twenty-four trainees responded. Data on disposable fibre-optic nasendoscopes showed no difference in overall satisfaction (p = 0.244). Reusable fibre-optic nasendoscopes had a lower cost per use compared with disposable nasendoscopes at 5 years (4.7 per cent reduction) and 10 years (7.1 per cent reduction). Of the trainees, 79.2 per cent were supportive of climate-friendly initiatives within ENT surgery, and 25 per cent felt supported by their departments. Conclusion: Trainees' satisfaction with disposable and reusable fibre-optic nasendoscopes is similar. Cost analysis favours reusable fibre-optic nasendoscopes in the long term at the host institution. Empowering departments and trainees to pursue climate-friendly initiatives should be encouraged. [ABSTRACT FROM AUTHOR]

Healthcare systems are responsible for 4%–5% of the emissions of greenhouse gases worldwide. The Greenhouse Gas Protocol divides carbon emissions into three scopes: scope 1 or direct emissions secondary to energy use; scope 2 or indirect emissions secondary to purchased electricity; and scope 3 for the rest of indirect emissions. Aim: To describe the environmental impact of health services. Design: A systematic review was conducted in the Medline, Web of Science, CINAHL, and Cochrane databases. Studies that focused their analysis on a functional healthcare unit and which included. This review was conducted from August to October 2022. Results: The initial electronic search yielded a total of 4368 records. After the screening process according to the inclusion criteria, 13 studies were included in this review. The reviewed studies found that between 15% and 50% of the total emissions corresponded to scopes 1 and 2 emissions, whereas scope 3 emissions ranged between 50% and 75% of the total emissions. Disposables, equipment (medical and non‐medical) and pharmaceuticals represented the higher percentage of emissions in scope 3. Conclusion: Most of the emissions corresponded to scope 3, which includes the indirect emission occurring as a consequence of the healthcare activity, as this scope includes a wider range of emission sources than the other scopes. Implications for the profession and/or patient care: Interventions should be carried out by the healthcare organizations responsible of Greenhouse Gas emissions, and also every single individual that integrates them should make changes. The use of evidence‐based approaches to identify carbon hotspots and implement the most effective interventions in the healthcare setting could lead to a significant reduction of carbon emissions. Impact: This literature review highlights the impact that healthcare systems have on climate change and the importance of adopting and carrying out interventions to prevent its fast development. Reporting Method: This review adhered to PRISMA guideline. PRISMA 2020 is a guideline designed for systematic reviews of studies that analyse the effects of heath interventions, and aim is to help authors improve the reporting of systematic review and meta‐analyses. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Tremendous progress has been made towards achieving tight glycaemic control in individuals with diabetes mellitus through the use of frequent or continuous glucose measurements. However, in patients who require insulin, accurate dosing must consider multiple factors that affect insulin sensitivity and modulate insulin bolus needs. Accordingly, an urgent need exists for frequent and real-time insulin measurements to closely track the dynamic blood concentration of insulin during insulin therapy and guide optimal insulin dosing. Nevertheless, traditional centralized insulin testing cannot offer timely measurements, which are essential to achieving this goal. This Perspective discusses the advances and challenges in moving insulin assays from traditional laboratory-based assays to frequent and continuous measurements in decentralized (point-of-care and home) settings. Technologies that hold promise for insulin testing using disposable test strips, mobile systems and wearable real-time insulin-sensing devices are discussed. We also consider future prospects for continuous insulin monitoring and for fully integrated multisensor-guided closed-loop artificial pancreas systems. An urgent need exists for technologies and devices capable of frequent and real-time insulin measurements in patients with diabetes mellitus to guide optimal insulin dosing. This Perspective discusses the advances and challenges in moving insulin assays from laboratory-based assays to frequent and continuous measurements in decentralized settings. [ABSTRACT FROM AUTHOR]

In this case report, we describe two difficult intubations in which an endotracheal tube was threaded over a fiberoptic bronchoscope that was acting as a bougie. Our patients initially presented with limited neck extension, narrow mouth opening, and restricted view of the glottic region. A fiberoptic bronchoscope was guided through while the patient was oxygenated through a laryngeal mask. After the scope provided an unrestricted view of the vocal cords, the digital module was removed by cutting the fiberoptic thread, and an endotracheal tube was passed through. After proper confirmation of the endotracheal tube position, the intubation was deemed successful and thereby, we share our experience with the novel technique. This technique may potentially improve critical patient outcomes whether in trauma or an unexpectedly difficult intubation. [ABSTRACT FROM AUTHOR]

Strategies to address misinformation and hesitancy about vaccines, including the fear of needles, and to overcome obstacles to access, such as the refrigeration that some vaccines demand, strongly suggest the need to develop new vaccine delivery technologies. But, given widespread distrust surrounding vaccination, these new technologies must be introduced to the public with the utmost transparency, care, and community involvement. Two emerging technologies, one a skin‐patch vaccine and the other a companion dye and detector, provide excellent examples of greatly improved delivery technologies for which such a careful approach should be developed in order to increase vaccine uptake. Defusing fears and conspiracy mongering must be a key part of their rollout. [ABSTRACT FROM AUTHOR]

Background: While e-cigarettes have been identified as an effective means of tobacco harm reduction, the degree to which these devices will realise their harm reduction potential will be determined in large part by how available these products are to adults who smoke. One of the key factors determining that availability is the regulatory regime around these products. Within the US e-cigarettes have become the most commonly used tobacco product by middle and high school students, with disposable e-cigarettes now the most popular type of device used by youth. In this paper, we report data on the prevalence with which one of the most popular disposable e-cigarettes within the US is being used by youth (aged 13–17) and underage young adults (aged 18–20). Methods: A cross-sectional online survey of a probability-based sample of 1215 youth (13–17 years) recruited via Ipsos' KnowledgePanel and 3370 young adults aged 18–24, among whom 1125 were aged 18–20, recruited via Ipsos' KnowledgePanel and online consumer research panels. Results: Among youth, 3.50% (95% CI: 2.46–4.83) reported smoking combustible cigarettes in the past 30 days, and 6.73% (95% CI: 5.26–8.48) reported using an e-cigarette in the past 30 days. Among underage young adults, 7.22% (95% CI: 5.24–9.67) reported smoking combustible cigarettes every day or some days, and 15.90% (95% CI: 12.96–19.21) reported using e-cigarettes every day or some days. Despite the scale of e-cigarette use in general among the US youth, only 0.04% (95% CI: 0.00–0.38) of 13–17 years old reported using the BIDI® Stick disposable e-cigarette in the past 30 days. Conclusions: While disposable e-cigarettes have become the most popular type of e-cigarette used by the US youth, it is likely that the prevalence of use of individual devices varies significantly. There is a need to regularly monitor the use of e-cigarettes by type of device and brand, in order to determine which products have the greatest potential to reduce smoking-related harm among adults who smoke and which products are being used by youth and underage young adults. [ABSTRACT FROM AUTHOR]

Markets have evolved from classic markets to concerned markets - that is, markets that focus not only on economic efficiency and the utilitarian matching between supply and demand but also on the negative externalities produced by market products and exchanges. The menstrual cup is used as a good example to address such matters. This device has supplemented disposable tampons and pads, and if the original focus on practical and material dimensions remains (absorbency, lightness, smallness, disposability, etc.), new concerns have invaded the scene. Significantly, in the advertisements for menstrual cups, reusability, recyclability, safety or hypoallergenic issues have replaced the past quest for efficiency and feeling carefree. How have matters of facts and of concern been involved and with what implications? I propose to address this question based on a computer-assisted analysis of 5,235 consumer reviews (posted on Amazon.com) about the Star Cup (pseudonym), a leading product on the market for menstrual cups. The analysis points out that health and sustainability are only two of the many reasons behind the current use of menstrual cups. Various and often conflicting concerns are intertwined in cup consumption. This helps us understand that the development of sustainable technologies requires taking many more elements and dimensions into consideration than mere environmental friendliness. [ABSTRACT FROM AUTHOR]

Background: It is often difficult to concurrently provide adequate analgesia while minimizing opioid requirements following ambulatory surgery. Nonthermal, pulsed shortwave (radiofrequency) fields are a noninvasive treatment used as an adjunct analgesic and wound healing therapy. The devices may be placed by nursing staff in less than a minute, are relatively inexpensive and readily available, theoretically provide analgesia for nearly any anatomic location, and have no systemic side effects—patients cannot detect any sensations from the devices—or significant risks. Here we present a case series to demonstrate the use of pulsed, electromagnetic field devices for outpatient herniorrhaphy and breast surgery. Case Report: Following moderately painful ambulatory umbilical (n = 3) and inguinal (n = 2) hernia repair as well as bilateral breast surgery (n = 2), patients had taped over their surgical incision(s) 1 or 2 noninvasive, wearable, disposable, pulsed shortwave therapy devices (RecoveryRx, BioElectronics Corporation, Frederick, Maryland) which functioned continuously for 30 days. Average resting pain scores measured on the 0–10 numeric rating scale were a median of 0 during the entire treatment period. Six patients avoided opioid use entirely, while the remaining individual required only 5 mg of oxycodone during the first postoperative day. Conclusions: These cases demonstrate that the ambulatory use of pulsed shortwave devices is feasible and may be an effective analgesic, possibly obviating opioid requirements following outpatient herniorrhaphy and breast surgery. Considering the lack of any side effects, adverse events, and misuse/dependence/diversion potential, further study with a randomized, controlled trial appears warranted. [ABSTRACT FROM AUTHOR]

Qualified nurses are accountable for selecting a suitable containment product for care home residents, which can be challenging for both the resident and health professional. Absorbent incontinence products are the most commonly used products for containing leakage. The purpose of this observational study was to review and understand how effective the Attends Product Selector Tool is when used to assess a resident for an appropriate disposable incontinence product and the in-use experience of products in relation to containment, product use and effectiveness. The study was undertaken in three care homes, with 92 residents who had an initial assessment undertaken either by an Attends Product Manager or a nurse trained in how to use the tool. A total of 316 products over a 48-hour period were individually assessed by the observer to check the time the pad was changed, the type of pad used, the voided volume in the pad and if the pad had leaked. The results showed that some residents had their products changed inappropriately. Not all residents were using the products that best suited their assessment; this mostly occurred at night. Overall, the tool was effective in enabling staff to select an appropriate style of containment product. However, when it came to selecting the absorbency, the assessor tended to choose a higher absorbency rather than starting at the lower absorbency in the product guide range. The observer found the assessed product was not always used and was sometimes changed inappropriately due to lack of communication and staff turnover. [ABSTRACT FROM AUTHOR]

Purpose: Foley catheter (FC) insertion is very basic yet one of the most widely performed procedures all across the fields of medicine. Since FC was first introduced in 19020's, no significant improvement has been made in view of methodology, despite the inconvenience associated with cumbersome preparation, procedure, and the patients' discomfort with having to have their genitalia exposed. We developed a new, easy-to-use FC insertion device, Quick Foley, that provides an innovative approach to introducing FC while simplifying and minimizing time spent without compromising the sterility. Methods: We developed an all-in-one disposable FC introducer contains all the necessary components in a single-device-kit. Minimal plastic components are necessary to keep accuracy and consistency, but the rest are made of the paper to minimize plastic waste. The preparation is done by connecting to the drainage bag, spurring the lubricant gel through gel insert, separating the tract, and connecting with the ballooning syringe. For the insertion, after sterilizing the urethral orifice, rotate the control knob to feed FC to the end of the urethra. After ballooning, dissembling of the device is done only by opening and removing the module, then only the FC remains. Results: As the device is all-in-one, there is no need to prearrange the FC tray, simplifies the FC preparation and catheterization procedure. This device not only makes it convenient for the practitioner, but ultimately, it will reduce the psychological discomfort experienced by patient by truncating perineal exposure time. Conclusions: We have successfully developed a novel device that reduces the cost and burden of using FC for practitioners while maintaining an aseptic technique. Furthermore, this all-in-one device allows the entire procedure to be completed much more quickly compared to the current method, so this minimizes perineal exposure time. Both practitioners and patients can benefit by this new device. [ABSTRACT FROM AUTHOR]

Purpose: This clinical study sought to evaluate the possible clinical effectiveness and practicality of URINO, an innovative, incisionless, and disposable intravaginal device, designed for patients suffering from stress urinary incontinence. Methods: A prospective, multicenter, single-arm clinical trial was carried out, involving women diagnosed with stress urinary incontinence who used a self-inserted, disposable intravaginal pessary device. Comparisons were made between the results of the 20-minute pad-weight gain (PWG) test at baseline and visit 3, where the device was applied. After 1 week of device usage, compliance, satisfaction, the sensation of a foreign body, and adverse events were assessed. Results: Out of 45 participants, 39 completed the trial and expressed satisfaction within the modified intention-to-treat group. The average 20-minute PWG of participants was 17.2±33.6 g at baseline and significantly dropped to 5.3±16.2 g at visit 3 with device application. A total of 87.2% of participants exhibited a reduction ratio of PWG by 50% or more, surpassing the clinical trial success benchmark of 76%. The mean compliance was recorded as 76.6%±26.6%, the average visual analogue scale score for patient satisfaction was 6.4±2.6, and the sensation of a foreign body, measured on a 5-point Likert scale, was 3.1±1.2 after 1 week of device use. No serious adverse events were reported; there was 1 instance of microscopic hematuria and 2 cases of pyuria, all of which recovered. Conclusions: The investigated device demonstrated significant clinical effectiveness and safety for patients with stress urinary incontinence. It was easy to use, showing favorable patient compliance. We propose that these disposable intravaginal pessaries could potentially be an alternative treatment for patients with stress urinary incontinence who are seeking nonsurgical options or are unable to undergo surgery. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the cost per use of video-rhinolaryngoscopy using reusable and disposable devices in a tertiary referral centre. Methods: A cost-comparison study was performed that utilised retrospective cost data and prospective utilisation data to compare the total costs of using reusable video-rhinolaryngoscopes versus a single-use alternative. Results: It was estimated that 4776 and 1821 procedures were performed annually with reusable and disposable video-rhinolaryngoscopes, respectively. The cost per use was £66.61 for reusable devices versus £150.00 for disposable devices. The break-even point (i.e. when cost per use was equal, occurred at 1374 procedures per year). Thereafter, it was cheaper to use reusable devices. Conclusion: Disposable rhinolaryngoscopes may present a cheaper solution to services with low rates of rhinolaryngoscope utilisation. However, for larger services considering replacement of their reusable rhinolaryngoscopes with disposable units, it is likely that the recurring costs will be prohibitive in the medium to long term. [ABSTRACT FROM AUTHOR]

Purpose: This study was carried out to determine the effect of high school students' perception of risk of COVID‐19, wearing masks and social distance behavior on stress during the COVID‐19 pandemic. Method: This descriptive study was performed on 1034 participants between the ages of 15 and 18 between June 21 and July 2, 2021. "Descriptive Questionnaire," "COVID‐19 Risk Perception Form," "Mask Wear Behavior Form," "Social Distance Behavior Form," and "Perceived Stress Scale" were used in data collection. Results: It was determined that 81.4% of the students used disposable medical masks, and 50.6% of them used the mask they wore for one day. In the characteristics of the risk perception of COVID‐19, 31% have a risk perception, 45% are afraid to contact people returning from abroad, 58.8% avoid going to crowded places, 66.8% are afraid of contacting people with flu symptoms. It was found that they always kept sufficient distance while communicating with others. As a result of the multiple regression, it was determined that gender, mask type, mask usage frequency, risk perception, social distance behavior, and mask‐wearing behavior had a statistically significant effect on the perceived stress level (p < 0.05). Conclusions: These results provide theoretical inferences for public health policies targeting the high school students to develop accurate risk perception and protective behaviors. [ABSTRACT FROM AUTHOR]