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Craniofacial fibrous dysplasia (CFFD) is a benign, bony disease that may affect the skull base.1,2 Most cases are asymptomatic and observed; however, advanced disease can present with cranial neuropathy or craniofacial deformity requiring intervention.3-5 A 16-year-old adolescent girl with known CFFD involving the sphenoid and frontal bones with severe bilateral optic canal narrowing developed progressive right eye visual decline and frontal cosmetic deformity. Visual acuity worsened oculus dextrus (OD) to 20/30 with a new superior nasal scotoma and 20% loss in the retinal nerve fiber layer and remained oculus sinister (OS) 20/20. The patient was recommended a staged subfrontal craniotomy for right optic decompression and simultaneous correction cosmetic deformity followed by endonasal right optic decompression. On postoperative day one, visual acuity OD improved to 20/20; however, she developed OS visual decline to 20/800. Curiously, there were no episodes of intraoperative hypotension or additional iatrogenic compression. Use of methylprednisolone led to improvement OS 20/400. Given persistent visual decline, urgent second stage endonasal bilateral optic nerve decompression, rather than unilateral, was performed. Postoperatively, vision improved to OS 20/200. At one month, her vision improved to OD 20/15 and OS returned to 20/20 with a paracentral scotoma and 29% decline in left retinal nerve fiber layer with further improvement anticipated. This video describes a multidisciplinary, multistaged approach in treatment of optic nerve compression due to CFFD in addition to the management of unanticipated contralateral visual decline. The patient consented to the procedure and publication of her image. No Institutional Review Board/ethics committee approval was necessary for this case report.
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Background: Recovery capital theory provides a biopsychosocial framework for identifying and measuring strengths and barriers that can be targeted to support recovery from alcohol and drug addiction. This systematic review analyzed and synthesized all quantitative approaches that have measured recovery capital since 2016. Method: Three databases were searched to identify studies published from 2016 to 2023. Eligible studies explicitly stated they measured recovery capital in participants recovering from alcohol and/or drug addiction. Studies focusing on other forms of addiction were excluded. Results: Sixty-nine studies met the inclusion criteria. Forty-six studies used one of the ten identified recovery capital questionnaires, and twenty-five studies used a measurement approach other than one of the ten recovery capital questionnaires. The ten recovery capital questionnaires are primarily developed for adult populations across clinical and community recovery settings, and between them measure 41 separate recovery capital constructs. They are generally considered valid and reliable measures of recovery capital. Nevertheless, a strong evidence base on the psychometric properties across diverse populations and settings still needs to be established for these questionnaires. Conclusion: The development of recovery capital questionnaires has been a significant advance in the field of addiction recovery, in alignment with the emerging recovery-oriented approach to addiction recovery care. Additionally, the non-recovery capital questionnaire-based approaches to recovery capital measurement have an important place in the field. They could be used alongside recovery capital questionnaires to test theory, and in contexts where the application of the questionnaires is not feasible, such as analyses of data from online recovery forums.
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Living in recovery housing can improve addiction recovery and desistance outcomes. This study examined whether retention in recovery housing and types of discharge outcomes (completed, "neutral," and "negative" outcomes) differed for clients with recent criminal legal system (CLS) involvement. Using data from 101 recovery residences certified by the Virginia Association of Recovery Residences based on 1,978 individuals completing the REC-CAP assessment, competing risk analyses (cumulative incidence function, restricted mean survival time, and restricted mean time lost) followed by the marginalization of effects were implemented to examine program outcomes at final discharge. Residents with recent CLS involvement were more likely to be discharged for positive reasons (successful completion of their goals) and premature/negative reasons (e.g., disciplinary releases) than for neutral reasons. Findings indicate that retention for 6-18 months is essential to establish and maintain positive discharge outcomes, and interventions should be developed to enhance retention in recovery residents with recent justice involvement.
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Craniofacial fibrous dysplasia (CFD) is a rare developmental disease of bone, which typically presents as a painless, expansile mass causing deformity of the craniofacial skeleton. In rare circumstances, compression of neurovascular structures may arise, causing symptoms such as pain, visual impairment, and hearing loss. Traditionally, CFD debulking has been performed with "freehand" techniques using preoperative imaging and anthropometric norms to determine the ideal amount of tissue removal. The advent of computer-assisted surgery, computer-aided design, and computer-aided manufacturing (CAD/CAM) has revolutionized the management of CFD. Surgeons can now fabricate patient-specific osteotomy/ostectomy guides, allowing for increased accuracy in bone removal and improved cosmetic outcomes. This series of 3 cases describe our institution's technique using patient-specific ostectomy "depth guides", which allow for maximum removal of fibro-osseous tissue while sparing deep and adjacent critical structures. These techniques can be widely applied to the craniofacial skeleton to assist in the surgical management of CFD.
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Displasia Fibrosa Craneofacial , Osteotomía , Cirugía Asistida por Computador , Adulto , Humanos , Diseño Asistido por Computadora , Displasia Fibrosa Craneofacial/cirugía , Displasia Fibrosa Craneofacial/diagnóstico por imagen , Osteotomía/métodos , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos XRESUMEN
Background: Social recovery capital (SRC) refers to resources and supports gained through relationships and is vital to adolescent addiction recovery. Much is known about how substance use relates to social networks, but little is known about how other dimensions of social networks influence recovery (e.g., network size/exposure, degree of conflict). Methods: This mixed-methods study sampled 28 adolescents who received treatment for alcohol and other drug (AOD) use disorder (14-19 yrs.: 71% male; M = 17.32 yrs., SD = 1.33; White 82%): 20 were recovery high school (RHS) students. Adolescents completed a social identity map for addiction recovery (SIM-AR), survey, and interview. Qualitative data were content analyzed and the data from the SIM-AR were quantified. Results: On average, participants reported belonging to five distinct groups within their network (Range, 2-9; SD = 1.63; M = 27.89 people, SD = 20.09). Of their social network connections, 51% drank alcohol and 46% used other substances, on average. Larger networks involved more conflict (r = 0.57). Participants were more likely to spend more time with groups that had greater proportions of non-substance-using members. These linkages were stronger for RHS than for non-RHS students. Qualitative analyses revealed that youth reported their recovery-oriented groups as supportive, but some reported that their substance-using friends also supported their recovery. Discussion: SIM-AR was a useful measurement tool, and, through qualitative interviews, we identified unique aspects of youths' social networks important for further examination. Research with recovering youth should examine SRC-related elements within their networks including relationship quality, belonging, and conflict, alongside the substance use behaviors of network members.
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Red Social , Trastornos Relacionados con Sustancias , Humanos , Adolescente , Masculino , Femenino , Trastornos Relacionados con Sustancias/psicología , Adulto Joven , Identificación Social , Apoyo SocialRESUMEN
Ameloblastic fibro-odontoma (AFO) is a rare, gnathic, benign, mixed odontogenic tumor that commonly presents in the first or second decade of life as a unilocular and rarely multilocular radiolucency with variable amounts of calcified material. Tumor progression is typically indolent, and generally accepted treatment is surgical enucleation and curettage. This case report describes an atypical presentation in a 14-year-old male with a multilocular, aggressive AFO requiring hemimandibulectomy with immediate osseous and dental "Jaw-in-a-Day" reconstruction. This report highlights the debate regarding whether AFO is a true neoplasm or an early-stage hamartoma in the continuum of complex odontoma formation. Regardless of the pathogenesis, maxillofacial surgeons and pathologists should be cognizant of the potential for AFO to develop locally aggressive behavior with considerable morbidity.
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Neoplasias Mandibulares , Odontoma , Humanos , Masculino , Adolescente , Odontoma/patología , Odontoma/cirugía , Odontoma/diagnóstico por imagen , Neoplasias Mandibulares/patología , Neoplasias Mandibulares/cirugía , Neoplasias Mandibulares/diagnóstico por imagen , Diagnóstico Diferencial , Radiografía PanorámicaRESUMEN
Subperiosteal implants (SPIs) using rigid fixation have recently emerged as an acceptable alternative to conventional endosteal implants when there is limited or absent alveolar bone. Modern advances in digital technology and manufacturing have improved the usability and stability of this latest generation of SPIs. Herein, we present the first reported case of a modern patient-specific SPI placed in the United States and, to the authors' knowledge, the first reported case performed in conjunction with a simultaneous free flap reconstruction of the opposing arch, and immediate dental rehabilitation of both arches in the world.
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In developing public resources for the Networks Enhancing Addiction Recovery - Forum Activity Roadmap (NEAR-FAR), we completed a systematic observational study of English-language online forums related to recovery from alcohol or other drug addiction in late 2021. Among 207 identified forums, the majority were classified as "general addiction" or alcohol-focused, though classifications related to other substances were common on websites hosting multiple forums. Commonly used social media platforms such as Reddit, Facebook, or Quora offered easily accessible venues for individuals seeking online support related to a variety of substances. Forums were related to established recovery programs such as 12-step and SMART Recovery as well as other nonprofit and for-profit recovery programs, and to community forums without formal recovery programming. Among 148 forums with any observed user activity, the median time between unique user engagements was 27 days (inter-quartile range: 2-74). Among 98 forums with past-month posting activity, we found a median of <10 posts per week (inter-quartile range: 1-78). This study compares three metrics of observed forum activity (posts per week, responses per post, time between unique user engagements) and operationalizes forum characteristics that may potentiate opportunities for enhanced engagement and social support in addiction recovery.
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INTRODUCTION: Strong and ever-growing evidence highlights the effectiveness of recovery housing in supporting and sustaining substance use disorder (SUD) recovery, especially when augmented by intensive support that includes assertive linkages to community services. This study aims to evaluate a pilot intensive recovery support (IRS) intervention for individuals (n = 175) entering certified Level II and III recovery residences. These individuals met at least three out of five conditions (no health insurance; no driving license; substance use in the last 14 days; current unemployment; possession of less than $75 capital). The study assesses the impact of the IRS on engagement, retention, and changes in recovery capital, compared to the business-as-usual Standard Recovery Support (SRS) approach (n = 1758). METHODS: The study employed quasi-experimental techniques to create weighted and balanced counterfactual groups. These groups, derived from the Recovery Capital assessment tool (REC-CAP), enabled comparison of outcomes between people receiving IRS and those undergoing SRS. RESULTS: After reweighting for resident demographics, service needs, and barriers to recovery, those receiving IRS exhibited improved retention rates, reduced likelihood of disengagement, and growth in recovery capital after living in the residence for 6-9 months. CONCLUSION: The results from this pilot intervention indicate that intensive recovery support, which integrates assertive community linkages and enhanced recovery coaching, outperforms a balanced counterfactual group in engagement, length of stay, and recovery capital growth. We suggest that this model may be particularly beneficial to those entering Level II and Level III recovery housing with lower levels of recovery capital at admission.
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Servicios Comunitarios de Salud Mental , Trastornos Relacionados con Sustancias , Humanos , Vivienda , Servicios Comunitarios de Salud Mental/métodos , Trastornos Relacionados con Sustancias/terapia , Proyectos de Investigación , Seguro de SaludRESUMEN
Recovery capital is a strengths-based and multi-level model for examining the process and outputs of recovery and desistance. Recovery capital posits that the more positive resources one accrues, the better the chances of recovery. Oftentimes growth of one's recovery capital must be initiated through identifying programs in the community to create supportive scaffolding: this may be especially true for individuals involved in the justice system who may experience additional barriers to accessing programming. This manuscript presents the results of a pilot evaluation of the REC-CAP, a recovery-capital oriented system of measurement, planning, and engagement in two drug treatment courts. We include a description of the implementation process and results from surveys and focus groups with the court staff. Results suggests that the trainings were useful and that court staff meaningfully engaged with the REC-CAP system. Court staff felt the REC-CAP provided important information about court clients' strengths and barriers and suggested next steps for staff to take to guide their clients. Future work should explore how the REC-CAP score profile may change with client progress through the court phases as well as how to incorporate more system level supports for a REC-CAP orientation among probation officers and other court staff.
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Aims: The current review investigated the psychosocial characteristics of late-onset problem drinkers, an under-researched area of alcohol harm that accounts for one-third of older problem drinkers. Method: Following the PRISMA model, the protocol and search strategy included a scoping search and main search of nine databases. A total of 1,595 papers were identified; after screening, 26 papers were considered eligible and were included in the review. The review used an investigative framework comprising three categories: standardising age of onset; gender differences; and psychosocial and mental health characteristics. The review also investigated how meaning and purpose in life, and treatment have been reported in relation to this cohort. Findings/Conclusions: The combined onset ages of the reviews' 26 papers (mean age = 52.69 years) and the participants' self-reported age at onset (mean age = 56.79 years), suggest that late-onset alcohol use disorder (AUD)/problem drinking is likely to emerge at the age of 55 years and older. Moreover, there is a high prevalence of co-morbid mental health disorders among elderly, late-onset drinkers. Retirement was reported as the most prevalent psychosocial risk factor for late-onset problematic drinking; other late-life events included bereavement, loneliness and social isolation, and boredom. In the context of gender, women are at greater risk of developing late-onset problem drinking than men. Furthermore, late-onset problem drinkers, particularly women, are more treatment compliant than their early-onset counterparts, highlighting the case for bespoke treatments/interventions for late-onset problem drinkers. Finally, the role that meaning and purpose in life plays in late-onset problem drinking has been under-reported and requires further investigation.
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BACKGROUND: The COVID-19 pandemic and measures have placed various burdens on societies and individuals. Emerging evidence suggests that people in drug addiction recovery were negatively affected. This study investigates whether risk and protective factors associated with return to problematic substance use differed between the periods before and during the pandemic for those in recovery. METHODS: A convenience sample of persons in drug addiction recovery for at least three months completed an assessment at baseline before the pandemic (T0, N = 367) and at two consecutive follow-ups 12 months apart (T1, N = 311; T2, N = 246). The final follow-up took place during the pandemic (2020-2021). We analyzed rates and predictors of problematic substance use in both periods, and whether relations between predictors and problematic use differed between the periods. RESULTS: Rates of problematic use did not differ significantly before and during the pandemic for those who were followed-up. However, the relationship between problematic use and commitment to sobriety differed between both periods (OR = 3.24, P = 0.010), as higher commitment was only associated with lower odds of problematic use during (OR = 0.27, P < 0.001), but not before, the pandemic (OR = 0.93, P = 0.762). In both periods, persons who were engaged in psychosocial support had lower odds of problematic use. CONCLUSIONS: The COVID-19 pandemic was not followed by significant return to problematic substance use in a cohort of people who were already in drug addiction recovery for some time before the pandemic. However, with restricted access to environmental resources, they may have been more dependent on internal motivations. Targeting personal recovery resources with interventions could therefore reduce the chances of return to problematic substance use during a pandemic.
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COVID-19 , Trastornos Relacionados con Sustancias , Humanos , Estudios Prospectivos , Bélgica/epidemiología , Países Bajos/epidemiología , COVID-19/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Reino Unido/epidemiologíaRESUMEN
BACKGROUND: Many fractures of the mandibular condylar neck are amenable to both open reduction and internal fixation (ORIF) and closed treatment. Clinical outcomes following these two modalities remains a topic of debate. This systematic review critically appraises the literature to compare them following these treatment options. METHODS: A systematic review and meta-analysis was performed to test the null hypothesis of no difference in clinical outcomes in ORIF versus closed treatment of mandibular condyle fractures. The PubMed, Embase, Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov trial registries were queried from 1946 to 2020. The quality of evidence was determined using Grading of Recommendations Assessment, Development, and Evaluation methodology. RESULTS: Of 1507 screened articles, 14 met inclusion criteria. ORIF was favored significantly when evaluating temporomandibular joint pain [relative risk (RR), 0.3; 95% CI, 0.1 to 0.7] (number needed to treat to prevent an outcome in one patient, 3; 95% CI, 2 to 6), laterotrusive movements of the mandible (mean difference, 2.3; 95% CI, 1.7 to 3.0) (standardized mean difference, 0.9; 95% CI, 0.4 to 1.3), and malocclusion (RR, 0.5; 95% CI, 0.4 to 0.7) (number needed to treat to prevent an outcome in one patient, 19; 95% CI, 10 to 200). However, ORIF yielded a higher incidence of postoperative infection (RR, 3.6; 95% CI, 0.9 to 13.8) and must be weighed against the understood risk of facial nerve injury. CONCLUSIONS: Meta-analysis of high-level evidence in randomized controlled trial suggests that ORIF significantly improves functional outcomes, decreases pain, and restores occlusion and jaw symmetry. These long-term benefits must be weighed against the increased risk of postoperative infection and exposure of the facial nerve to potential injury.
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Fijación Interna de Fracturas , Fracturas Mandibulares , Humanos , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Resultado del Tratamiento , Fijación de Fractura/efectos adversos , Fijación de Fractura/métodos , Fracturas Mandibulares/cirugía , Cóndilo Mandibular/cirugía , Cóndilo Mandibular/lesiones , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , DolorRESUMEN
PURPOSE: The presence of extranodal extension (ENE) conveys a poor prognosis in oral cavity squamous cell carcinoma (OSCC); however, there is no consensus regarding whether the histopathologic extent of ENE (e-ENE) may be a more discriminating prognostic indicator. The purpose of this study was to assess the impact of minor ENE (<2.0 mm) versus major ENE (≥ 2.0 mm) on overall survival (OS) and disease-free survival (DFS) in OSCC. MATERIALS AND METHODS: A single-institution, retrospective cohort study was designed using an electronic medical record review. Inclusion criteria included patients with OSCC and cervical node metastasis. All subjects were treated between the years 2009 and 2017 in the Michigan Medicine Department of Oral and Maxillofacial Surgery (Ann Arbor, Michigan). The primary predictor variable was e-ENE, measured as the maximum distance of tumor invasion into extranodal tissue from the outer aspect of the nodal capsule. Primary outcome variables were OS and DFS. Other covariates included demographic data, tumor staging, and histopathologic data. Descriptive statistics were performed. Kaplan-Meier survival plots for OS and DFS were performed. The data were mined for an alternative threshold at which e-ENE may impact survival using Cox proportional hazards models. RESULTS: One hundred sixty eight subjects were included (91 ENE-negative, 48 minor ENE, and 29 major ENE). Most subjects were male (62%) and the mean age was 62.9 years. Mean follow-up time was 2.97 +/- 2.76 years. There was no statistically significant difference in OS or DFS between minor and major ENE. Five-year OS for minor ENE was 30.4% versus 20.7% for major ENE (P = .28). Five-year DFS for minor ENE was 26.7% versus 18.1% for major ENE (P = .30). Five-year OS and DFS was worse for subjects with ENE-positive disease versus ENE-negative disease (OS: 26.9% vs 63.1%, hazard ratio [HR]: 2.70, 95% confidence interval [CI]: [1.77, 4.10], P < .001; DFS: 23.7% vs 59.7%, HR = 2.55, 95% CI [1.71, 3.79], P < .001). At an alternative threshold of 0.9 mm e-ENE, there was greater DFS in subjects with e-ENE 0.1-0.9 mm versus e-ENE > 0.9 (40.6% vs 18.9%, respectively) (HR = 0.49, 95% CI [0.24, 0.99], P = .047). CONCLUSION: There was no independent association between survival and e-ENE at a 2.0-mm threshold.
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Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Neoplasias de la Boca , Humanos , Masculino , Persona de Mediana Edad , Femenino , Extensión Extranodal , Carcinoma de Células Escamosas de Cabeza y Cuello , Supervivencia sin Enfermedad , Estudios Retrospectivos , Neoplasias de la Boca/cirugía , Neoplasias de la Boca/patología , Carcinoma de Células Escamosas/patología , Estadificación de Neoplasias , Pronóstico , Neoplasias de Cabeza y Cuello/patologíaRESUMEN
Importance: Despite the magnitude of alcohol use problems globally, treatment uptake remains low. Telephone-delivered interventions have potential to overcome many structural and individual barriers to help seeking, yet their effectiveness as a stand-alone treatment for problem alcohol use has not been established. Objective: To examine the effectiveness of the Ready2Change telephone-delivered intervention in reducing alcohol problem severity up to 3 months among a general population sample. Design, Setting, and Participants: This double-blind, randomized clinical trial recruited participants with an Alcohol Use Disorders Identification Test (AUDIT) score of greater than 6 (for female participants) and 7 (for male participants) from across Australia during the period of May 25, 2018, to October 2, 2019. Telephone assessments occurred at baseline and 3 months after baseline (84.9% retention). Data collection was finalized September 2020. Interventions: The telephone-based cognitive and behavioral intervention comprised 4 to 6 telephone sessions with a psychologist. The active control condition comprised four 5-minute telephone check-ins from a researcher and alcohol and stress management pamphlets. Main Outcomes and Measures: The primary outcome was change in alcohol problem severity, measured with the AUDIT total score. Drinking patterns were measured with the Timeline Followback (TLFB) instrument. Results: This study included a total of 344 participants (mean [SD] age, 39.9 [11.4] years; range, 18-73 years; 177 male participants [51.5%]); 173 participants (50.3%) composed the intervention group, and 171 participants (49.7%) composed the active control group. Less than one-third of participants (101 [29.4%]) had previously sought alcohol treatment, despite a high mean (SD) baseline AUDIT score of 21.5 (6.3) and 218 (63.4%) scoring in the probable dependence range. For the primary intention-to-treat analyses, there was a significant decrease in AUDIT total score from baseline to 3 months in both groups (intervention group decrease, 8.22; 95% CI, 7.11-9.32; P < .001; control group decrease, 7.13; 95% CI, 6.10-8.17; P < .001), but change over time was not different between groups (difference, 1.08; 95% CI, -0.43 to 2.59; P = .16). In secondary analyses, the intervention group showed a significantly greater reduction in the AUDIT hazardous use domain relative to the control group at 3 months (difference, 0.58; 95% CI, 0.02-1.14; P = .04). A greater reduction in AUDIT total score was observed for the intervention group relative to the control group when adjusting for exposure to 2 or more sessions (difference, 3.40; 95% CI, 0.36-6.44; P = .03) but not 1 or more sessions (per-protocol analysis). Conclusions and Relevance: Based on the primary outcome, AUDIT total score, this randomized clinical trial did not find superior effectiveness of this telephone-based cognitive and behavioral intervention compared with active control. However, the intervention was effective in reducing hazardous alcohol use and reduced alcohol problem severity when 2 or more sessions were delivered. Trial outcomes demonstrate the potential benefits of this highly scalable and accessible model of alcohol treatment. Trial Registration: ANZCTR Identifier: ACTRN12618000828224.
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Alcoholismo , Humanos , Masculino , Femenino , Adulto , Alcoholismo/diagnóstico , Alcoholismo/terapia , Teléfono , Etanol , Psicoterapia , Conductas Relacionadas con la SaludRESUMEN
Although the research base around 12-step effectiveness has been grown markedly in recent years, there has also been growth in the broader evidence base around recovery models, and this article reviews three key components: the transition to a social model of recovery; the emergence of a metric of recovery progress, recovery capital focused on building strengths; and multiple pathways to recovery, involving mutual aid groups, recovery community organizations, and access to jobs, friends, and housing. We conclude with an overview of the practical implications for addiction treatment and sustaining the gains made in specialist treatment services.
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Medicina de las Adicciones , Conducta Adictiva , Trastornos Relacionados con Sustancias , Humanos , Trastornos Relacionados con Sustancias/terapiaRESUMEN
During COVID and lockdown, many prisoners have not only been affected by infection transmission in crowded and ill-equipped institutions, they have also been separated from a range of supports, including loss of family and professional supports and support for prisoners with addiction and/or mental health problems has been disrupted. This paper reports on evidence of how peer-based recovery organizations have attempted to mitigate these adverse effects, based on a case study of one prison in the North-West of England, using a range of routine reporting data and original research data. The paper shows how prison-based peer recovery support has not only continued through lockdown but grown both in the prison and in continuing care on release. The key conclusion is that Lived Experience Recovery Organizations (LEROs) have a vital role to play in offering continuing care to prison populations both to support early recovery and to sustain change around release back into the community, in COVID but also more generally.
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BACKGROUND: There is a growing evidence base around predictors of retention and completion in a range of recovery residence models, particularly Oxford Houses and Sober Living Houses, and recovery housing is recognized as a clearly evidenced area of recovery intervention. The aim of the study was to quantitatively assess recovery capital in a sample of recovery residence clients. METHOD: The study used a repeated measures self-completion of a standardized recovery capital instrument (REC-CAP) for clients retained across various houses within one Level 2 recovery residence provider whose program was based on a 12-step approach. While 823 clients participated in the baseline assessment, a sample of 267 clients was achieved for six-month follow-up interview, based on those retained in the residence. A logistic regression model examined factors associated with retention and a repeated measures marginal mixed model evaluated the factors associated with changes in recovery capital between the baseline and the follow-up assessment. RESULTS: Members of the group that remained in recovery residences were more likely to be older with a record of high participation in recovery groups, with greater drop-out among younger residents, female residents and those with an identified housing need. For those retained to follow-up, greater recovery capital growth was associated with employment, higher levels of social support and more recovery group involvement, as well as age and a higher quality of life. The need for family support was shown to reduce levels of recovery capital. However, those younger people who were retained reported better recovery capital growth during the initial six months of residence. CONCLUSION: The key conclusion is that while recovery capital generally increases during a stay in a recovery residence, it does not do so consistently across the sample population. This has implications for how pathways to recovery group engagement are supported for women and young people and how social support (encompassing housing, employment and family issues) is provided to those populations during periods of residence. This suggests the potential need for training and guidance for house managers working with these groups.
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Vivienda , Trastornos Relacionados con Sustancias , Adolescente , Femenino , Florida , Humanos , Proyectos Piloto , Calidad de Vida , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
PURPOSE: Oral and maxillofacial surgery residency programs are increasingly adopting microsurgery as a core element of training; however, many barriers exist that limit trainees' proficiency. The purpose of this study was to perform a validation of 2 tabletop microscope simulations for their use as a training tool, which could serve as an affordable, alternative method to traditional microsurgery training methods. METHODS: A prospective, single-institution, multidepartmental validation study was performed. Two microscopes (monocular digital [DM] and binocular stereo [SM]) were used to perform anastomoses on simulation vessels including a silastic tube and a chicken thigh femoral artery. A microsurgeon panel was selected from a population of microsurgery faculty and fellows at Michigan Medicine (Ann Arbor, MI) to perform the anastomoses. The surgeons each performed 4 anastomoses, using each microscope with each vessel, and subsequently completed a survey evaluating the simulation. Predictor variables were the microscope and the vessel. Primary outcome variable was readiness for use, which was defined as the simulation's ability to incorporate into a microsurgical training curriculum in its current state. Secondary outcome variables included realism, value, usefulness, relevance, difficulty, and cost. Paired t tests were used to compare responses. Alpha was set to 0.05. RESULTS: Seven microsurgeons performed the simulation from the departments of oral and maxillofacial surgery (n = 5), plastic and reconstructive surgery (n = 1), and otolaryngology (n = 1). For readiness, the SM simulation required either no modification (n = 4) prior to implementation into a microsurgery curriculum or minimal modification (n = 3), compared to the DM simulation which required significant modification (n = 4) or extensive modification and re-evaluation (n = 3) (P = .002). The SM demonstrated a greater mean realism score than the DM for depth perception (5.00 vs 1.57, P < .001), field of view (4.57 vs 3.57, P = .038), lighting (5.00 vs 4.00, P = .038), and clarity (5.00 vs 3.86, P = .030). There was no statistically significant difference between SM and DM in value, usefulness, relevance, difficulty, or cost. CONCLUSIONS: Tabletop microscopes demonstrate considerable promise in the future of microsurgical education. The SM simulation was a realistic simulation that may be ready for use in a microsurgical curriculum. Future studies are required to demonstrate the efficacy of this simulation on microsurgical trainees.