Predictors of condom use among men enrolled in drug treatment programs.

This study identified predictors of condom use and developed a model of condom use in a sample of men (n = 324) enrolled in drug treatment. Utilizing a series of logistic regression analyses reported condom use was predicted by possession of condoms, future intention to use condoms, future intention to increase condom use, having a high-risk partner, low Condom Barriers Scale scores, being unmarried and ethnic minority status. A probit path analysis revealed the following model of condom use among men in drug treatment: Taking condoms from clinic stocks was the best predictor of condom possession, which in turn was the best predictor of condom use.

Renal gunshot wounds: clinical management and outcome.

Background: To analyze our experience with renal gunshot wounds (GSW).

Methods: We analyzed our prospective trauma database for patients with renal GSW.

Results: Two hundred one patients (206 renal units) with renal GSW were collected from our database.

Hospital- versus community-based syringe exchange: a randomized controlled trial.

This study examined the effect of syringe exchange program setting on the injection practices, health status, and health service utilization patterns of injection drug users (IDUs) recruited from a public urban hospital. One hundred sixty-six participants were randomized to either community- or hospital-based syringe exchange services. Poisson regression models were used to compare service utilization between groups.

Effects of tidal volume on work of breathing during lung-protective ventilation in patients with acute lung injury and acute respiratory distress syndrome.

Objective: To assess the effects of step-changes in tidal volume on work of breathing during lung-protective ventilation in patients with acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS).

Design: Prospective, nonconsecutive patients with ALI/ARDS.

Setting: Adult surgical, trauma, and medical intensive care units at a major inner-city, university-affiliated hospital.

Clinical implementation of the ARDS network protocol is associated with reduced hospital mortality compared with historical controls.

Objective: To assess the impact of implementing a low tidal volume ventilation strategy on hospital mortality for patients with acute lung injury or acute respiratory distress syndrome.

Design: Retrospective, uncontrolled study.

Setting: Adult medical-surgical and trauma intensive care units at a major inner city, university-affiliated hospital.

Relative effects of insulin resistance and protease inhibitor treatment on lipid and lipoprotein metabolism in HIV-infected patients.

Background: The relationship between insulin resistance, dyslipidemia, HIV infection, and antiretroviral therapy remains unclear, and the atherogenic nature of lipid and lipoprotein profiles in HIV-infected patients has not been fully characterized.

Method: We measured plasma lipid and lipoprotein subfractions using Vertical Auto Profile-II methodology and directly measured insulin-mediated glucose disposal in 45 protease inhibitor (PI)-treated and non-PI-treated HIV-infected patients.

Results: PI-treated patients had higher total, LDL, and narrow-density LDL cholesterol (p <.

Management of acidosis during lung-protective ventilation in acute respiratory distress syndrome.

In ARDS, when acidosis complicates LPV, the goal of alkali therapy is to maintain arterial pH at a safe level (> or = 7.20). A pure respiratory acidosis generally does not require alkali therapy.

Pressure-volume curves in the management of acute respiratory distress syndrome.

The interpretation of P-V curves is uncertain for several reasons: the influence of chest wall compliance, differences in regional lung compliance and intrapulmonary gas distribution, lung volume history, lung recruitment beyond the LIP, peripheral airway fluid movement, expiratory-flow limitation, differences between inflation and deflation limb characteristics, and interobserver variability in curve analysis. In addition, many studies of acute lung injury have constructed P-V curves following disconnection from the ventilator. The inevitable lung volume changes that occur may alter the elastic and viscoelastic behavior so that the resulting P-V curve characteristics may not accurately reflect conditions during mechanical ventilation.

Respiratory system mechanics in acute respiratory distress syndrome.

Respiratory mechanics research is important to the advancement of ARDS management. Twenty-eight years ago, research on the effects of PEEP and VT indicated that the lungs of ARDS patients did not behave in a manner consistent with homogenously distributed lung injury. Both Suter and colleagues] and Katz and colleagues reported that oxygenation continued to improve as PEEP increased (suggesting lung recruitment), even though static Crs decreased and dead-space ventilation increased (suggesting concurrent lung overdistension).

Medical service use and financial charges among opioid users at a public hospital.

We examined the prevalence of drug use related infectious complications among opioid using or dependent individuals and service charges associated with medical care received over a 2-year period at a public hospital. A computerized medical record review was used to identify 3147 individuals with diagnoses related to opioid use or dependence. Forty-nine percent of these patients were treated for bacterial infections and 30% presented for treatment of medical problems arising from the effects of the drugs themselves (e.

Differences between methamphetamine users and cocaine users in treatment.

To better understand the distinguishing characteristics of methamphetamine users versus cocaine users, we conducted a retrospective chart review of the 345 patients admitted to an outpatient stimulant treatment program during 1995--1997. Analyses revealed an increase in methamphetamine patients over the 3-year period, and that these patients were more likely than cocaine patients to be male, Caucasian, and gay or bisexual. Methamphetamine patients were also more likely to be HIV-positive, engage in behaviors such as using and sharing needles that place them at high risk for HIV transmission, have a psychiatric diagnosis, and be on psychiatric medications.

The treatment of acidosis in acute lung injury with tris-hydroxymethyl aminomethane (THAM).

Mechanical hyperventilation of acidemic patients with acute lung injury (ALI) requires the use of high volumes and pressures that may worsen lung injury. However, permissive hypercapnia in the presence of shock, metabolic acidosis, and multi-organ system dysfunction may compromise normal cellular function. Tris-hydroxymethyl aminomethane (THAM) may be an effective method to control acidosis in this circumstance.

Acute withdrawal syndrome related to the administration of analgesic and sedative medications in adult intensive care unit patients.

Objectives: To estimate the frequency of acute withdrawal syndrome related to the administration of analgesic and sedative medications in mechanically ventilated adult intensive care unit (ICU) patients; to identify associated clinical factors.

Design: Retrospective review of medical records.

Setting: An adult trauma/surgical ICU in an urban Level I trauma center.