Analysis of infant lumbar puncture success rates: sitting flexed versus lateral flexed positions.

OBJECTIVES: The primary objective was to determine whether the sitting flexed position yields higher success rates of obtaining cerebrospinal fluid (CSF) for culture. The secondary objectives were to determine whether the sitting flexed position yields higher success rates of obtaining the following: CSF for cell count, non-traumatic CSF, and CSF on the first attempt. METHODS: The study investigator performed a retrospective chart review of infants 0 to 365 days of age who had a lumbar puncture (LP) performed from January 1 to December 31 of 2010. Data on the LP position and the number of attempts were abstracted from procedure notes. Twenty-one LPs were excluded because of incomplete data on LP position and/or number of attempts. Spinal fluid count results were obtained from electronic medical records. Non-traumatic LPs were defined in 2 categories: CSF red blood cell counts of 500 cells per cubic millimeter or less and 10,000 cells per cubic millimeter or less. RESULTS: One hundred thirty-two LPs were included: 30 sitting flexed and 102 lateral flexed. There were no differences in success rates between positions for the primary objective of obtaining CSF for culture and the secondary study objectives of obtaining CSF for cell count and non-traumatic CSF. A significant secondary objective was that operators who performed the LP in the sitting flexed position were more likely to obtain CSF on the first attempt (odds ratio, 2.74; confidence interval, 1.17-6.45). CONCLUSIONS: The sitting flexed position was as successful as the lateral flexed position in the primary objective of obtaining CSF for culture and the secondary objectives of obtaining CSF for cell count and non-traumatic CSF. For the secondary objective of obtaining CSF on the first attempt, the sitting flexed position was associated with a higher rate of obtaining CSF on the first attempt in infants younger than 12 months.

Career longevity in clinical pediatric emergency medicine.

OBJECTIVES: Pediatric emergency medicine (PEM) is more than a quarter of a century old; yet, very little is known about the career longevity of its practitioners. The purpose of our survey was to examine different aspects of career longevity in the clinical practice of PEM. METHODS: An electronic survey was mailed in November 2008 to all members of the section on pediatric emergency medicine at the American Academy of Pediatrics who were older than 50 years. The survey consisted of 10 questions concerning demographic data, years of practice, clinical load, and retirement expectations. RESULTS: One hundred three of the 408 mailed surveys were returned (response rate, 25.2%). The survey participants were 55.25 +/- 5.15 years old (range, 50-81 years) 70% were male, 84.5% were PEM board certified, and they had been in practice for 20.20 +/- 6.16 years (range, 3-32 years). Fifteen of the study participants had retired from clinical practice of PEM. Those clinically active work on 21.82 +/- 10.95 clinical hours per week, 50% work overnight shifts, 97% work on weekends, 94% work on holidays, and 70% work on shifts longer than 8 hours. Study participants expect to retire from clinical PEM practice at the age of 62.27 +/- 6.04 years and from practice of all aspects of medicine at the age of 66.43 +/- 5.23 years. Sixty-four percent of those surveyed are concerned about their career longevity in clinical PEM practice. CONCLUSIONS: Most senior PEM physicians participating in our survey continue to carry a significant clinical load and are concerned about their career longevity in clinical practice of PEM.

[Strength, flexibility, balance, resistance and flexibility assessment according to body mass index in active older women]. / Valoración de la fuerza, la flexibilidad, el equilibrio, la resistencia y la agilidad en función del índice de masa corporal en mujeres mayores activas.

INTRODUCTION: Overweight and obesity are increasing at an alarming rate among older people. This is mainly because this population is predominantly sedentary. The aim of this study was to classify, according to the body mass index (BMI), a group of older active women and to evaluate the different basic physical abilities as a function of this. MATERIAL AND METHODS: The BMI and fitness were evaluated in 60 elderly active women (mean age: 66.14 ± 6.59 years) using the 2-minute step test, arm curl test, chair stand test, back scratch test, chair-sit and reach-test, flamenco test, and 8-foot up-and-go test. RESULTS: It was found that 52.23% of the women studied had a normal BMI and 47.76% were slightly overweight. There were no cases of obesity or underweight. Women with normal BMI had better values in all tests than overweight women. Significant differences were found in the flamenco test (P<.05), and 8-foot up-and-go test (P<.01). CONCLUSIONS: Older women who usually do physical activity had a normal or slightly overweight BMI. It was also found that women with lower BMI have better resistance, flexibility, balance and strength.