Management of posterior malleolus fractures: A multicentre cohort study in the United Kingdom.

BACKGROUND: There is a need to assess clinical practice in light of increasing literature recommending fixation of posterior malleolus (PM) fractures. This multicentre study examines treatment approaches, within both Major Trauma Centres and District General Hospitals and role of radiographs and CT scanning. METHODS: Trauma lists and databases were used to identify patients and data collected from electronic and paper medical records and imaging systems between August 2017-18. Analysis of treatment and outcomes was then conducted. RESULTS: One-hundred-and-sixty ankle fractures were included in the study, only 68 ankle fractures underwent CT scanning following initial radiographs and of these, 65 were managed operatively, with 32 undergoing PM fixation. Syndesmotic stabilisation was performed in 9.6% where the PM was fixed. CONCLUSION: CT is still under-utilised, PM fractures that appear to be anything other than small avulsion-type injuries should undergo CT scanning. Syndesmotic stabilisation is statistically less likely to be performed with fixation of the PM.

How effective is alcoholism treatment in the United States?

OBJECTIVE: Following in the footsteps of several prior attempts, this review seeks a meaningful and data-based answer to the common question of how people fare, on average, after being treated for alcoholism (broadly defined as alcohol use disorders). METHOD: Findings from seven large multisite studies were combined to derive estimates of the average effectiveness of alcoholism treatment. To provide common outcome measures, conversion equations were used to compute variables not reported in the original studies. RESULTS: During the year after treatment, 1 in 4 clients remained continuously abstinent on average, and an additional 1 in 10 used alcohol moderately and without problems. During this period, mortality averaged less than 2%. The remaining clients, as a group, showed substantial improvement, abstaining on 3 days out of 4 and reducing their overall alcohol consumption by 87%, on average. Alcohol-related problems also decreased by 60%. CONCLUSIONS: About one third of clients remain asymptomatic during the year following a single treatment event. The remaining two thirds show, on average, large and significant decreases in drinking and related problems. This substantial level of improvement in "unremitted" clients tends to be overlooked when outcomes are dichotomized as successful or relapsed.

Early findings from a disciplinary program to reduce problem drinking by college students.

This article describes an intervention for college students cited for alcohol-related infractions of the student code of conduct. First-time offenders are required to attend a three-hour class that includes educational, attitudinal and skills-based activities. Students also complete self-report measures of quantity/frequency of consumption and are mailed personalized drinking feedback one week following the group session. A preliminary evaluation of the program is described and the intervention is discussed in relation to other programs available on campus.

Reducing alcohol use in college students: a controlled trial of two brief interventions.

This study tested two forms of alcohol reduction programming for college students. Thirty-seven moderate to heavy drinkers completed measures of quantity/frequency, drinking consequences, and attitude questionnaires. Participants were randomly assigned to one of three groups: 1) a two-hour information and motivation session plus mailed personal feedback on their drinking; 2) mailed feedback only; or 3) no treatment. At a 6-week follow-up session, the feedback-only group decreased drinks per month as compared to control. No other differences were statistically significant, though decreases favored the treatment conditions about equally over control. Implications for research and treatment are discussed.

Drinking on campus. What Do we know about reducing alcohol use among college students?

Drinking and related problems on the college campus have reached near epidemic levels. In order to address this trend, many colleges have launched alcohol prevention and intervention programs for college students. Unfortunately, most such programs are either not empirically validated or are plainly based on models that have shown poor efficacy. This overview of the college treatment literature describes the kinds of interventions that have shown the best success and offers directions for future studies. In general, educational and abstinence-based approaches show the least efficacy, while other types of skills, attitudinal and feedback-based interventions based on aspects of the social learning model appear to be more successful. In addition to employing those approaches that have shown empirical success, a re-examination of the role that alcohol plays in the larger campus culture is crucial.

In praise of feedback: an effective intervention for college students who are heavy drinkers.

The efficacy of brief motivational feedback to reduce drinking among college students has been reported by several researchers. As an extension of this theoretical and applied framework, the author tested the use of mailed feedback to influence the drinking behavior of students self-identified as moderate-to-heavy drinkers in two randomized trials. A 6-week follow-up of the efforts suggested the efficacy of the feedback intervention at reducing alcohol consumption. The feedback mechanism used in the studies is described in detail and possible reasons for its efficacy are explored. In light of the cost-effective nature of this intervention, it may warrant a place in larger campus prevention programs.

Relationship of early inhalant use to substance use in college students.

This study examined the relationship between early inhalant use and later substance use in a sample of college students. Data were taken from four campus-wide surveys that assessed changes in rates of substance use over time at a large Southwestern university. Within these surveys, a group of students (n = 187) who reported early use of inhalants (i.e., before age 18) was identified and examined in terms of their substance use behavior while in college (i.e., during the year and month prior to the survey). These students were compared to two other groups of students: those who reported early use of marijuana but no early use of inhalants (n = 1271) and students who reported no early use of either inhalants or marijuana (n = 1479). Results show that early use of either inhalants or marijuana substantially increased risk of frequent drinking, binge drinking, smoking, illicit drug use, and substance-related consequences during the college years. However, the early use of inhalants conferred the greatest risk and was associated with twice the rate of binge and frequent drinking and significantly greater rates of tobacco and drug use than early marijuana use alone. Implications of these findings for intervention and prevention with college students are discussed.