Acceptance of apitherapeutic methods in patients consulting general physicians or gynaecologists.

BACKGROUND: and purpose: Apitherapists promote the medical use of products from the beehive (bee venom, propolis, pollen, honey, royal jelly, dead bees, apilarnil, wax, wax moths), the use of beehive air or therapeutic sleep on a beehive. However, little is known about how far such treatment options are perceived as acceptable by patients. METHODS: Patients visiting either a family doctor in Kehl or a gynecologist in Weilburg (both in Germany) were asked to rate their knowledge of apitherapy as well as their readiness to use apitherapeutic measures. RESULTS: Honey and propolis represent the best-known bee products whereas beehive air and apilarnil are greatly unknown to the patients. Only honey seems to be an acceptable treatment option whereas propolis, pollen and royal jelly seem to be less acceptable. Bee venom was not considered an interesting treatment possibility and, in particular, live bee stings were considered less desirable. This study found that gender and acquaintance with a beekeeper influenced the patients' ratings but age, education and current medical condition did not. CONCLUSION: Live bee stings, apilarnil or the inhalation of beehive air are not appealing to the majority of patients. Before apitherapeutic methods are promoted, it seems to be important to know about patients' willingness to tolerate such treatments. Perhaps therapy modifications can be offered which seem more acceptable.

Comparison of refractometry and biuret assay for measurement of total protein concentration in canine abdominal and pleural fluid specimens.

OBJECTIVE: To compare total protein (TP) concentrations in canine pleural and abdominal fluid specimens as measured by refractometry and biuret assay. DESIGN: Diagnostic test evaluation. SAMPLE: Data regarding 92 pleural and 148 abdominal fluid specimens from dogs with various diseases. PROCEDURES: TP concentrations in fluid specimens as measured by refractometry and biuret assay were recorded. Strength of association between sets of measurements was assessed by Spearman rank correlations and Bland-Altman plots. Optimal concentration cutoff for diagnostic discrimination between exudate and nonexudate was identified by construction of receiver operating characteristic curves. RESULTS: Median TP concentration in pleural fluid specimens was 2.7 g/dL (range, 0.3 to 4.8 g/dL) for refractometry and 2.9 g/dL (range, 0.7 to 5.8 g/dL) for biuret assay. Median TP concentration in abdominal fluid specimens was 3.5 g/dL (range, 0.1 to 6.0 g/dL) for refractometry and 3.5 g/dL (range, 0.6 to 5.7 g/dL) for biuret assay. Correlation was significant between refractometric and biuret results for pleural (ρ = 0.921) and abdominal (ρ = 0.908) fluid. Bland-Altman plots revealed bias of -0.18 g/dL for pleural fluid and -0.03 g/dL for abdominal fluid for refractometry versus biuret assay. With a TP concentration of ≥ 3 g/dL used to distinguish exudate from nonexudate, sensitivity of refractometry was 77% for pleural fluid and 80% for abdominal fluid. Specificity was 100% and 94%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Refractometry yielded acceptable results for measurement of TP concentration in canine pleural and abdominal fluid specimens, providing a more rapid and convenient method than biuret assay.

Automatic helicopter standby policy for seriously injured patients.

BACKGROUND: Automatic standby (AS) of helicopter emergency medical services (HEMS) may allow improved utilization appropriateness (UA) for scene trauma, although this has not been studied. METHODS: HEMS records were reviewed for 16 months, including date, county of origin, and UA. Data were analyzed descriptively with chi(2) where appropriate. RESULTS: Of 274 flights, there was no significant change in UA where AS was in place versus where it was not (P =.36). One county had an increase in total flights with AS in use without a significant change in UA (P =.10). CONCLUSION: In this region, use of an AS policy for scene trauma resulted in increased utilization of HEMS without a corresponding change in UA. Specifically, inappropriate utilization did not increase. This finding suggests that such a policy does not incur overutilization despite increasing total flights. Further study with larger numbers is necessary to draw definitive conclusions.

Parental report of child restraint device use in an emergency department population.

To survey parents regarding use of child restraint devices (CRD) and knowledge of CRD recommendations, parents of children < or = 14 years of age presenting to an emergency department (ED) provided demographic data and answered questions regarding the family's restraint use and their understanding of CRD recommendations. Three hundred thirteen adults completed surveys, providing data on 541 children. Decreasing restraint use was reported with advancing child age. Parental restraint use remained constant. Demographics were similar. Optimal infant CRD position was not identified by 27%. Incorrect answers were associated with single parents, lower income, less education, and older child age. Only 41% identified the age for mandatory car seat use. Most identified the safest vehicle position for any child. No variables were associated with correct answers. In conclusion, CRD use decreases with increasing child age. In this study, many parents were unaware of CRD recommendations.

Necessity of fire department response to the scene of motor vehicle crashes.

The purpose of this study was to identify how often fire department (FD) response to the scene of motor vehicle crashes (MVCs) is necessary for rescue and fire suppression. A retrospective review of MVCs between January 1, 1997 and December 13, 2000 occurring in a suburban municipality (population 79,000, 13 FDs) was conducted. Data abstracted included the total number of reported MVCs, MVCs with personal injury (PIAC), MVCs to which the FD responded, MVCs requiring any extrication, MVCs requiring extensive extrication, and MVCs requiring fire suppression. Data were analyzed using descriptive statistics. A total of 14,450 MVCs occurred during the study period. Two thousand ninety-five (14.5%) resulted in personal injury. The FD responded to 198 MVCs (9.5% of PIAC). Twenty-four (1.1% of PIAC) required simple door release. Fourteen (0.7% of PIAC) required more extensive extrication. No MVC required fire suppression. During this study period, specialized equipment and personnel were rarely needed for patient extrication from MVCs in this municipality. At no time was fire suppression required. Routine FD response to MVCs for purposes of extrication or fire suppression is not warranted in this emergency response system. A prospective study, including a cost analysis, should be undertaken to further clarify the role of FD response to MVCs.

Physician and patient factors influencing the treatment of low back pain.

Previous retrospective studies have suggested that patient demographics may influence analgesic administration. These studies have not taken physicians' impression of patient pain into account. This prospective study investigates the influence of (i) physician impression of the degree of pain and (ii) patient demographics on the use of analgesic. A convenience sample of adults with non-traumatic lower back pain was studied. Possible predictors of analgesic administration included physician pain scores (assessed by visual analogue scale), patient ethnicity, gender, age, and insurance. These variables were tested individually and then using logistic regression. For the total of 91 patients enrolled, only physician pain scale was found to be associated with analgesic use. Median scores were 68 mm (interquartile range = 62-80 mm) for those receiving treatment versus 48 mm (interquartile range = 30-58 mm) for those who did not (P < 0.001). This study therefore suggests that physician impression of patient pain rather than patient demographics influences analgesic use.