Long-term physiologic consequences of the adult respiratory distress syndrome.

Six survivors of the adult respiratory distress syndrome were studied. Measurements were made of lung volumes, flow rates, single-breath diffusing capacity for carbon dioxide (Dsb), arterial blood gas levels at rest and during exercise, the ratio of physiologic dead space to tidal volume (VD/VT), alveolar-arterial oxygen pressure difference (P[A-a]O2) and percent shunt (using an assumed arteriovenous oxygen content difference). At the time of study, which varied from 3 to 16 months after recovery, we found minor and inconsistent abnormalities in the lung volumes (reduced vital capacity in one patient, elevated residual volume [RV] in two, and reduced RV in three) and in the flow rates (reduced instantaneous forced expiratory flow after 50 percent of the forced vital capacity had been exhaled in two patients). In those tests having to do with transfer of gas, there were more abnormalities, consisting of a decreased Dsb in three patients, an elevated P(A-a)O2 in four, a low resting arterial oxygen pressure (PaO2) in two, a decrease in exercise PaO2 in three, an elevated shunt fraction (Qsan/Qt) in three, and an elevated VD/VT in one patient. Clinically, at the time of study, the patients all had returned to their status before illness.

Adolescent drug use, health and personality.

Four factors have confounded the association between drug use and morbidity: (a) known drug users may be less healthy than unknown drug users; (b) drug users are rarely compared to control subjects; (c) the socio-economic status of drug users predisposes them to ill-health; (d) the personality of drug users predisposes them to ill-health. Here, controlling for these confounds, in a study of 210 adolescent drug users it was found that subjective ill-health was more strongly related to drug use than was objective ill-health. Drug use was related to neuroticism and psychopathic deviance. Controlling for personality, drug use accounted for little additional variance in health. It is concluded that drug use and health are not strongly related amongst adolescent drug users, although, because of their personalities, drug users tend not to feel well. Implications are discussed for the self-treatment explanation of drug use and for the design of preventative programmes.

Scottish cocaine users: wealthy snorters or delinquent smokers?

Ninety-two cocaine users were interviewed in Scotland. Most were middle-class nasal users, also used other drugs and generally gave cocaine a positive rating. One half of them had at some time used cocaine more than once a week. For some, this period lasted some months, when as much as 30 'lines' of cocaine were used per day of cocaine use. More of these heavy users reported adverse effects of cocaine than was the case for light users. Nonetheless, most heavy users had reduced their use by themselves to the point that their current cocaine use was no different from that of light users. Possible explanations for this apparently spontaneous reduction are discussed.

The use of buprenorphine and temazepam by drug injectors.

There has been concern over the growing misuse of buprenorphine and temazepam in Scotland. In interviews with 78 clients of Glasgow drug agencies during 1989-1990, it was found that buprenorphine and temazepam are now more widely and frequently misused than heroin or other opiates. Fifty-eight percent of buprenorphine users used six to seven days weekly. Fewer users of other drugs used as frequently. Heroin, other opiates and temazepam were associated with criminality. Buprenorphine, perhaps because it is relatively inexpensive, was not associated with criminality. Implications for drug policy and treatment are discussed.

A Council on Certification of Nurse Anesthetists report on the candidate satisfaction survey for the national certification examination.

Since the implementation of computerized adaptive testing for the national certification examination in April 1996 through June 30, 1998, over 2,400 candidates have been tested. Ongoing monitoring and evaluation of candidate satisfaction on the national certification examination has been an essential component of the Council on Certification of Nurse Anesthetists' testing procedures. During the year period of July 1, 1997 through June 30, 1998, 988 first-time candidates took the national certification examination. Of the 988 candidates, 932 were administered the same eight-statement satisfaction survey. This article reports on candidate satisfaction for this group of first-time takers. Overall response rate to the survey was 96%. Completion of the eight-statement survey is voluntary after the examination has been completed. The majority of candidates are very satisfied with the computerized adaptive test process and procedures.

Predicting initiation to and cessation of buprenorphine and temazepam use amongst adolescents.

Two interviews separated by 12 months (mean) were conducted with a purposive sample of Glaswegian adolescent drug misusers. Across that interval, beginning to use buprenorphine and temazepam were predictable by prior extent of other substance use, especially cannabis and tobacco, and by the Drug Misuse Scale, using selected MMPI items. About 50% of those who had been using either drug prior to first interview did not use at all between first and second interview. For temazepam, this cessation was not predictable, but ceasing to use buprenorphine was more likely the less time subjects had used this drug and if they had never injected. It is concluded that personality and frequent substance use predispose to drug misuse, but that additional factors must lead to dependence.

A short scale for predicting drug misuse using selected items from the MMPI.

The Minnesota Multiphasic Personality Inventory (MMPI) was administered to 210 young people who either used no drugs, used non-opioids, used opioids but did not inject and drug injectors. From the data collected a short scale of 37 items was derived which distinguished between non-users and drug users. Validation was then attempted using 214 subjects who were either in drug treatment programmes or alcohol treatment programmes as well as appropriate control groups. The Drug Misuse Scale was able to distinguish between these groups. The MacAndrew Scale proved better at distinguishing subjects in alcohol treatment programmes. However, the Drug Misuse Scale proved to be significantly better at distinguishing the drug misusers. It is suggested that the Drug Misuse Scale may prove a valuable clinical tool.

The criminality of new drug users in Glasgow.

The drug use and crime of 210 teenage licit and illicit drug users were examined. Over 90% of the sample, including non-users, soft drug users, opioid users and injectors, were obtained via the same 'snowball' of friends and acquaintances. None had been injecting for more than 2 years. It was found that the frequency of use of all licit and illict drugs and the frequency of all crimes were intercorrelated. However, even many of the opioid injectors in this sample were not near-daily users and 'addiction' did not explain the results of regression equations predicting crime and drug use; crime explained drug use more than drug use explained crime and drug use was not a major unique predictor of theft. The criminal drug-using teenagers in this sample were better regarded as 'delinquents' than as 'drug-abusers' or 'drug addicts'. Delinquent behaviour of all kinds appeared to be increased by prior criminal experience, having delinquent friends and lack of conventional social support (notably including having spent time in care). Implications of these findings for theories of delinquency and the practice of treatment and prevention are discussed.

Isoflow-volume curves in the diagnosis of upper airway obstruction.

We evaluated the ability of air and helium-O2 maximal expiratory flow-volume curves to distinguish upper airway obstruction from the diffuse, peripheral airway obstruction of chronic obstructive pulmonary disease. The increase in expiratory flows at peak, 75, 50, and 25 per cent of the vital capacity during helium-O2 breathing compared to air breathing was determined in 5 normal subjects and 3 patients with chronic obstructive pulmonary disease while breathing through fixed resistances, and in 6 patients with documented tracheal obstruction. In the normal subjects, the helium response at all 4 points remained normal and was unchanged from baseline until the simulated obstruction was severe (6-mm orifice), at which point all ofthe helium responses increased by 50 per cent. The patients with chronic obstructive pulmonary disease maintained their low baseline helium responses until the obstruction was severe (6-mm orifice), when only the expiratory flows at peak, 75, and 50 per cent of the vital capacity increased by at least 50 per cent. Five of the 6 patients with upper airway obstruction had helium responses very similar to those of the normal subjects with similar degrees of simulated obstruction, but the one patient with concomitant airway obstruction extending well below the carina had very small helium responses at each point. We conclude that upper airway obstruction can usually be identified by high helium responses and that upper airway obstruction, if severe, can be identified even in the presence of more peripheral airway obstruction by a normal helium response at high lung volumes.