British Columbia Lung Association

Gay men living with HIV (GMLWH) who smoke are less responsive to generalized smoking reduction and cessation (SRC) programs than heterosexual persons. This study explored perspectives of GMLWH during the design of a web-based SRC intervention. Participatory design techniques were used to guide the creation of personas that are composite representations of a person who would use the web-based SRC intervention. Researcher-participants (n = 13) created all data. Data analysis involved thematic coding drawing from an ethnographic perspective. Thematic analysis revealed seven intersecting themes related to SRC among participants, and an overarching theme navigating life. Concepts drawn from our ethnographic approach highlight cultural differences between GMLWH and mainstream society. Personas offer a mechanism for interpreting experiences and traditions of GMLWH. SRC interventions with GMLWH must address their social realities that include tools for navigating life, disease, and social identity.

Correct early prediction of successful extubation decreases morbidity and mortality. The use of single time point measurements and surrogate markers of true extubation success limits weaning studies. Our aim was to determine whether a "stress test" improves prediction of extubation outcome and to determine the most predictive variables. Observational study. Intensive care unit of a teaching hospital. A convenience sample of 68 patients judged to be ready for extubation. We decreased pressure support from 5 to 0 cm H2O for 1 hr before extubation (stress test) while patients were on 5 cm H2O continuous positive airway pressure. We measured respiratory frequency, tidal volume, ratio of respiratory frequency to tidal volume (f/VT), airway occlusion pressure after onset of inspiration (P0.1), and gastric-arterial PCO2 (deltaPg-aCO2 both on 5 cm H2O and 0 cm H2O pressure support. Then all patients were extubated. Failure of extubation was defined as reintubation within 24 hrs. Seventeen patients (25%) failed extubation. With pressure support of 5 cm H2O and continuous positive airway pressure of 5 cm H2O, most predictors were not different between patients who failed and patients who were successfully extubated. After the stress test, deltaPg-aCO2 was 2 (-5; 15) mm Hg (median; quartiles) in successfully extubated patients vs. 28 (-9; 48) in failures (p = .0003), tidal volume was 473 (387; 558) vs. 400 (323; 435) mL (p = .02), and P0.1 was 2.8 (2; 4.1) vs. 4.1 (2.7; 5.3) mm Hg (p = .03), respectively. The stress test increased specificity of deltaPg-aCO2 from 0.45 to 0.94 and positive predictive value from 0.85 to 0.97. The specificity and positive predictive values for f/VT after the stress test were 0.23 and 0.78. A simple stress test improves prediction of extubation outcome. deltaPg-aCO2 has superior specificity and positive predictive value compared with other variables. The use of true clinical outcome (i.e., extubation) instead of the use of surrogate markers (e.g., tachypnea) distinguishes these results from previous studies.