The Next Step

(by Pascale Lane) Sep 29 2014

So I have been working with my standing desk for some time now. I have gotten comfortable with upright posture for most of my office duties, so I thought I would up my game and add physical activity.

Turns out an under-the-desk treadmill is $600 minimum. I'm not that ready for commitment. One website showed a standard treadmill that you could detach the handrails from, but I am not up for that sort of project.

StepperInstead, I spent $50 for a stair-stepper. It requires no power source. You can buy them at a variety of price points with various bells and whistles, but I went low-tech here. I have it set on the lowest tension.

It does take some time to get used to the stepping while you do stuff. I usually take calls without stepping, but I am able to write this blog post while I'm working my butt.

Only disadvantage I can see is that I am climbing a staircase to heaven but my Fitbit registers it as steps, not stairs. Oh, well, I'm burning extra calories.

So far I'm pretty happy with this investment. For the first time since I moved to Oklahoma I can easily get inm 10,000 steps without setting foot in the gym.

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Big Surprise Coming

(by Pascale Lane) Sep 24 2014

In the next couple of weeks I have a big surprise coming. It will explain my relative lack of posts lately.

In the meantime, I have to go to a wedding and take care of my patients.

Try to pee without me...

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Screening Urinalysis in Practice

(by Pascale Lane) Sep 18 2014

Guidelines based on evidence or expert opinion, even when available, seem to be followed only occasionally. What do pediatricians do in practice with screening UAs?

Pediatricians’ screening urinalysis practices. J Pediatr 147:362-5, 2005  doi:  10.1016/j.peds.2005.05.009

This survey study examined the self-reported practices of general pediatricians in the US at a time when UA was recommended at 2 ages: start of school, ~5 years old, and sexually active adolescents. They asked when all asymptomatic children seen in the practice were screened at least once with the following choices:

  • Infancy (<1 year of age)
  • Early childhood (1 to 5 years of age)
  • Late childhood (5 to 12 years of age)
  • Adolescence (12 to 20 years of age)

Yes, they included the only definitely recommended age in two choices in their survey (why didn’t someone see this ahead of time?). The majority of responders (78%) screened at least once, with 58% screening more than one age group, leading to the following results:

  • Infancy 9%
  • Early childhood 60%
  • Late childhood 55%
  • Adolescence 58%

Pediatricians reported that they felt this screening benefitted the children and their overall health. Beyond that, the survey did not attempt to elucidate the rationale for practices identified. Were physicians unaware of changes in guidelines?

What is the downside of screening so many, so often? Next up we will look at the costs of this practice.

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Pediatric Screening Urinalysis in the US

(by Pascale Lane) Sep 16 2014

A Brief History of Recommendations

Back in the 1980s when I trained, the American Academy of Pediatrics (AAP) recommended a screening urinalysis at four age points during childhood: infancy, early childhood, late childhood, and adolescence. Getting urine out of a child can be incredibly time consuming. Stick-on bags can be used in children not yet toilet trained, although results are often contaminated by skin flora. Bags can also leak, making the process a frustrating waiting game.

In 2000 the AAP published new guidelines with screening UA recommended only at 2 ages: 5 years old, the typical age of school entry, and in sexually active adolescents.

Hmm...UA doesn't seem to be a procedure...

Hmm...UA doesn't seem to be a procedure...

Today's well child preventive care guidelines are known as Bright Futures. The components of care are enlarged in the figure at the right; recommended lab studies are listed under Procedures, and no urinalysis can be found in this table or elsewhere in the document.

At present, it would appear that otherwise healthy, asymptomatic children do not need screening UAs.

What About Sports?

After exploring a number of professional sites, including the AAP, I found no recommendations for UAs prior to athletic participation. Blood pressure screening is included, with the recommendation that children with unexplained or uncontrolled hypertension should not participate in power lifting or body building. A urinalysis should be included in the work-up of hypertension in children, but that goes beyond the scope of the sports physical.

So the Answer is...?

Poll

None of the above wins!

None of the above. Currently, no UA is recommended at any age or before any activity for healthy, asymptomatic children.

So what are primary care providers actually doing? And why is this an issue? More fun to come, WhizBangers!

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When to Pee in the Cup

(by Pascale Lane) Sep 11 2014

Screening urinalysis (UA), usually performed by dipstick in a physician's office, ultimately results in a lot of referrals for nephrologists. I am reviewing this topic, and I will have a series of posts about UAs over the coming weeks. First, I want to start with a poll about what is really recommended for healthy, asymptomatic children:

What are the current recommendations for screening urinalysis by the American Academy of Pediatrics?Next week I will reveal the answers from the crowd, as well as what the real answer is.

One response so far

Reap What You Sow

(by Pascale Lane) Sep 10 2014

While in my fellowship, I became interested in the role of puberty and sex in the progression of kidney disease. I studied this and related sex differences in the renal responses for more than 20 years. Then the NIH would not, could not bring itself to fund my work. My spouse had a new job offer, and the writing on the wall was clear: I closed my lab and moved into full-time clinical medicine.

From this perspective, I can appreciate NPR's series on the state of NIH funding and folks quitting science. At least I knew my clinical skills made me employable, although at times I dream of running a distillery.

Of course, there is the additional irony of the NIH calling for more study of both sexes, even in basic science studies, earlier this year. Gee, exactly what I was doing that was not important enough to merit funding...and now you are issuing special calls for it. Any regrets, NIH?

One response so far

Is This Right?

(by Pascale Lane) Sep 09 2014

Today a new book from Dr. Seuss will hit the stores featuring stories from magazines 60 years ago.

Working in pediatrics, Dr. Seuss inspires a lot of stuff around me. Some of our junior artists based their work on his characters as shown below:

Hmmmm...

Hmmmm...

It took me a minute to realize that this is an articulated puppet; that string makes the arms and legs move when it's not mounted under glass.

I must admit my first thought was why on earth the Cat in the Hat needed a tampon...

I think I would have tucked the string behind the puppet before framing.

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Forty-Six

(by Pascale Lane) Sep 06 2014

It's been a dry week.

Zer0. Zip. Nada.

Today, the urine output box shows 46 mL overnight.

Less than an ounce, but an important sign of the return of kidney function.

Keep it up, kid.

Urine is golden.

One response so far

The Fix for Bad Slides: MORE SLIDES!

(by Pascale Lane) Aug 28 2014

I love this slide-show about breaking dense slides into "layers of slides." I have been trying to get some colleagues to do something like this for awhile.

Enjoy and please take this advice!

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"Happy" Women's Equality Day

(by Pascale Lane) Aug 26 2014

94 years ago, the 19th amendment to the Constitution was ratified, giving women the right to vote. Our fore-mothers fought for this right, believing that without political power any other rights could be denied. They also believed that with political voices we could achieve true equality.

Their belief in the vote sustained them through public humiliation, beatings, starvation, jail, forced feedings, and a number of other indignities.

Despite the passage of nearly a century, women still have not achieved full equality. We make less than 80% of our male counterparts in similar jobs. We are underrepresented in the best -paid careers, and even when we enter those fields we are marginalized. Corporate boards, congress, and other decision-making bodies rarely demonstrate gender equality, despite the evidence that more women in those positions increases profits and other measures of efficacy.

Today we see rights we thought were won under attack. It's time we used that vote, the political voice our ancestors fought for. Learn the issues and make your choices. Run for office, or at least support those you like in whatever way you can.

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