Diagnoses and visit length in complementary and mainstream medicine.

BACKGROUND: The demand for complementary medicine (CM) is growing worldwide and so is the supply. So far, there is not much insight in the activities in Dutch CM practices nor in how these activities differ from mainstream general practice. Comparisons on diagnoses and visit length can offer an impression of how Dutch CM practices operate. METHODS: Three groups of regularly trained physicians specialized in CM participated in this study: 16 homeopathic physicians, 13 physician acupuncturists and 11 naturopathy physicians. Every CM physician was asked to include a maximum of 75 new patients within a period of six months. For each patient an inclusion registration form had to be completed and the activities during a maximum of five repeat visits were subsequently registered. Registrations included patient characteristics, diagnoses and visit length. These data could be compared with similar data from general practitioners (GPs) participating in the second Dutch national study in general practice (DNSGP-2). Differences between CM practices and between CM and mainstream GP data were tested using multilevel regression analysis. RESULTS: The CM physicians registered activities in a total of 5919 visits in 1839 patients. In all types of CM practices general problems (as coded in the ICPC) were diagnosed more often than in mainstream general practice, especially fatigue, allergic reactions and infections. Psychological problems and problems with the nervous system were also diagnosed more frequently. In addition, each type of CM physician encountered specific health problems: in acupuncture problems with the musculoskeletal system prevailed, in homeopathy skin problems and in naturopathy gastrointestinal problems. Comparisons in visit length revealed that CM physicians spent at least twice as much time with patients compared to mainstream GPs. CONCLUSIONS: CM physicians differed from mainstream GPs in diagnoses, partly related to general and partly to specific diagnoses. Between CM practices differences were found on specific domains of complaints. Visit length was much longer in CM practices compared to mainstream GP visits, and such ample time may be one of the attractive features of CM for patients.

Uma permanência nada fortuita [Editorial] / A not fortuitous stay [Editorial]

Chegamos a mais edição da Revista de Homeopatia da APH, Vol 85 nº 1. Notem que a homeopatia é inevitável. Não só porque oferece uma outra abordagem de tratamento, não apenas porque propõe um acompanhamento acessível e eficaz para quadros agudos e crônicos, mas porque permite o resgate de uma atuação médica que envolve o Cuidado. Evidentemente a homeopatia sofre com as dificuldades para fazer as pesquisas necessárias e apresentar todo seu potencial clínico, e além dos motivos auto evidentes há aqueles que ultrapassam o escopo de uma análise imediata, como, por exemplo, sua notável viabilidade econômica para a saúde pública e sua ampla aceitação social. Evidentemente existem críticas e objeções justas e que merecem ser seriamente examinadas. Destarte, na maior parte das vezes, as bases da medicina do sujeito são superficialmente contestadas, menos por suas supostas fragilidades, do que pelo despreparo intelectual de interlocutores que reduzem toda a discussão epistemológica ao dogma de uma postura anacrônica e cientificista. E, senhores, muitas destas críticas propagadas nas mídias leigas advém de personalidades sem o preparo clínico adequado, vale dizer, sem noção de medicina, especialmente sem a vivência médica-terapêutica para avaliá-la corretamente.

We have reached another edition of the APH Homeopathy Magazine, Vol. 85, No. 1. Note that homeopathy is inevitable. Not only because it offers another treatment approach, not only because it proposes accessible and effective monitoring for acute and chronic conditions, but because it allows the recovery of a medical practice that involves Care. Clearly, homeopathy suffers from difficulties in conducting the necessary research and presenting its full clinical potential, and in addition to the self-evident reasons, there are those that go beyond the scope of an immediate analysis, such as, for example, its notable economic viability for public health and its broad social acceptance. Clearly, there are fair criticisms and objections that deserve to be seriously examined. Thus, most of the time, the bases of subject medicine are superficially challenged, less because of its supposed weaknesses, than because of the intellectual unpreparedness of interlocutors who reduce the entire epistemological discussion to the dogma of an anachronistic and scientific stance. And, gentlemen, many of these criticisms propagated in the lay media come from people without adequate clinical training, that is, without any notion of medicine, especially without the medical-therapeutic experience to correctly evaluate it.

Em busca de consensos em homeopatia: perspectivas em 2023 / In search of consensus in homeopathy: perspectives in 2023

Consenso também pode ser entendido como anuência, aprovação, licença, concessão e acordo. A comunidade de praticantes da clínica da similitude sempre apresentou uma generosa variedade metodológica em seus procedimentos. Muitas das discussões concentraram-se em aspectos considerados filosóficos encontrados nos textos canônicos da homeopatia, enquanto outras enfocaram os aspectos terapêuticos dos procedimentos clínicos. Diante deste quadro entendemos que se tornou necessário construir um processo dialógico entre os médicos. O desejo é encontrar bases corroborativas que nos permita estabelecer limites e alcances para definir o estado da arte. Nesta procura por consensos mínimos a partir da coleta de informações obtidas através de um formulário, adotou-se a escala de Likert com quatro alternativas para resposta às afirmações contidas em cada questão. Os resultados, junto com dados demográficos da comunidade homeopática brasileira encontram-se representados neste artigo. Esperamos aumentar a representatividade destes acordos durante uma nova consulta nas atividades que serão realizadas na Cidade de São Paulo durante o 36º Congresso Brasileiro de Homeopatia.

Consensus can also be understood as consent, approval, license, concession, and agreement. The similitude clinic's community of practitioners has always displayed generous methodological variety in its procedures. Many of the discussions focused on aspects considered philosophical found in canonical homeopathy texts, while others focused on the therapeutic aspects of clinical procedures. Faced with this situation, we understand that it has become necessary to build a dialogic process between physicians. The desire is to find corroborative bases that allow us to establish limits and scope to define the state of the art. In this search for minimum consensus from the collection of information obtained through a form, the Likert scale was adopted with four alternatives to answer the statements contained in each question. The results, along with demographic data of the Brazilian homeopathic community are represented in this article. We hope to increase the representativeness of these agreements during a new consultation in the activities that will be carried out in São Paulo, during the 36th Brazilian Congress of Homeopathy.

Homeopatia e racionalidade médica / Homeopathy and medical rationality

A prática racional e integral da homeopatia exige que o profissional médico explique a doença do paciente e ao mesmo tempo o compreenda, sendo portanto necessária a individualização do doente com sua(s) doença(s). Por outro lado, a terapêutica homeopática também tem sido historicamente empregada na prática médica, em diferentes situações e com resolutividade, em casos com parcial similitude e uso de um ou mais medicamentos homeopáticos. A homeopatia tem evoluído ao longo do tempo, com realização de pesquisas clínicas que se valem de métodos clínicos validados à avaliação da efetividade e eficácia da homeopatia e que, em certa medida, levam em consideração as peculiaridades do método terapêutico homeopático, com sua exigência de abordagem individualizada do paciente. Entre a terapêutica homeopática e a alopática há muitas compatibilidades e, a distingui-las, a aplicação de dois princípios de base: O princípio dos semelhantes e o dos contrários. A avaliação clínica da homeopatia que considera os seres humanos semelhantes entre si pode seguir razoavelmente o modelo adotado nos estudos clínicos clássicos, enquanto na perspectiva da unicidade do ser humano são requeridos novos modelos de pesquisa que considerem a competência do médico, a variabilidade humana e a confiabilidade das fontes informativas da matéria médica homeopática.

The rational and integral practice of homeopathy requires that the medical professional explain the patient's disease and at the same time understand it, therefore, it is necessary to individualize the patient with his/her disease(s). On the other hand, homeopathic therapy has also been historically used in medical practice, in different situations and with resolution, in cases with partial similarity and use of one or more homeopathic medicines. Homeopathy has evolved over time, with clinical research carried out using validated clinical methods to assess the effectiveness and efficacy of homeopathy and which, to a certain extent, take into account the peculiarities of the homeopathic therapeutic method, with its requirement of individualized patient approach. There are many compatibilities between homeopathic and allopathic therapy and, to distinguish them, the application of two basic principles: the principle of similars and the principle of opposites. The clinical evaluation of homeopathy that considers human beings similar to each other can reasonably follow the model adopted in classic clinical studies, while in the perspective of the uniqueness of the human being, new research models are required that consider the competence of the physician, human variability and the reliability of homeopathic materia medica information sources.

Complementary and alternative therapies in dentistry and characteristics of dentists who recommend them.

OBJECTIVES: The aims of this study were to analyse whether dentists offer or recommend complementary and alternative medicine (CAM) remedies in their clinical routine, and how effective these are rated by proponents and opponents. A second aim of this study was to give a profile of the dentists endorsing CAM. DESIGN: A prospective, explorative, anonymised cross-sectional survey was spread among practicing dentists in Germany via congresses, dental periodicals and online (n=250, 55% male, 45% female; mean age 49.1±11.4years). RESULTS: Of a set of 31 predefined CAM modalities, the dentists integrated plant extracts from Arnica montana (64%), chamomile (64%), clove (63%), Salvia officinalis (54%), but also relaxation therapies (62%), homeopathy (57%), osteopathic medicine (50%) and dietetics (50%). The effectiveness of specific treatments was rated significantly higher (p<0.0001) by CAM proponents than opponents. However also CAM opponents classified some CAM remedies as highly effective, namely ear acupuncture, osteopathic medicine and clove. For ear acupuncture these scores did not significantly differ between both groups. With respect to the characteristic of the proponents, the majority of CAM endorsing dentists were women. The mean age (50.4±0.9 vs 47.0±0.9years) and number of years of professional experience (24.2±1.0 vs 20.0±1.0years) were significantly higher for CAM proponents than the means for opponents (p<0.0001 respectively). CAM proponents worked significantly less (p<0.0001) and their perceived workload was significantly lower (p=0.008). Their self-efficacy expectation (SEE) and work engagement (Utrecht work engagement, UWE) were significantly higher (p≤0.01 and p<0.0001) compared to dentists who abandoned these treatment options. The logistic regression model showed (exploratively) an increased association from CAM proponents with the UWES subscale dedication, with years of experience, and that men are less likely to be CAM proponents than women. CONCLUSION: Various CAM treatments are recommended by German dentists and requested by their patients, but the scientific evidence for these treatments are often low or at least unclear. CAM proponents are often female, have higher SE and work engagement.

Complementary and alternative medicine's occupational closure in Portuguese healthcare: Contradictions and challenges.

This article analyses strategies of closure recently enacted by complementary and alternative medicine practitioners in order to achieve occupational control over work domains in healthcare, taking Portugal as an example. A combination of the neo-Weberian occupational closure theory of the professions and Abbott's jurisdictional vacancy theory is proposed as the framework for analysis. Acupuncture and homeopathy will be presented as case studies. Data are derived from in-depth interviews with 10 traditional acupuncturists and 10 traditional homeopaths. Data analysis suggests that (1) professionalisation, (2) alignment with biomedical science and (3) expressing 'legitimating values' of a countervailing nature have been three significant strategies complementary and alternative medicine practitioners have used in an attempt to achieve market closure. It is argued that these strategies are contradictory: some involve allegiances, while others involve demarcation from biomedical science. A further outcome of these strategies is the promotion of complementary and alternative medicine treatments and solutions in everyday life. The success of these strategies therefore, although helping to reinforce the biomedical model, may simultaneously help complementary and alternative medicine to demarcate from it, posing thus challenges to mainstream healthcare.

Performing 'pragmatic holism': Professionalisation and the holistic discourse of non-medically qualified acupuncturists and homeopaths in the United Kingdom.

Complementary and alternative medicine practitioners have often utilised 'holism' as a key identification mark of their practice, distancing themselves from 'the reductionist biomedicine'. However, the past couple of decades have witnessed increased engagement of several complementary and alternative medicines in professionalisation, which includes a degree of biomedical alignment while 'reducing' holistic claims in order to provide practice with a 'credible outlook' and move closer to the mainstream, a development which challenges the role of holism in complementary and alternative medicine practices. This article explores the strategies by which two groups of complementary and alternative medicine practitioners, namely, non-medically qualified acupuncturists and homeopaths in the United Kingdom, pragmatically accommodate holistic notions as a professional resource, a process of negotiation between maintaining their holistic premise, on the one hand, and the drive to professionalise and enhance their societal status, on the other. Based on in-depth interviews with non-medically qualified acupuncture and homeopathy practitioners and school principals, textual analysis of practitioners' web sites and observation of practice, the findings demonstrate the dynamic approach to 'holism' in complementary and alternative medicine practice. This discourse, through which practitioners use a range of strategies in order to 'narrow' or 'expand' their holistic expression, can be described as 'pragmatic holism', by which they try to make gains from the formalisation/standardisation processes, without losing the therapies' holistic outlook and appeal.

Homeopathy and managed care: manageable or unmanageable.

Managed care presents a challenge to homeopaths and to consumers of homeopathic care. If homeopaths want to be a part of managed care, they will have to organize themselves to a higher level of professional order. Although the vast majority of practicing homeopaths are licensed in one of many conventional health professions, with the medical license being the most common, homeopaths need to develop more clearly defined educational standards and certification programs in the specialty of homeopathic medicine, and they need to have these programs certified by respected, independent agencies. The small number of homeopaths who are unlicensed will either have to become licensed or work with those who are and whose malpractice insurance would cover their care. This article notes that there is a small but significant body of clinical research and additional evidence that homeopathic care is cost effective. A recent increase in public and private research monies is leading to a larger body of evidence that homeopathic medicines are effective, and this will help it achieve greater acceptance and recognition from governmental bodies, medical professional associations, and managed care organizations. Reasons are given as to why managed care organizations will play a leading role in advocating that consumers learn to use homeopathic medicines for non-emergency self-care ailments as a way to empower them to take greater control over their health and to reduce doctor visits and hospitalizations.

[Physician-patient relationship, scientific medicine and alternative therapies]. / La relación médico-paciente, la medicina científica y las terapias alternativas.

The objective of this paper is to describe the magnitude and characteristics of the use of complementary therapies in clinical practice. A consecutive sample of 540 outpatients who had sought medical care for the first time at the General Internal Medicine Program of a University Hospital were interviewed. A questionnaire was completed, collecting socio-demographic informations, data on physical and psychological health, perception of physician-patient relationship, self-medication, and beliefs associated with the disease and its treatment. Lifetime prevalence use of alternative therapies was near 55%. The most used were homeopathy and herbal medicines (40.8% and 37.6%, respectively). The evaluation of these practices was considered "excellent/very good/and good" 84.5% of the time. Significant associations were: females (p < 0.00001), high level of education (p < 0.001), dissatisfaction with the way in which the cause of the disease had been investigated and how the diagnosis and treatment had been communicated (p < 0.03), psychological and psychiatric treatment (p < 0.00001), self-medication (p < 0.0002), pain and concern during over 6 months due to disease or disability (p < 0.00001), lack of confidence in scientific medicine (p < 0.00001), the belief that "spiritual problems" (p < 0.00001), "mental conditions" (p < 0.003), and "emotional conditions" (p < 0.00001), popular beliefs, particularly daño & envidia (p < 0.00001), and mal de ojo (p < 0.001) have triggered the disease. One third of the patients attended the hospital while undergoing an alternative therapy that may pose an interference or interaction hazard. Emphasis is placed on the importance of medical education to assess physician-patient relationship and the ability to convey trust in medical procedures and treatments, and scientific consulting for other practices.

Cumplimiento de los registros clínicos, esquemas terapéuticos e intervenciones de enfermería en un hospital de segundo nivel de atención / Compliance with clinical records, therapeutic schemes and nursing interventions in a second-level care hospital

Resumen

Introducción: los registros clínicos de enfermería constituyen un documento legal en donde se evalúa la calidad científica, humana y ética de la atención al paciente.

Objetivo: determinar el cumplimiento de los registros clínicos de enfermería con base en la "Herramienta única de evaluación de los registros clínicos, esquemas terapéuticos e intervenciones de enfermería".

Metodología: estudio descriptivo transversal. En una muestra de 156 expedientes clínicos, se evaluó la hoja de enfermería mediante un instrumento diseñado como "Herramienta única de evaluación de los registros clínicos, esquemas terapéuticos e intervenciones de enfermería".

Resultados: en general el cumplimiento de los registros clínicos fue del 61%. La omisión en el registro se presentó en la valoración continua del dolor. El registro de intervenciones fue del 70% y de estudios 48%. Solo el 41% registró las acciones para reducir el riesgo de úlceras por presión. La mayoría (75%) no firma sus notas o lo hace de forma incompleta.

Conclusiones: la utilidad práctica de este estudio se traduce en un diagnóstico situacional sobre los registros de enfermería como información esencial sobre la cual tomar futuras decisiones con respecto a la temática abordada.

Abstract

Introduction: Nursing clinical records are a legal document in which the scientific, human and ethical quality of patient care is evaluated.

Objective: To determine compliance with nursing clinical records based on the "Single tool for the evaluation of clinical records, therapeutic schemes and nursing interventions".

Methods: Cross-sectional descriptive study. In a sample of 156 clinical files, the nursing sheet was evaluated by means of an instrument designed as "Single tool for evaluation of clinical records, therapeutic schemes and nursing interventions".

Results: In general, compliance with clinical records was 61%. The omission in the registry was presented in the continuous pain assessment. The registry of interventions was 70% and studies 48%. Only 41% registered the actions to reduce the risk of pressure ulcers. The majority (75%) do not sign their notes or do so in an incomplete way.

Conclusions: The practical utility of this study is translated into a situational diagnosis of nursing records as essential information on which to make future decisions regarding the subject matter addressed.

Forming connections in the homeopathic consultation.

OBJECTIVE: A previous study which explored homeopathic practitioners' in depth understanding and experiences of homeopathic consultations identified "connecting" as a key component of the consultation. This paper reports on "connecting" and its role in the consultation. METHOD: Using a qualitative grounded theory approach data was collected from homeopaths using in-depth interviews, observations of homeopathic consultations and solicited practitioner reflective diaries. Constant comparison assisted code, concept and category formation to form a model of the UK classical homeopathic consultation. RESULTS: "Connecting", describes a complex notion of relationship in the homeopathic consultation consisting of four dimensions, and performs several roles within the consultation that enable practitioners to elicit symptoms, identify expectations, assist with prescribing, help patients engage with homeopathic principles and stimulate healing. CONCLUSION: This study shows the homeopath as an important component of the therapeutic context forming complex relationships and using communication that is skills based and inductively shaped to interpret and respond to each individual patient and their narrative in the consultation. PRACTICE IMPLICATIONS: This study could have implications for teachers, students and practitioners of homeopathy by influencing training needs, and could prove instructive for other clinicians as homeopaths' communication style could be used to augment other consultations.

How do homeopaths reason and make decisions? Integrating theory, practice, and education.

BACKGROUND: Homeopathy is a major modality in complementary and alternative medicine. Significant tensions exist between homeopathic practice and education, evident in the diversity of practice styles and pedagogic models. Utilizing clinical reasoning knowledge in conventional medicine and allied health sciences, this article seeks to identify and critique existing research in this important area. MATERIALS AND METHODS: A literature search utilizing MEDLINE,(®) Allied and Complementary Medicine (AMED), and CINAHL(®) (Cumulative Index to Nursing and Allied Health Literature) was conducted. Key terms including clinical thinking, clinical reasoning, decision-making, homeopathy, and complementary medicine were utilized. A critical appraisal of the evidence was undertaken. RESULTS: Four (4) studies have examined homeopathic clinical reasoning. Two (2) studies sought to measure and quantify homeopathic reasoning. One (1) study proposed a reasoning model, based on pattern recognition, hypothetico-deductive reasoning, intuition, and remedy-matching (PHIR-M), resembling much that has been previously mapped in conventional medical reasoning research. The fourth closely investigated the meaning and use of intuition in homeopathic decision-making. CONCLUSIONS: Taken together, these four studies provide valuable insight into what is currently known about homeopathic clinical reasoning. However, despite the history and breadth of practice, little is known about homeopathic clinical reasoning and decision-making. Building on the research would require viewing clinical reasoning not only as a cognitive phenomenon but also as a situated and interactive one. Further research into homeopathic clinical reasoning is indicated.

Homeopathic practitioner's experiences of the homeopathic consultation: a protocol of a grounded theory study.

BACKGROUND: The apparent success of homeopathy is often attributed to a collaborative, holistic, and empathic consultation and to the practitioner-patient relationship. Despite the practitioner's consultative style being shown to affect patient's health outcomes in conventional medicine, most research into the homeopathic consultation has focused on patients' experiences. However, the practitioner is a crucial component of the therapeutic context and may therefore have an important part to play in optimizing health outcomes in homeopathy. Additionally, the mechanisms underlying therapist effects are still poorly understood in clinical medicine generally and particularly so in homeopathy. AIM: The aim of this research is to gain an in-depth understanding of homeopathic practitioners' perceptions and experiences of the consultation, and the process of engaging with the patient and prescribing the remedy. We propose to generate a theoretical model to explain the processes that underpin the homeopathic consultation. DESIGN: This is a qualitative study using grounded theory methodology. Two (2) phases of data collection will be involved. Phase 1 will involve face-to-face in-depth interviews with homeopaths. From these interviews, a theoretical model of the homeopathic consultation will be developed. Phase 2 of data collection will involve observations of homeopathic consultations and the use of practitioner diaries in order to test the emerging theoretical model from phase 1. Homeopaths will be sampled from the Faculty of Homeopathy and the Society of Homeopaths. RESULTS: Results will be available in summer 2009. CONCLUSIONS: The findings from this study will lead to the development of a theoretical model of how homeopaths view and enact the consultation process. Revealing this process may influence the training of new practitioners and improve the practice of experienced practitioners and will therefore be of benefit to patients. In addition, the findings may be of potential benefit to practitioners of other therapeutic consultations.

Homeopathy is not placebo effect: proof of scientific evidence for homeopathy

Homeopathy has been a medical practice recognized worldwide for more than two centuries, performing care, teaching and research activities in several health institutions and medical schools. It employs a clinical approach based on heterodox and complementary scientific principles (principle of therapeutic similitude, homeopathic pathogenetic experimentation, use of individualized medicines and dynamized or potentiated doses), with the aim of awakening a curative response in the body against its own disorders and/or diseases. Based on different premises from those used by conventional medical practice, homeopathy is often the target of unfounded and widespread criticism from individuals who systematically deny homeopathic assumptions and any scientific evidence that proves them due to their pseudoskeptical and pseudoscientific stance, which prevents a correct and bias-free analysis. In order to enlighten doctors, researchers, health professionals and the general public, demystifying culturally rooted dogmatic positions and the pseudoskeptical fallacies that "there is no scientific evidence for homeopathy" and "homeopathy is placebo effect", the Technical Chamber of Homeopathy of the Regional Council of Medicine of the State of São Paulo (TC-Homeopathy, Cremesp) prepared the "Special Dossier: Scientific Evidence for Homeopathy" in 2017, made available in three independent editions (online in Portuguese and English; printed in Portuguese) in the Revista de Homeopatia (São Paulo). Then, the dossier was published in Spanish in the La Homeopatía de México journal in 2023 in an edition commemorating the journal's 90th anniversary. Encompassing nine narrative reviews on the various lines of homeopathy research and containing hundreds of scientific articles describing experimental and clinical studies, the Dossier highlighted the state of the art of homeopathic science. Proving and expanding this scientific evidence in 13 chapters, the current work aims to update and clarify knowledge in the area. In addition to elucidating the epistemological premises of the homeopathic model in detail, the work describes the various aspects of basic and clinical research which endorse homeopathic practice and treatment in a continuum of information, data and bibliographic references. The work discusses various topics related to research in homeopathy, covering everything from "homeopathic clinical epidemiology" to "pseudoskeptic and pseudoscientific strategies used in attacks on homeopathy", including "pharmacological basis of the principle of similitude", "experimental studies in biological models", "randomized controlled clinical trials", "systematic reviews, meta-analyses and global reports" and "observational studies", among others. In view of the fact that it becomes fruitless and tiring to describe and analyze all the studies and experiments from the different research lines, we suggest and systematize in the different chapters for those who want to delve deeper into the areas of interest, bibliographical surveys of existing literature through the different databases. As we reiterate throughout the work, despite the difficulties and limitations that exist in developing research in homeopathy due to both methodological aspects and the lack of institutional and financial support, the set of experimental and clinical studies described is indisputable proof that "there is scientific evidence for homeopathy" and "homeopathy is not placebo effect", contrary to falsely disseminated prejudice. However, new studies must continue to be developed to improve clinical practice and elucidate peculiar aspects of the homeopathic paradigm. Acting as an integrative and complementary therapy to other specialties, homeopathy can add efficacy, effectiveness, efficiency and safety to medical practice, acting in a curative and preventive manner, reducing symptomatic manifestations and the predisposition to falling ill, with low cost and minimal adverse events, helping doctors to fulfill their "highest and only mission, which is to make sick people healthy, which is called healing" (Samuel Hahnemann, Organon of Medicine, § 1).

La homeopatía no es efecto placebo: comprobación de las evidencias científicas en homeopatía / Homeopathy is not Placebo Effect: Proof of Scientific Evidence for Homeopathy

La Homeopatía ha sido una práctica médica de renombre mundial durante más de dos siglos, desarrollando actividades asistenciales, docentes y de investigación en varias instituciones de salud y escuelas de medicina. Emplea un enfoque clínico basado en principios científicos heterodoxos y complementarios (principio de similitud terapéutica, experimentación patogénica homeopática, uso de medicamentos individualizados y dosis dinamizadas), con el objetivo de despertar una respuesta curativa del organismo frente a sus propios trastornos o enfermedades. Partiendo de premisas diferentes a las empleadas por la práctica médica convencional, la Homeopatía suele ser objeto de críticas infundadas y generalizadas por parte de individuos que niegan sistemáticamente los supuestos homeopáticos y cualquier evidencia científica que los demuestre porque tienen una postura pseudoescéptica y pseudocientífica que impide un análisis correcto y desprejuiciado. Son "pseudoescépticos" disfrazados de "pseudocientíficos". Ilustrar a médicos, investigadores, profesionales de la salud y al público en general, desmitificando las posturas dogmáticas culturalmente arraigadas y las falacias pseudoescépticas de que "no hay evidencia científica en la Homeopatía" y "la Homeopatía es un efecto placebo", en 2017, la Cámara Técnica de Homeopatía del Consejo Regional de Medicina del Estado de São Paulo (CT-Homeopatía, Cremesp) elaboró el "Dossier Especial: Evidencia Científica en Homeopatía", disponible en tres ediciones independientes (en línea en portugués e inglés; impresa en portugués) en la Revista de Homeopatía (São Paulo). En 2023, el dossier fue publicado en español en la revista La Homeopatía de México, en una edición conmemorativa del 90 aniversario de la revista. Abarcando nueve revisiones narrativas sobre las diversas líneas de investigación en Homeopatía, que contienen cientos de artículos científicos que describen estudios experimentales y clínicos, el dossier destacó el estado del arte de la ciencia homeopática. Demostrando y ampliando esta evidencia científica, el presente trabajo ("La Homeopatía no es Efecto Placebo": Comprobación de las Evidencias Científicas en Homeopatía) pretende esclarecer los conocimientos en el área en trece capítulos. Además de dilucidar en detalle las premisas epistemológicas del modelo homeopático, el trabajo describe, en un continuo de información, datos y referencias bibliográficas, los diversos aspectos de la investigación básica y clínica que avalan la práctica y el tratamiento homeopático. Discutiendo diversos temas relacionados con la investigación en Homeopatía, el libro aborda desde la "epidemiología clínica homeopática" hasta las "estrategias pseudoescépticas y pseudocientíficas utilizadas en los ataques a la Homeopatía", pasando por el "fundamento farmacológico del principio de similitud", "estudios experimentales en modelos biológicos", "ensayos clínicos controlados aleatorizados", "revisiones sistemáticas, metaanálisis e informes globales" y "estudios observacionales", entre otros. Como hemos reiterado a lo largo del libro, a pesar de las dificultades y limitaciones en el desarrollo de la investigación en Homeopatía, tanto por aspectos metodológicos como por la ausencia de apoyo institucional y financiero, el conjunto de estudios experimentales y clínicos descritos es una prueba irrefutable de que "existen evidencias científicas en Homeopatía" y "la Homeopatía no es efecto placebo", contrariamente al prejuicio falsamente difundido. Actuando como terapia integradora y complementaria a otras especialidades, la Homeopatía puede agregar eficacia, efectividad, eficiencia y seguridad a la práctica médica, reduciendo las manifestaciones sintomáticas y la predisposición a la enfermedad, con bajo costo y mínimos eventos adversos.

Failures in dental prosthesis: dentists perception of the involved legal aspects / Insucessos em prótese dental: percepção dos cirurgiões-dentistas quanto aos aspectos odontolegais envolvidos

This aim of this study was to verify the level of knowledge of prosthodontics specialists from the city of Porto Alegre, Rio Grande do Sul State, concerning the failures of prosthetic works, and to provide a reflection on the type of responsibility assumed by the prosthodontist during the dental treatment. This was a descriptive cross-sectional study with a non-probabilistic sample, conducted through questionnaires with closed and open questions. The data was analyzed using the Fisher's Exact Test (p value < or = 0.005). The sample consisted of 143 questionnaires. The statistical analysis evidenced that the dentists with up to 15 years of professional practice assign the responsibility of failures most often to the laboratory (p = 0.001) and to the patient (p = 0.021), but over the years this trend is reversed. The prosthodontists included in the study proved to have an adequate knowledge of issues that pervade the failures in the prosthodontics specialty. In relation to the parameters of the professional responsibility, it is necessary to consider the type of duty assumed by the prosthodontist as for the responsibility of means.

O objetivo deste estudo foi verificar o grau de conhecimento do CD especialista em prótese dentária da cidade de Porto Alegre/RS sobre aspectos relacionados aos insucessos de trabalhos protéticos, bem como propor uma reflexão sobre o tipo de obrigação assumida pelos protesistas durante o tratamento odontológico. Tratou-se de um estudo transversal descritivo, com amostra não probabilística de indivíduos realizada por meio de questionários, nos quais constavam questões fechadas e abertas. A análise dos dados foi realizada utilizando-se o Teste Exato de Fischer (sendo p < ou = 0,005). A amostra foi composta de 143 questionários. O estudo estatístico mostrou quando interpretado em relação ao tempo de exercício profissional, que até os primeiros 15 anos de formado o profissional tem o entendimento de que os erros advêm mais frequentemente do laboratório (p = 0,001) e dos pacientes (p = 0,021), invertendo esta tendência com o passar dos anos. Os protesistas componentes da amostra mostraram ter um conhecimento adequado das questões relacionadas aos aspectos que permeiam os insucessos na especialidade de prótese. Ao considerarmos os parâmetros da responsabilidade profissional, deve-se considerar o tipo de obrigação assumida pelos protesistas como responsabilidade de meio.