The effects of acute aerobic exercise on cognitive functions in humans have been the subject of much investigation; however, these studies are limited by several factors, including a lack of randomized controlled designs, focus on only a single cognitive function, and testing during or shortly after exercise. Using a randomized controlled design, the present study asked how a single bout of aerobic exercise affects a range of frontal- and medial temporal lobe-dependent cognitive functions and how long these effects last. We randomly assigned 85 subjects to either a vigorous intensity acute aerobic exercise group or a video watching control group. All subjects completed a battery of cognitive tasks both before and 30, 60, 90, or 120 min after the intervention. This battery included the Hopkins Verbal Learning Test-Revised, the Modified Benton Visual Retention Test, the Stroop Color and Word Test, the Symbol Digit Modalities Test, the Digit Span Test, the Trail Making Test, and the Controlled Oral Word Association Test. Based on these measures, composite scores were formed to independently assess prefrontal cortex- and hippocampal-dependent cognition. A three-way mixed Analysis of Variance was used to determine whether differences existed between groups in the change in cognitive function from pre- to post-intervention testing. Acute exercise improved prefrontal cortex- but not hippocampal-dependent functioning, with no differences found between delay groups. Vigorous acute aerobic exercise has beneficial effects on prefrontal cortex-dependent cognition and these effects can last for up to 2 hr after exercise.
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IMPORTANCEThe ongoing opioid epidemic in the United States has been fueled by prescription opioids. Increases in opioid-related deaths and complications mandate clinicians in all fields to scrutinize their prescribing patterns. OBJECTIVE To characterize the current status and potential complications of opioid prescribing practices among dermatologists for Medicare beneficiaries. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study used Medicare Part D prescriber data to evaluate opioid prescriptions by dermatologists from January 1 to December 31, 2014. The number of prescribers, opioid claims, beneficiaries, and days supplied as well as the type of opioid and geographic location of prescribers were extracted and analyzed. The top 1% of dermatologists prescribing opioids were identified and compared with a random sample of the same size among the remaining dermatologists based on sex, geographic location, type of practice, and time in practice. A systematic literature review was conducted to estimate the outcome of opioid prescribing practices on the exposed population.MAIN OUTCOME AND MEASURES Practice characteristics, epidemiologic factors, and consequences of opioids prescribed by dermatologists. RESULTSOf the 12 537 dermatologists in the study, 5305 (42.3%) prescribed no opioid claims, 5408 (43.1%) prescribed 1 to 10 opioid claims, and 1824 (14.5%) prescribed more than 10 opioid claims. Among dermatologists prescribing at least 10 opioid claims, a mean of 1.0 opioid claims was given to each beneficiary, with a supply lasting a mean of 4.4 days. A total of 108 dermatologists (93.9%) in the top 1% of opioid prescribers (n = 115) work in a surgical practice. Estimates suggest that opioids prescribed by dermatologists could annually lead to 3877 to 7602 beneficiaries continuing to use opioids at 1 year and 1825 to 4209 continuing to use opioids at 3 years. A total of 9882 to 22 806 beneficiaries could experience gastrointestinal tract or central nervous system adverse effects and 588 to 999 could experience fractures. CONCLUSIONS AND RELEVANCE Opioid prescribing among dermatologists is limited and concentrated in the surgical setting, but it may be associated with a substantial number of adverse events that serve as a reminder to emphasize nonopioid pain medications in the postoperative setting.Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. 30.Sniezek PJ, Brodland DG, Zitelli JA. A randomized controlled trial comparing acetaminophen, acetaminophen and ibuprofen, and acetaminophen and codeine for postoperative pain relief after Mohs surgery and cutaneous reconstruction.
Melanoma has historically been thought to be radioresistant, and postoperative radiation therapy (RT) has typically been sparingly used. Although the role of RT in melanoma remains controversial, RT has been established as a palliative treatment option for unresectable melanoma, and the TROG 02.01 trials observed that RT following lymphadenectomy for selected patients with node-positive melanoma reduces risk of locoregional recurrence. We analyzed national patterns of care regarding utilization of adjuvant RT for melanoma. We evaluated all melanoma patients who received surgery between 2004-2014 and lymph node dissection in the National Cancer Database (NCDB). Inclusion criteria included: age ! 18 years and positive lymph node involvement. Patients with metastatic disease, in situ histology, and palliative intent therapy were excluded. The proportion of those who received adjuvant RT increased from 1.92% in 2004-2008 to 2.34% in 2009-2014 (p<0.001). Factors associated with increased adjuvant RT use included sex (1.50% in females vs 2.73% in males, p<0.001), older age (1.90% in <65yrs vs 2.72% in 65+yrs, p<0.001), and more lymph nodes dissected (1.07% in 0-5 nodes vs 6.40% in 6+ nodes, p<0.001). The rising use of RT in melanoma within the past decade may reflect the updated reappraisal of the value of adjuvant RT in melanoma. Further investigation into the disease benefits of RT warrants further investigation. 267Regional disparities in healthcare utilization and costs of atopic dermatitis Regional differences in the utilization and costs of dermatologic care are seldom explored. 271From clinical to genotypic modeling: Recessive Dystrophic Epidermolysis Bullosa (RDEB)
Objective. There is insufficient evidence to generate skin cancer screening guidelines at the population level, resulting in arbitrary variation in patient selection for screening skin examinations. This study was aimed at developing an easy-to-use predictive model of nonmelanoma skin cancer (NMSC) risk on screening total body skin examination (TBSE). Methods. This epidemiologic assessment utilized data from a prospective, multicenter international study from primarily academic outpatient dermatology clinics. Potential predictors of NMSC on screening TBSE were identified and used to generate a multivariable model that was converted into a point-based scoring system. The performance characteristics of the model were validated in a second data set from two healthcare institutions in the United States. Results. 8,501 patients were included. Statistically significant predictors of NMSC on screening TBSE included age, skin phototype, and history of NMSC. A multivariable model and point-based scoring system using these predictors exhibited high discrimination (AUC = 0.82). Conclusion. A simple three-variable model, abbreviated as CAP (cancer history, age, phototype) can accurately predict the risk of NMSC on screening TBSE by dermatology. This tool may be used in clinical decision making to enhance the yield of screening TBSE.
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