I can't believe I missed that! How the fear of missing out impacts on alcohol behaviours.

BACKGROUND: The Fear of Missing Out (FoMO), which is often experienced over missing opportunities for social gains associated with drinking, has been linked to heavy episodic drinking and experiencing negative consequences. The UK Coronavirus (COVID-19)-related lockdown provided a unique context to study FoMO's ability to predict of alcohol consumption. The aim of the current study was to test if FoMO predicted alcohol consumption during a time of social restrictions. METHODS: One hundred and five UK adults (aged 18-30, 61% female) participated in a study using an ecological momentary assessment design. Surveys were completed on smartphones and assessed FoMO and drinking intentions, three time a day (morning, afternoon, evening) over three consecutive weekends (Friday, Saturday, Sunday). Alcohol consumption was recorded once per day, based on previous day consumption. RESULTS: Repeated mixed model analyses found FoMO significantly predicted quantity of alcohol consumption (b =.05, p =.01) and drinking intentions (b =.47, p <.001), but did not predict frequency of consumption. Being male (b = 2.93, p =.02) and higher intentions (b = 0.5, p <.001) predicted higher quantity of consumption. Drinking intentions was the only variable to predict frequency of consumption (b =.004, p <.001). CONCLUSIONS: The study showed FoMO can predict quantity of alcohol consumption and drinking intentions, which are linked to increased negative consequences. Future studies should assess FoMO against other predictive factors. Results provide an insight into how a social predictor influenced alcohol consumption during a time of restrictions.

Exploratory mixed methods analysis of self-authored content from participants in a digital alcohol intervention trial.

BACKGROUND: Digital interventions readily permit data capture of participant engagement with them. If future interventions are intended to be more interactive, tailored, or a useful resource offered to users, it may be valuable to examine such data. One module available in a digital alcohol intervention recently tested in a randomised control trial offered participants the opportunity to self-author prompts that were sent to them by a text message at a time of their choosing. This study thus aimed to evaluate these self-authored prompts to increase knowledge on how individuals negotiate behaviour change and assess whether intervention content can be improved in the future. METHODS: The self-authored prompts were evaluated qualitatively using a combination of content and thematic analysis. The identified themes and subcategories are exemplified using anonymized quotes, and the frequency that each identified theme was coded for among the prompts was calculated. Associations between baseline characteristics and the odds of authoring a prompt at all, as well as a prompt within each theme, were investigated using logistic regression. RESULTS: Five themes were identified (Encouragement Style, Level of Awareness, Reminders of reasons to reduce/quit, Strategies to reduce/quit, and Timescale), all with several subcategories. The prompts module was more likely to be used by women and older individuals, as well as those for whom reducing alcohol consumption was perceived as important, or who felt they had the know-how to do so. Participants who had immediate access to the support tool (intervention group) were more than twice as likely to author a prompt (OR = 2.36; probability of association > 99%) compared to those with 4-month delayed access (control group). CONCLUSIONS: Individuals who engaged with the prompts module showed evidence of using the information provided in the support tool in an active way, with several showing goal setting and making plans to change their drinking behaviour. Individuals also used this opportunity to remind themselves of personal and specific reasons they wanted to change their drinking, as well as to encourage themselves to do so.

Novel technique for inline orientation of disarticulated limbs to seal type III endoleaks.

In this report, we present a novel maneuver used to align disarticulated limbs to resolve a type III endoleak. The patient, a 77-year-old man, initially underwent endovascular abdominal aortic repair for infrarenal abdominal aortic aneurysm in 2017. During routine annual duplex ultrasound in 2022, a late type III endoleak was identified. A novel method of using current techniques was applied, allowing for successful limb graft repair. Managing the longitudinal care of endovascular grafts is an evolving aspect of endovascular repairs. This case report demonstrates the ability to preserve the original endograft repair and ensure the safety of the aneurysm sac.

'You see the pictures the morning after and you're like I wish I was in them': an interpretative phenomenological analysis of university student's alcohol-related regrets.

OBJECTIVES: University students report experiencing regrettable health and social outcomes following excessive alcohol consumption. Students also report experiencing regret when they are unable to attend drinking events. This study explored how such experiences influence risk appraisals and decisions about future alcohol consumption. DESIGN AND MEASURES: Thirteen university students (69% female, 18-20 years old) discussed the interplay of regret with alcohol consumption, and nonattendance at drinking events, in one of three focus groups. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA). RESULTS: IPA produced three super-ordinate themes: 'It's not something I would have done sober', 'Attitudes towards action regret' and 'Fear of Missing Out (FoMO)'. Participants reported regrettable experiences (e.g. alcohol poisoning, tattoos), and a gender difference in risk appraisals was apparent. Attitudes towards action regret affected risk appraisals and informed future drinking decisions. Participants reported experiencing FoMO when they were unable to attend drinking events. CONCLUSION: Regrettable incidents following excessive consumption were seen as common but did not affect risk appraisals or future drinking decisions. Students' reported they preferred the regrettable experiences that follow excessive consumption than the FoMO experienced when they were unable to attend drinking events, suggesting FoMO may drive attendance at future drinking events.

Procedural comparison of a standard PTA balloon for fistula and graft maintenance procedures with the novel Chameleon™ PTA balloon catheter.

INTRODUCTION: The incidence of cephalic arch (CA) and central venous (CV) stenosis has been reported in the range of 30% in the literature. The purpose of this study is to compare contrast use, fluoroscopy time, and procedure time between standard imaging by injection of contrast through the access sheath versus injection of contrast through a novel PTA balloon with an integrated injection port. METHODS: A multi-centered, retrospective evaluation of consecutive patients treated for CA and CV stenosis was performed. Data captured included demographics, co-morbidities, lesion characteristics/location, procedural details, volume of contrast used, fluoroscopy time, and procedure time. The control group was imaged and treated using standard practice with pre and post imaging performed through the sheath and intervention using standard PTA balloon. Imaging and treatment were performed using the Chameleon™ PTA catheter in the treatment arm. RESULTS: A total of 68 consecutive patients were included. There were 34 patients in Group A and 34 patients in Group B. Average age was 65.2 versus 66.5 (p = 0.284), respectively. There were no significant gender differences between groups. Prevalence of co-morbidities of hypertension, coronary artery disease, and diabetes was similar to national rates in both groups. Contrast volume, fluoroscopy time, and procedure time in Group B were significantly less when compared by multiple regression to Group A, correcting for potential confounders (p = 0.0001, 0.0180, and 0.0008, respectively). CONCLUSION: Use of a PTA balloon with an integrated injection port shows potential for significant reduction in contrast dose, fluoroscopy time, and procedure time.

Regret Me Not: Examining the Relationship between Alcohol Consumption and Regrettable Experiences.

BACKGROUND: Alcohol use is a considerable public health concern, leading to negative health and adverse social consequences. Despite widespread knowledge and acceptance of these consequences many individuals continue to drink excessively. Lack of regret for these consequences may partially explain this. Objectives: To examine the prevalence of regrettable experiences and their role in future intentions to drink. Methods: In two studies (Study 1: cross-sectional; Study 2: longitudinal) participants reported on 18 regrettable experiences; from common regrets (e.g. hangover), to risky behaviors (e.g. drug taking), and serious regrets (e.g. driving under the influence), over a two-week period. Results: Prevalence of regrettable experiences was high (e.g. 79.0% of individuals in study 1 and 66.9% of individuals in study 2 experienced a hangover). Prevalence was greater for common regrets compared to risky behaviors and serious regrets. In study one, alcohol consumed over the previous fortnight predicted the number of different regrettable experiences over the same period. In study two, units consumed on a day-to-day basis predicted the number of regrets on that same basis. Neither study demonstrated evidence for the predictive utility of regrets for intentions to consume alcohol in the future. Conclusions: These findings suggest high prevalence of regrettable experiences, that are predicted by increased alcohol consumption. However, there was little evidence that increased number of experiences predicted future drinking intentions. Regrettable experiences are prevalent following consumption, however a focus on these regrets to deter future alcohol consumption may not be an effective psychological intervention.

A review of United States endovenous ablation practice trends from the Medicare Data Utilization and Payment Database.

OBJECTIVE: The growth of endovenous ablation in the United States over the last few years has raised concerns of overuse by many vascular societies and payers. Reasons for such growth are unclear (ie, increased awareness, less invasive procedure, or inappropriate overuse). The Medicare Provider Utilization and Payment database was analyzed to define metrics of current practice trends in Medicare patients by providers. METHODS: The Medicare Provider Utilization and Payment database was queried for endothermal ablation Current Procedural Terminology codes (36475, 36476, 36478, and 36479) from 2012 through 2015. These results were imported into a relational database program. Queries were designed to ascertain the practice trends of all providers, inclusive of all specialties, and the data were exported to a spreadsheet program for analysis. Analysis for ablations per patient was calculated by assessing the number of beneficiaries who underwent at least one ablation by a provider in relation to the total number of ablations performed by that provider. RESULTS: Most saphenous vein ablations were done by vascular surgeons (29%), cardiologists (21%), or general surgeons (14%). The remaining one-third was performed by 33 other provider specialties ranging from nuclear medicine specialists to ophthalmologists. Regional variation was significant with 51% of ablations being performed in the south (Florida, 15.7% and Texas, 11.4%). The Western region had the greatest percentage growth of 62% with the addition of 14,788 cases added between 2012 and 2015. Ablations per patient averaged 1.8 in the aggregate dataset. Over the 4-year period, there was a steady increase seen in the number of patients undergoing ablation, number of ablations performed, number of providers performing ablation, average amount of ablations being performed as well as the number and proportion of providers performing more than ablations per patient. The number of ablations per patient was higher than average in specialties without any formal vascular training. CONCLUSIONS: Endovenous ablation is performed by a wide variety of subspecialists with different levels of formal training for the management of chronic venous disease. This data analysis can help to establish better guidelines and governance over the use of endovenous ablation, but care should be taken to realize this is only an average and many patients will require more than two ablations for appropriate care. As our health care system shifts from a fee-for-service to a value-based system, and taxpayer-funded resources in Medicare patients become less available, it is important that practice trends be scrutinized using data-driven initiatives so that the appropriate physician treats the appropriate patient for the appropriate reasons.

Fistuloplasty using a radiation-and-time-saving sheathless balloon catheter.

INTRODUCTION: Sheath placement in dialysis access interventions is traditionally necessary to obtain imaging, guide percutaneous angioplasty, and evaluate results. The aim of this study was to assess the feasibility of performing sheathless Arterio-venous (AV) access interventions using a novel percutaneous angioplasty balloon catheter. METHODS: Between May and September 2017, data on all dialysis access interventions using a novel percutaneous angioplasty balloon with a dedicated injection port were collected. All procedures were performed without a sheath. Success was established as no conversion to sheath placement. Demographic data, location of lesion, time to perform procedure, amount of contrast used, radiation exposure, and access complications were recorded. Ultrasound was used to evaluate access site complications. RESULTS: Sheathless interventions were successful in 24 patients with the mean age of 62 years (29-94). There were 5 PTFE grafts and 19 native fistulas. Lesions were located anywhere from the arterial anastomosis to the cephalic arch. The average balloon size was 6 mm (5-7 mm), and the procedure time was 15.8 min (8-45 min). No access site complications were observed. CONCLUSION: Sheathless intervention is feasible with several potential advantages, including short procedure time, minimal contrast volume, and reduced radiation exposure. Finally, the lower profile at the access site may result in fewer complications.

Treatment pattern of consecutive patients with chronic venous disease.

BACKGROUND: No clear data exist on the treatment patterns in patients with chronic venous disease. This study was designed to determine how such patients were treated in our center. METHODS: Consecutive patients presenting for a vein consultation at our center were collected during a 9-month period, allotting for at least 6 months of follow-up. All patients had a detailed history and physical examination by experienced vascular surgeons and a complete venous ultrasound evaluation by registered vascular technologists having experience in venous imaging. Charts were reviewed for patient factors including body mass index, age, clinical class (Clinical, Etiology, Anatomy, and Pathophysiology [CEAP] classification), and treatment. Deidentified data from the chart review were entered into a local database. Queries were designed to identify trends in the data. The results of the queries were exported to a spreadsheet program for analysis per patient and per limb. RESULTS: There were 506 patients evaluated for venous disease during a period of 9 months. We identified 200 patients with chronic venous disease who required superficial vein treatment. There were 136 (68%) women. Ablation was required in 156 patients (78%), whereas 44 (22%) required only adjunctive therapy (microphlebectomy or sclerotherapy). The average number of ablations in patients with venous disease was 1.3 (259 ablations in 200 patients). In patients who needed at least one ablation, the average was 1.7 ablations per patient (259 ablations in 156 patients). Unilateral ablation was done in 94 patients (60%), and 62 patients (40%) had bilateral treatment. Of those who underwent unilateral ablations, 61% required adjunctive treatment of the contralateral limb. In patients who required only adjunctive therapy (no ablation), 73% underwent bilateral treatment. There were 182 limbs (45.5%) that did not require ablation as no reflux was found in the saphenous systems. Of the 156 patients who underwent ablation, 218 limbs had at least one ablation; 52% of limbs had C2 disease and on average underwent 1.1 ablations/limb. Only 7 of 113 (6%) limbs required more than one ablation. Average ablations per limb increased with clinical class, C3 having 1.2 ablations/limb, C4 having 1.4 ablations/limb, and C5 and C6 having 1.56 ablations/limb. CONCLUSIONS: Patients with venous disease required on average 1.3 ablations/patient. Most (78%) require at least one ablation for an average of 1.7 ablations/patient. There were 182 limbs (45.5%) with no saphenous reflux that did not require an ablation. The average number of ablations/limb increased with CEAP class.

Pathophysiology of venous ulceration.

Our understanding of the pathophysiologic process of venous ulceration has dramatically increased during the past two decades because of dedicated, venous-specific basic science research. Currently, the mechanisms regulating venous ulceration are a combination of macroscopic and microscopic pathologic processes. Macroscopic alterations refer to pathologic processes related to varicose vein formation, vein wall architecture, and cellular abnormalities that impair venous function. These processes are primarily caused by genetic factors that lead to the destruction of normal vein wall architecture and venous hypertension. Venous hypertension causes a chronic inflammatory response that over time can cause venous ulceration. The inciting inflammatory injury is chronic extravasation of macromolecules and red blood cell degradation products and iron overload. Chronic inflammation causes white blood cell extravasation into the dermis with secretion of numerous proinflammatory cytokines. These cytokines transform the phenotype of fibroblasts to a contractile phenotype that increases tension in the dermis. In addition, iron overload keeps macrophages in an M1 phenotype, which leads to tissue destruction instead of dermal repair. Current surgical and medical therapies are primarily directed at eliminating venous hypertension and promoting venous ulcer wound healing. Despite advances in our understanding of venous ulcer formation and healing, ulcers still take an average of 6 months to heal, and ulcer recurrence rates at 5 years are >58%. To improve the care of patients with venous ulcers, we need to further our understanding of the underlying pathologic events that lead to ulcer formation, prevent healing, and decrease ulcer-free recurrence intervals.

Invasive ductal carcinoma of the breast with clear cell and pseudo-lactating changes.

Invasive ductal carcinoma of the breast with clear cell changes is a very rare pathological entity. There are <150 cases of this breast cancer subtype reported in the literature. Clear cell carcinoma could be easily missed or under-diagnosed in a breast core biopsy specimen due to the fact that this subtype tends to show a papillary pattern with clear cell and pseudo-lactating changes, especially in young female patients. Normal breast tissue may possess clear cells as a consequence of the physiological changes of pregnancy, the clearing of the cytoplasm within myoepithelial cells, or the clearing of the cytoplasm in apocrine metaplasia. Owing to its aggressive clinical course, clear cell carcinoma must be differentiated from other subtypes of breast carcinoma. Special attention given to this rare subtype by pathologists and clinicians could avoid misdiagnosis and delay of treatment.