'The convenience is a double-edged sword': Qualitative interviews with people who use online alcohol delivery services

INTRODUCTION

The past decade has seen a shift towards online purchasing and home delivery of alcohol, with this trend accelerated due to the COVID-19 pandemic. However, research in this area is limited. This study aims to explore how and why people use online alcohol delivery services.

METHODS

Semi-structured qualitative interviews (mean = 12.5 min; range = 7-19.5 min) with a convenience sample of 40 Australians ≥18 years who purchase alcohol online for delivery at least once per month. Reflexive thematic analysis was used to analyse and report the data.

RESULTS

Three themes were generated. (i) The convenience is a 'double-edged sword': almost all participants expressed that they use alcohol delivery services because they reduce difficulty in obtaining alcohol by saving time or energy/effort; however, for some this could lead them to purchase and consume more alcohol than they otherwise would have. (ii) Cost savings motivate online purchases: some participants expressed that they could access alcohol more cheaply online than in-store due to promotions, cost-comparisons and the ability to shop at low-cost outlets. (iii) Initiating or increasing use during the COVID-19 pandemic: for some people continued or increased use had been maintained as they had grown accustomed to the convenience or changed shopping habits.

DISCUSSION AND CONCLUSION

Participants purchased alcohol online for home delivery primarily for convenience; however, for some the convenience could lead them to purchase and consume more alcohol than they otherwise would have. Targeted improvements to the regulation of these services are needed to minimise the risks they may pose for alcohol harm.

Cross-sectional survey of a convenience sample of Australians who use alcohol home delivery services

INTRODUCTION

Online alcohol purchasing and home delivery has increased in recent years, accelerated by the onset of the coronavirus disease 2019 pandemic. This article aims to investigate the purchasing and drinking behaviour of Australians who use online alcohol delivery services.

METHOD

A cross-sectional self-report survey with a convenience sample of 1158 Australians ≥18 years (49.3% female) who used an online alcohol delivery service in the past 3 months, recruited through paid social media advertisements from September to November 2021. Quota sampling was used to obtain a sample with age and gender strata proportional to the Australian adult population. Descriptive statistics were generated and logistic regression used to explore variables that predict hazardous/harmful drinking (Alcohol Use Disorders Identification Test score ≥8).

RESULTS

One-in-five (20.1%, 95% confidence interval [CI] 17.8-22.5) participants had used an alcohol delivery service to extend a home drinking session because they had run out of alcohol and wanted to continue drinking and, of these, one-third (33.9%, 95% CI 27.9-40.4) indicated that if the service was not available they would have stopped drinking. Using delivery services in this way was associated with six times higher odds of drinking at hazardous/harmful levels (odds ratio 6.26, 95% CI 3.78-10.36). Participants ≤25 years were significantly more likely to report never having their identification verified when receiving their alcohol delivery at the door compared with purchasing takeaway alcohol in-person at a bottle shop (p < 0.001, McNemar).

DISCUSSION AND CONCLUSION

Given the risks associated with alcohol delivery, regulation of these services should be improved to meet the same standards as bricks-and-mortar bottle shops.

You've got mail: Drinks are on sale! A study to assess volume and content of direct marketing received from online alcohol retailers in Australia

BACKGROUND

Customers of online alcohol retailers are exposed to marketing displayed on alcohol retailers' websites and may also receive direct marketing via email and text message once contact details are provided in an online sale. To date, this direct marketing activity from online alcohol retailers has not been studied. This study aims to document the quantity and content of marketing material received by customers of online alcohol retailers in Australia, and whether the material complies with relevant regulation.

METHODS

A cross-sectional study of direct marketing from the 100 most popular online alcohol retailers in Australia. Marketing material received via email and text message was collected for three-months from March to June 2021. Email and text messages were coded for 17 variables in four categories: primary purpose of the communication; compliance with relevant regulations; marketing themes and practices used; and offers, promotions, and discounts.

RESULTS

We received 1496 emails from 85 of the 100 retailers. Of the retailers who sent emails, the number sent varied widely (Mdn=8; IQR=2-21). Seven retailers sent a total of 18 text messages. The primary purpose of most emails (67.4%) was to advertise a special or offer a discount. Almost all emails (98.6%) complied with spam legislation to include an unsubscribe link, but around half (46.5%) of emails from retailers in jurisdictions where the inclusion of a liquor license number is mandatory, failed to include one. The most common marketing theme was to link specific times or events to drinking (18.8%). Almost half (48.5%) of emails advertised free or discounted delivery for purchasing over a specified threshold.

CONCLUSION

Most online alcohol retailers in Australia are engaging in direct marketing to their customers via email. More research is needed to understand how these emails may influence purchasing and consumption.

1000 Basal-Squamous Cell Carcinoma Collision Tumour Of the Preauricular Region

Case description

An 87-year-old farmer presented to the Maxillofacial Surgery department following referral by his general practitioner concerned with multiple suspected skin neoplasms. Four lesions were identified, two of which required surgical excision with 4mm margins. Following histological investigation, the lesion in the right preauricular area was identified as a basal-squamous cell carcinoma collision tumour which was completely excised with clear margins.

Discussion

This case highlights the possibility of multiple skin neoplasms in a single site and gives an insight into the surgical management of a basal-squamous cell carcinoma collision tumour while aiming to increase clinician awareness of collision tumours especially in high-risk sites such as the head and neck. This case suggests that a 4-5mm surgical margin may be sufficient in removing similar presentations of basal-squamous cell carcinoma collision tumours however highlights the importance of appropriate histological examination of specimens not only to correctly diagnose the tumour but to ensure surgical margins are clear to mitigate recurrence risk. It must be noted that systemic metastases are more common in squamous cell carcinoma than in basal cell carcinoma cases and therefore it is possible that basal-squamous cell carcinoma collision tumours may have higher rates of metastases than traditional basal cell carcinomas.

452 Dermal Filler Injection Leading to Facial Cellulitis: A Case Report

Background

Aesthetic medicine is a rapidly expanding field that is progressively becoming a normal part of society’s health and beauty regime. Hyaluronic Acid dermal filler injections are the second most widely performed aesthetic procedure, following Botulinum Toxin type A. Although serious complications are rare, they can have a detrimental impact on aesthetic outcome and general health. Infections following dermal fillers can be difficult to treat and have the potential to require hospital admission, intravenous antibiotics and surgical intervention.

Case description

We present a case of a 41-year-old female who suffered from facial cellulitis as a consequence of palpebro-malar groove dermal filler injections. The patient had 0.1ml of Monalisa dermal filler injected over her right malar prominence and suffered complications 6 days later, which eventually lead to the need for hospital admission on day 12 following the procedure for intravenous antibiotics. The management of this aesthetic procedure complication is outlined to highlight the risks and serious complications of these procedures.

Conclusions

Facial cellulitis is a rare adverse event following facial filler injection; however, it is an important risk factor to discuss during the consent process for these procedures. In addition, it is important that a highly trained and skilled professional performs these injections using a sterile non-touch technique due to the potential for serious complications and the anatomical proximity to vital structures.

Smartphone apps for managing alcohol consumption: a literature review

Background

Smartphone applications (apps) designed to assist users to reduce hazardous and harmful alcohol consumption show potential as an inexpensive alternative to traditional brief intervention in primary care. The aim of this paper is to provide an overview of the literature on alcohol reduction apps and the availability of evidenced-based apps on top commercial app stores.

Methods

We reviewed literature through to December 2019 using the databases PubMed, MEDLINE, PsycINFO and Google Scholar and keyword search terms smartphone/mobile/phone AND application/app AND alcohol. Articles were included if the primary intervention was a smartphone app and the study measured participant changes in frequency or volume of alcohol consumption.

Results

21 relevant articles were identified that evaluated 19 unique smartphone apps. Of the 19 unique apps, seven were designed for use among youth and 12 in adult populations. The available evidence for the efficacy of alcohol reduction apps among youth is inconclusive, with results from these evaluations not showing a clear benefit in reducing alcohol consumption compared to control groups. The results of apps designed for adult populations appears more promising, but results are still mixed. Of the 19 alcohol reduction apps that have been evaluated only eight of these are currently publicly available in commercial app stores. Of these eight apps, only four were demonstrated in the literature to assist with reducing alcohol consumption.

Conclusion

The evidence for alcohol reduction apps is promising but inconclusive. Few apps that have been evaluated in the scientific literature are currently available for download in commercial app stores.

Does the great auricular nerve predict the size of the main trunk of the facial nerve? A clinical and cadaveric study

There seems to be only individual clinical experience and some anecdotal evidence about a relation between the width of the great auricular nerve (GAN) and the size of the main trunk of the facial nerve during parotidectomy. To our knowledge no anatomical studies have been published. In this cadaveric and clinical study we measured the widest point of the GAN as it crosses the sternomastoid muscle before it divides, and the main trunk of the facial nerve before it bifurcates. Measurements were obtained from 16 patients who required formal superficial parotidectomies with identification of the facial nerve, and from 21 cadavers (16 formalin-fixed and 5 fresh frozen) where both sides were dissected. We recorded the results and the side of dissection. The mean (SD) width of the GAN and facial nerve from all the dissections was 2.75 (0.53)mm and 2.83 (0.54)mm, respectively. There was a strong correlation between the width of the nerves from both sides (left: r=0.934, p<0.001; right: r=0.940, p<0.001). The nerves did not differ significantly in size in patients or cadavers (GAN: right, p=0.873; left, p=0.486; facial nerve: right, p=0.931; left, p=0.691). We have found that the GAN accurately predicts the width of the main trunk of the facial nerve. This is particularly useful surgically as a narrow GAN can alert the surgeon to expect a small facial nerve.

Short communications published online in the British Journal of Oral and Maxillofacial Surgery during 2010-2011

The British Journal of Oral and Maxillofacial Surgery (BJOMS) publishes many types of papers including original articles, review articles, and short communications. Many of the latter are isolated case reports of rare or interesting diseases or of difficult or unexpected complications. While case reports are sometimes considered to be of little educational or clinical value, and as such do little to advance medical knowledge, they do have an important role, and many trainees begin their publishing careers writing such papers. There is increasing pressure for space in paper medical journals and, for this reason, some journals either limit or do not publish short publications in print copy but instead put them online. Using established criteria, we previously evaluated all 142 short communications published in the BJOMS during 2008-2009 and found that 48% of them had little or no educational value. As a result, the editorial board of BJOMS took the decision to publish most short communications online only. We have now analysed 48 short communications that were published online only during 2010-2011. Most (80%) were single case reports that covered virtually the whole remit of the specialty, and over half (56%) were published by authors based in the UK. While many of these papers did not add important new information to existing knowledge, these types of article are clearly of value both for trainees and for experienced surgeons. We think that these should continue to be supported as, in addition to their educational value, they are an excellent way for trainees to start to write.

Acute vasculitis resulting in free flap failure: the importance of early recognition and options for management

Unusual or unexpected medical causes for free flap failure do occur but are uncommon. We present a rare case of a fibula free flap failure due to an acute vasculitis which was undiagnosed until after the flap had failed. In addition to two successful flap salvages and intravenous heparin, an epoprostenol infusion was commenced but a third salvage was not successful. The vasculitis resulted in marked blood vessel wall thickening, and cutaneous manifestations which presented as late signs. High peri-nuclear anti nuclear cytoplasmic antibody (pANCA) and myeloperoxidase (MOP) titres were subsequently found and histology from several blood vessels showed marked inflammation throughout the wall. A diagnosis of microscopic polyangiitis was made and high dose steroids were subsequently commenced. Interestingly, he had vasculitis several years previously treated with oral steroids but had been discharged from the rheumatology clinic. This rare case illustrates the potential hazards of free flap surgery in the vasculitides and discusses the warning signs and various management options to reduce the likelihood of flap failure in these patients.

Interference with judgements of control and learning as a result of prior exposure to controllable and uncontrollable feedback during concept-learning tasks

Two experiments examined whether exposure to an uncontrollable relationship between an action and its outcome during a nonaversive pretreatment phase would attenuate subsequent ratings of control given to actions emitted by subjects. In Experiment 1, such an interference effect was demonstrated relative to a group that received prior training with a controllable action-outcome relationship, and relative to a group not exposed to any prior relationship. In Experiment 2, these effects were replicated, and interference was also found to occur when learning a maze task. Thus, the effects of helplessness were shown to be quite general, to be produced by a nonaversive induction procedure, and to occur most readily when the current contingency between action and outcome was weakest.

The effect of rectal diclofenac on pruritus in patients receiving intrathecal morphine

In this prospective randomised study, pruritus and pain were evaluated in patients undergoing abdominal surgery in which intrathecal morphine was administered. Each patient received intrathecal morphine 0.3 mg prior to induction, followed by a standard anaesthetic. The patients were randomly allocated to one of two groups. One group received 100 mg of rectal diclofenac immediately post-induction. Patients receiving diclofenac had significantly lower pruritus scores at 30 min (p = 0.0076), 2, 4, 8 and 24 h postoperatively, as well as significantly reduced pain scores at each time point (p < 0.0001 at each study interval). Morphine consumption in the first 24 h was also significantly lower in this group. In conclusion, rectal administration of diclofenac significantly reduces the incidence and severity of postoperative pruritus. It also significantly reduces pain and further analgesic requirements postoperatively.

The effect of intravenous tenoxicam on pruritus in patients receiving epidural fentanyl

In this prospective randomised study, pruritus and pain were evaluated in patients undergoing abdominal surgery during which epidural fentanyl was administered. All patients had an epidural catheter inserted at the time of surgery. Epidural fentanyl 100 micrograms was administered intra-operatively and infused at a concentration of 2 micrograms.ml-1 for 48 h postoperatively. All patients received a standard anaesthetic and, in addition, the study group had a 20 mg bolus of tenoxicam intravenously, intra-operatively. Patients receiving tenoxicam demonstrated significantly lower pruritus and pain scores at 30 min, 2, 4, 8 and 24 h postoperatively as well as reduced pethidine requirements for breakthrough pain in the first 24 h. In conclusion, tenoxicam 20 mg significantly reduces the incidence and severity of postoperative pruritus in patients who received peri-operative epidural fentanyl. In addition, it significantly reduces pain and further analgesic requirements postoperatively.

Analgesia following appendicectomy--the value of peritoneal bupivacaine

PURPOSE

Peritoneal inflammation is an important feature in many patients presenting with appendicitis. The contribution of peritoneal nerve fibres to pain experienced after appendicectomy has received little attention.

METHOD

In this prospective double blind randomized study a consecutive series of 60 patients undergoing appendicectomy for suspected appendicitis were enrolled. A dose of 1.5 mg.kg-1 bupivacaine 0.5% was used. Group one patients received the entire dose of bupivacaine subcutaneously. Group two patients received half the dose subcutaneously (s.c.) and half the dose to the peritoneum. Pain scores were assessed pre-operatively and at 30 min, 12 and 24 hr post-operatively using a visual analogue scale. Time to first analgesia and total analgesia requirements in the first 24 hr were recorded.

RESULTS

The patients receiving the s.c. combined with peritoneal bupivacaine had a lower pain score 30 min post-operatively (32 +/- 2 vs 54 +/- 4; P < 0.0001), a longer time to first analgesia (248 +/- 20 vs 164 +/- 17 min; P = 0.002) as well as lower opioid (68 +/- 5 vs 100 +/- 7 mg; P = 0.0002) and non steroidal analgesic requirements (65 +/- 6 vs 96 +/- 6 mg; P = 0.007) in the first 24 hr post-operatively.

CONCLUSION

A combination of s.c. and peritoneal infiltration with bupivacaine is superior to skin infiltration alone in the relief of pain post appendicectomy.

Vestibular function in Belgian Waterslager canaries (Serinus canarius)

The purpose of this study was to measure vestibular function in Belgian Waterslager canaries using short latency vestibular evoked potentials (VsEPs) elicited by linear acceleration stimuli. Responses were recorded with vertex to mastoid leads using traditional signal averaging. Response thresholds, latencies, and amplitudes were quantified and compared to non-Waterslager controls. Cochlear and vestibular organs were also processed for scanning electron microscopy. Results indicated that vestibular response thresholds were slightly, but significantly, higher for Belgian Waterslager canaries and response amplitudes at 0 dBre: 1.0 g/ms were significantly reduced compared to non-Waterslagers. Response peak latencies were not significantly different. The most striking morphological finding was that the stereociliary bundles of Waterslager saccular hair cells showed no common orientation. Previous reports have also found significantly less hair cells in Waterslager saccules (Weisleder and Park, Hear. Res. 80 (1994) 64-70); however, the present study did not confirm this finding. The utricle and ampullae appeared normal. The present results indicate that vestibular neural function, as measured with VsEPs, is affected in Belgian Waterslager canaries. The results also suggest that one structural correlate of the functional loss is the disordered stereociliary bundles in the sacculus.

The adequate stimulus for avian short latency vestibular responses to linear translation

Transient linear acceleration stimuli have been shown to elicit eighth nerve vestibular compound action potentials in birds and mammals. The present study was undertaken to better define the nature of the adequate stimulus for neurons generating the response in the chicken (Gallus domesticus). In particular, the study evaluated the question of whether the neurons studied are most sensitive to the maximum level of linear acceleration achieved or to the rate of change in acceleration (da/dt, or jerk). To do this, vestibular response thresholds were measured as a function of stimulus onset slope. Traditional computer signal averaging was used to record responses to pulsed linear acceleration stimuli. Stimulus onset slope was systematically varied. Acceleration thresholds decreased with increasing stimulus onset slope (decreasing stimulus rise time). When stimuli were expressed in units of jerk (g/ms), thresholds were virtually constant for all stimulus rise times. Moreover, stimuli having identical jerk magnitudes but widely varying peak acceleration levels produced virtually identical responses. Vestibular response thresholds, latencies and amplitudes appear to be determined strictly by stimulus jerk magnitudes. Stimulus attributes such as peak acceleration or rise time alone do not provide sufficient information to predict response parameter quantities. Indeed, the major response parameters were shown to be virtually independent of peak acceleration levels or rise time when these stimulus features were isolated and considered separately. It is concluded that the neurons generating short latency vestibular evoked potentials do so as "jerk encoders" in the chicken. Primary afferents classified as "irregular", and which traditionally fall into the broad category of "dynamic" or "phasic" neurons, would seem to be the most likely candidates for the neural generators of short latency vestibular compound action potentials.

Cardiac output during liver transplantation

PURPOSE

Measurement of cardiac output is an essential part of anaesthetic practice in patients undergoing major operative procedures. A thermodilution technique, using a pulmonary artery catheter is currently accepted as the gold standard in clinical practice. However its use is associated with several limitations.

METHOD

In this prospective randomised controlled study measurement of cardiac output, an oesophageal Doppler monitor (ODM) was compared with the thermodilution technique in 18 patients undergoing orthotopic liver transplantation. Measurements were taken during the three phases of liver transplantation, i) dissection phase (three measurements), ii) anhepatic phase (four) and iii) reperfusion phase (six).

RESULTS

There were no differences observed between the two measurements at any of the times studied and a strong correlation was observed (r = 0.714; P < 0.00001). However, when the data was analysed using Bland and Altman analysis, while the mean difference was small (0.07 l.min-1) it was > 2 l.min-1 in one third of measurements recorded i.e., the bias was near zero but the precision was large. No consistent differences were seen using the two methods in individual patients.

CONCLUSION

The use of the ODM results in cardiac output measurements which are considerably different from those obtained using thermodilution and its use cannot be recommended in patients undergoing orthotopic liver transplantation.

Swan Ganz catheter--all in a knot

In this case report an unusual complication is described following insertion of a Swan Ganz catheter. A 79-year-old male patient experienced knotting of the catheter. Methods of avoiding this problem and removal of a knotted catheter are discussed.

Haemodynamic changes with the laryngeal mask airway--off the cuff

The cross-sectional area of the common carotid artery bulb was measured using a 5 MHz pulse wave Doppler probe in a patient undergoing general anaesthesia using a laryngeal mask airway (LMA). A simultaneous measurement of blood velocity was performed to allow determination of the blood flow. Following inflation of the cuff on the LMA, the cross-sectional area of the right carotid artery bulb decreased from 1.09 to 0.89 cm2, flow velocity increased 120 to 176 cm s-1 and the blood flow increased from 130.8 to 156.6 cm3 s-1. On the left the cross-sectional area decreased from 1.16 to 1.13 cm2, the velocity increased 136 to 151 cm s-1 and the blood flow increased from 157.8 to 170.6 cm3 s-1. While a reduction in cross-sectional area was observed in the carotid bulb in this patient, this was accompanied by an increase in the velocity and a consequent increase in blood flow. In patients with atheromatous disease involving the carotid arteries this decrease in cross-sectional area may prove clinically significant. The use of the LMA may not be suitable for this population.

Human immunodeficiency virus and hepatitis--implications for operating room personnel

Human Immunodeficiency Virus, Hepatitis B and C are important blood borne viruses and pose occupational risks for operating room personnel. Increasing numbers of patients with these infections are appearing in Irish hospitals. In this review we describe in detail the occupational risks of these blood borne viruses for operating room personnel and how best to minimise them.