GPs' practice and attitudes to initiating isotretinoin for acne vulgaris in Ireland: a cross-sectional questionnaire survey in primary care.

BACKGROUND: Isotretinoin is prescribed in secondary care for severe acne vulgaris. Anecdotal reports suggest that GPs in Ireland currently initiate isotretinoin. AIM: To ascertain the prevalence and management of isotretinoin in Irish general practice and to describe GPs' attitudes about the use of isotretinoin in Ireland. DESIGN AND SETTING: A cross-sectional questionnaire survey of GPs in Ireland between October 2018 and February 2019. METHOD: Two short questionnaires were developed: one for GPs who prescribe isotretinoin and one for GPs who do not prescribe isotretinoin. Questionnaires were distributed via email and online via GP Forum to GPs in Ireland. RESULTS: Of a total 298 GPs who completed the questionnaire, 52 (17%) initiated isotretinoin. Older GPs (aged 35 years) and male GPs were more likely to prescribe isotretinoin. GPs cited prolonged dermatology waiting lists (n = 34, 65%) and a special interest in dermatology (n = 31, 60%) as two key drivers to initiating isotretinoin. However, this study found evidence of suboptimal blood monitoring, pregnancy testing, and contraceptive advice. Most GPs (n = 246, 83%) did not initiate isotretinoin and identified multiple barriers: medicolegal concerns (n = 150, 61%), being unaware that GPs may initiate isotretinoin (n = 135, 55%), and being unfamiliar with managing isotretinoin (n = 102, 41%). Important enablers to initiating isotretinoin cited by GPs include Irish College of General Practitioners guidelines (n = 118, 48%) and dermatologist support (n = 119, 48%). Two-thirds of the GPs questioned (n = 164, 67%) expressed an interest in initiating isotretinoin and most (n = 223, 91%) agreed that GPs can safely manage isotretinoin. CONCLUSION: Few GPs in Ireland currently initiate treatment of acne with isotretinoin, and there is suboptimal adherence to recommended monitoring. Barriers to and enablers for GPs initiating isotretinoin were identified. Most GPs expressed an interest in initiating isotretinoin.

Effects of acute sleep deprivation and caffeine supplementation on anaerobic performance.

PURPOSE: Athletes involved in team sports may be subject to varying degrees of sleep deprivation either before or after training and competition. Despite the belief among athletes and coaches of the importance of adequate sleep for ensuing performance, the effect of sleep loss on team-sport anaerobic performance remains unclear. There is conflicting evidence in the scientific literature as to the impact of acute sleep deprivation and caffeine supplementation on anaerobic performance indices. The purpose of this study is to investigate the effect of 24 hours of acute sleep deprivation on anaerobic performance and the effect of caffeine supplementation on anaerobic performance in the sleep deprived state. METHODS: 11 club level games players (n=11, 25±4 yr, 178±7.5 cm, 80.2±10.4 kg, 15.1±5.6% body fat) participated in a repeated measures double-blinded placebo control trial. Following familiarisation, each participant returned for testing on three separate occasions. One of the testing sessions took place following a night of normal sleep and the other two sessions took place following 24 hours of sleep deprivation with supplementation of either placebo or 6 mg.kg- 1 of caffeine. During each testing session participants performed the vertical jump height, 20-m straight sprint, Illinois speed agility test and 5-m shuttle run. RESULTS: No significant differences were detected comparing non sleep deprived and sleep deprived interventions in any of the assessed outcome measures. There were also no significant differences observed in any of the outcome measures when comparing caffeine and placebo data in the sleep deprived state. CONCLUSION: In this cohort of athletes, a 24-h period of acute sleep deprivation did not have any significant impact on anaerobic performance. Caffeine also did not have any effect of on anaerobic performance in the sleep-deprived state.

Acute Effects of 24-h Sleep Deprivation on Salivary Cortisol and Testosterone Concentrations and Testosterone to Cortisol Ratio Following Supplementation with Caffeine or Placebo.

Caffeine has become a popular ergogenic aid amongst athletes and usage to improve athletic performance has been well documented. The effect of caffeine on anabolic and catabolic hormones in a sleep-deprived s tate has had little investigation to date. The purpose of the current study was to investigate the potential of caffeine to offset the effects, if any, of short-term sleep deprivation and exercise on an athlete's testosterone and cortisol concentrations via salivary technique. Eleven competitive male athletes volunteered to be part of this prospective double-blinded study. Three test days were scheduled for each athlete; one non-sleep deprived, one sleep-deprived with caffeine supplementation (6 mg.kg-1) and one sleep-deprived with placebo ingestion. Sleep deprivation was defined as 24-h without sleep. Each test day was composed of 2 aerobic components: a modified Hoff test and a Yo-Yo test. Testosterone and cortisol concentrations were measured via salivary analysis at 4 different time-points; T1 to T4, representing baseline, and pre- and post-aerobic components, respectively. Overall no significant differences were detected comparing the different sleep states for testosterone or cortisol concentrations. A trend existed whereby the sleep-deprived with caffeine ingestion state mirrored the non-sleep deprived state for cortisol concentration. Therefore, caffeine supplementation may have potential benefits for athletes during short-term aerobic exercise when sleep-deprived. An increase in mean testosterone concentration post-aerobic exercise was only observed in the sleep-deprived with caffeine ingestion state.