J Trauma
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The use of illicit drugs, specifically heroin and cocaine, complicates trauma patient management and consumes extensive hospital resources. This paper focuses on heroin- and cocaine-related injuries observed by physicians at Detroit Receiving Hospital, a large urban Level I trauma center. The pharmaceutical effects, mode of administration, and the manner in which these drugs affect diagnosis and treatment of injuries are documented and discussed. ⋯ Illicit drug use significantly complicates initial diagnosis and trauma management and is associated with severe adverse pathophysiologic effects. Currently, prevention efforts, such as interventions in trauma centers, should be considered as the most efficient and feasible way to prevent injury recidivism in this patient population. We also conclude that legislative change may be the answer in reducing or preventing the horrendous problems caused by illicit drugs.
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This article summarizes the Stages of Change model, which identifies five stages that people experience as they gradually move away from engaging in harmful behaviors to sustaining healthy behaviors. Patients in different stages of change need different kinds of interventions. The Stages of Change model enhances brief counseling interventions for trauma patients with substance use problems because counselors can now accurately choose an appropriate intervention strategy. The authors present three case studies illustrating the three earliest stages of change most commonly encountered in trauma center patients.
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Alcohol-related injuries comprise a large percentage of injuries in the United States. As the impact of these injuries on society increases, a well-functioning trauma system becomes increasingly important. ⋯ Further, evidence supports the effectiveness of brief intervention programs to reduce alcohol-related injuries and demonstrates that trauma centers can improve patient outcomes by integrating them into care. Although many obstacles have inhibited progress and made implementing preventive interventions a difficult task, economic constraints are among the biggest challenges to implementing intervention programs as part of routine trauma care.
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In sepsis, activation of inflammatory cells and excessive production of proinflammatory cytokines leads to tissue injury, multiple organ failure, and death. We postulated that attenuation but not complete abrogation of hyperinflammation is of clinical benefit in sepsis. Because pentoxifylline (PTX) is known to decrease tumor necrosis factor (TNF)-alpha production and to increase anti-inflammatory cytokine synthesis, we tested the hypothesis that PTX treatment would change the pro- and anti-inflammatory balance and decrease mortality in a murine model of acute endotoxemia. In addition, we investigated the effects of PTX on nuclear factor (NK)-kappaB activation using lipopolysaccharide (LPS)-stimulated human peripheral blood mononuclear cells (PBMCs) as a model. ⋯ PTX enhances anti-inflammatory activity and decreases mortality in acute endotoxemia. PTX may be an important adjunct to therapies aiming to modulate the inflammatory response in sepsis.