The effect of a single early high-dose vitamin D supplement on fracture union in patients with hypovitaminosis D: a prospective randomised trial

AIMS

To evaluate the effect of a single early high-dose vitamin D supplement on fracture union in patients with hypovitaminosis D and a long bone fracture.

PATIENTS AND METHODS

Between July 2011 and August 2013, 113 adults with a long bone fracture were enrolled in a prospective randomised double-blind placebo-controlled trial. Their serum vitamin D levels were measured and a total of 100 patients were found to be vitamin D deficient (< 20 ng/ml) or insufficient (< 30 ng/mL). These were then randomised to receive a single dose of vitamin D₃ orally (100 000 IU) within two weeks of injury (treatment group, n = 50) or a placebo (control group, n = 50). We recorded patient demographics, fracture location and treatment, vitamin D level, time to fracture union and complications, including vitamin D toxicity. Outcomes included union, nonunion or complication requiring an early, unplanned secondary procedure. Patients without an outcome at 15 months and no scheduled follow-up were considered lost to follow-up. The t-test and cross tabulations verified the adequacy of randomisation. An intention-to-treat analysis was carried out.

RESULTS

In all, 100 (89%) patients had hypovitaminosis D. Both treatment and control groups had similar demographics and injury characteristics. The initial median vitamin D levels were 16 ng/mL (interquartile range 5 to 28) in both groups (p = 0.885). A total of 14 patients were lost to follow-up (seven from each group), two had fixation failure (one in each group) and one control group patient developed an infection. Overall, the nonunion rate was 4% (two per group). No patient showed signs of clinical toxicity from their supplement.

CONCLUSIONS

Despite finding a high level of hypovitaminosis D, the rate of union was high and independent of supplementation with vitamin D₃. Cite this article: Bone Joint J 2017;99-B:1520-5.

California Collaborative Center for Substance Abuse Policy Research: a history and update

The California Collaborative Center for Substance Abuse Policy Research is engaged in policy research, training, and information dissemination on substance abuse policy in and for the state of California. As such it is a cosponsor of the recent Therapeutic Jurisprudence conference with Haight Ashbury Free Clinics. The following recoups a presentation made by Richard B. Seymour on behalf of Center codirector Carroll Estes at that conference on the nature, history, and future priorities of the Center.

CCCSAPR: a new approach to drug policy research in the twenty-first century. California Collaborative Center for Substance Abuse Policy Research

The California Collaborative Center for Substance Abuse Policy Research (CCCSAPR) was established in 1997 to provide a nucleus for policy research in addiction and allied fields throughout the nine University of California campuses and allied research endeavors. The primary goal of CCCSAPR is that of providing data on statewide and national substance abuse issues toward the development and maintaining of a coherent substance abuse policy in the state of California. The authors present the history and scope of the Center as a new approach to drug policy research for a new century.

At war in the fields of play: current perspectives on the nature and treatment of adolescent chemical dependency

While the numbers of adolescents entering drug abuse treatment are not increasing dramatically, those entering treatment are getting sicker, according to clinical reports. Adolescents are entering treatment with multiple problems, including severe learning disorders, borderline personality disorders, multiple diagnoses of addiction, mental health and physical problems (including HIV/AIDS), and issues arising from child abuse and incest. A case study in client-therapist interaction is presented, highlighting the concept of the wounded healer. The disease model of addiction is discussed as it applies to adolescents, as is their need for habilitation, not rehabilitation. Current abuse trends and the drugs involved are also discussed. Multiple diagnoses, physiologic disorders, HIV testing and counseling, surgical problems, and maternal/neonatal complications are reviewed.

Cultural points of resistance to the 12-Step recovery process

This article addresses some of the key issues in developing culturally relevant approaches to drug abuse treatment and recovery, using the HAFC/Glide African-American Extended Family Program as a positive example of effective cultural adaptability within recovery. Cultural points of resistance to the recovery process are also addressed, including the perception that 12-Step fellowships are exclusive and confused with religion, confusion over surrender versus powerlessness, and concerns about low self-esteem, dysfunctional family structure, communication difficulties, and institutionalized and internalized racism. The authors also focus on professional resistance in other countries, where different treatment approaches and philosophies block the acceptance of a recovery concept in general and the 12-Step process in particular. In explicating these issues, addiction is presented as a multicultural problem in need of multicultural solutions. The challenge is to adapt the process of recovery to all cultures and races, to counter stereotypes on all sides, and to eliminate the perception that recovery only works for addicts from the White mainstream.

Identifying and responding to drug abuse in the workplace: an overview

A realistic program for managing drug abuse in the workplace requires a clear understanding of the nature and effects of both licit and illicit drugs, as well as a knowledge of reliable methods for identifying and responding to both industry and individual needs. This article reviews the nature and effects of psychoactive drugs and discusses the medical steps to be taken when they are being abused. In addition, an overview of the means for identifying workplace drug abusers is presented. Testing methods and procedures are described, and such problems as false-positive and false-negative test results are clarified. The formation of corporate drug abuse policies is discussed and a continuum of industry interaction with health and drug abuse treatment professionals is presented. The roles of industry medical review officers, employee assistance programs, and other pertinent groups and individuals are also discussed.

The Haight Ashbury Free Medical Clinic

The article highlights the philosophy, history, growth and current dimensions of the Haight Ashbury Free Medical Clinic. Started in the spring of 1967, the clinic was the first of more than 600 free clinics that appeared nationwide over the next decade. With a philosophy that health care is a right, not a privilege, and should be free, humane, demystified and nonjudgemental, the clinic has continued to fill a need among the medically indigent and drug abusing clients it serves in San Francisco. In the last 17 years, it has logged over 600,000 patient visits, and today has grown into a nationally renowned research and treatment center, providing a wide spectrum of services.