Rates of Epidural Blood Patch following Lumbar Puncture Comparing Atraumatic versus Bevel-Tip Needles Stratified for Body Mass Index.

BACKGROUND AND PURPOSE: Postdural puncture headache, a known complication of lumbar puncture, typically resolves with conservative management. Symptoms persist in a minority of patients, necessitating an epidural blood patch. One method of decreasing rates of postdural puncture headache is using atraumatic, pencil-point needles rather than bevel-tip needles. To the best of our knowledge, this is the first study comparing epidural blood patch rates between pencil- and bevel-tip needles with a subgroup analysis based on body mass index. MATERIALS AND METHODS: This single-institution retrospective study identified 4435 patients with a recorded body mass index who underwent a lumbar puncture with a 22-ga pencil-tip Whitacre needle, a 20-ga bevel-tip Quincke needle, or a 22-ga Quincke needle. The groups were stratified by body mass index. We compared epidural blood patch rates between 22-ga pencil-tip Whitacre needles versus 22-ga Quincke needles and 22-ga Quincke needles versus 20-ga bevel-tip Quincke needles using the Fischer exact test and χ2 test. RESULTS: Postdural puncture headache necessitating an epidural blood patch was statistically more likely using a 22-ga Quincke needle in all patients (P < .001) and overweight (P = .03) and obese (P < .001) populations compared with using a 22-ga pencil-tip Whitacre needle. In the normal body mass index population, there was no statistically significant difference in epidural blood patch rates when using a 22-ga pencil-tip Whitacre needle compared with a 22-ga Quincke needle (P = .12). There was no significant difference in epidural blood patch rates when comparing a 22-ga Quincke needle versus a 20-ga bevel-tip Quincke needle in healthy (P = .70), overweight (P = .69), or obese populations (P = .44). CONCLUSIONS: Using a 22-ga pencil-tip Whitacre needle resulted in lower epidural blood patch rates compared with a 22-ga Quincke needle in all patients. Subgroup analysis demonstrated a statistically significant difference in epidural blood patch rates in overweight and obese populations, but not in patients with a normal body mass index.

Burnout in occupational therapists.

Burnout is a job-related condition involving feelings of emotional exhaustion, depersonalization, and reduced personal accomplishment. The Maslach Burnout Inventory (Maslach & Jackson, 1981a) is the instrument most widely used to measure job-related stress in human service professions, such as occupational therapy. This study explored the application of the Maslach Burnout Inventory for use with occupational therapists. The subjects were 99 registered occupational therapists residing in the southeastern United States. Mean scores lower than the aggregate occupational norms provided by the test's authors on the Emotional Exhaustion and Depersonalization subscales supported the need to develop specific norms for occupational therapists. Results of this study indicate that use of the aggregate norms would underestimate the level of experienced burnout. Correlational analyses delineated significant relationships between age and Emotional Exhaustion and Depersonalization, education and Emotional Exhaustion and Depersonalization, years of work as an occupational therapist and Depersonalization and Personal Accomplishment, years in the present position and Personal Accomplishment (intensity only), hours of direct patient contact and Emotional Exhaustion (intensity only), and hours of direct patient contact and Depersonalization (frequency only). These correlates of burnout furnish clues for understanding the development of work-related stress in occupational therapists.