A comprehensive approach to complementary and alternative medicine usage among patients from a vascular department.

INTRODUCTION: Use of complementary and alternative medicine (CAM) therapies had been described in patients with disabling, chronic and painful conditions; these characteristics define the majority of vascular surgery (VS) entities. A lack of disclosure about CAM use from patients has been universally cited and may impact effective patient-doctor communication. Our primary objective was to describe CAM use, modalities, perceived benefits, safety, and associated factors among adult patients attending a VS outpatient clinic; we additionally explored patient's attitudes about CAM disclosure with their primary vascular surgeon. METHODS: This cross-sectional study invited 223 consecutive outpatients to an interview where the ICAM-Q (International Complementary and Alternative Medicine Questionnaire) and the PDRQ-9 (Patient-Doctor Relationship Questionnaire-9 items) were applied. In addition, sociodemographics, vascular disease and treatment-related information, comorbidity, and disease severity characteristics were obtained. Appropriated statistics was used; multiple logistic regression analysis identified factors associated to CAM use. All statistical tests were two-sided, and a p value ≤ 0.05 was considered significant. IRB approval was obtained. RESULTS: Patients recruited were primary females (69%) and had a median age of 65 years (54-75). Most frequent vascular diagnoses were chronic venous insufficiency (36.2%) and peripheral artery disease (26%). There were 104 (46.6%) patients who referred CAM use, primarily self-helped practices (96%), and use of herbal, vitamins, or homeopathic medicines (23.7%). Overall, the majority of the patients perceived CAM modalities helpful and 94.6% denied any adverse event. Female sex (OR: 1.768, 95% CI: 0.997-3.135, p = 0.051) and hospitalization during the previous year (OR: 3.173, 95% CI: 1.492-6.748, p = 0.003) were associated to CAM use. The majority of the patients (77%) agreed about CAM disclosure with their primary vascular surgeon; meanwhile, among CAM users, up to 54.9% did not disclose it, and their main reasons were "Doctor didn't ask" (32%) and "I consider it unnecessary" (16%). The patient-doctor relationship was rated by the patients with high scores. CONCLUSIONS: CAM use is frequent and perceived as safe and beneficial among VS outpatients; nonetheless, patients do not disclose CAM use with their primary vascular surgeons, and a wide range of reasons are given by the patients that prevent effective and open communication.

Advancing supportive oncology care via collaboration between psycho-oncology and integrative medicine.

PURPOSE: As survival after cancer diagnosis increases, patients are increasingly turning toward integrative therapies (e.g., yoga, acupuncture, massage) to manage acute and chronic concerns related to cancer treatment and survivorship. As such, integrative medicine programs devoted to combining conventional Western cancer care with complementary treatments such as yoga, acupuncture, botanicals, and homeopathy are increasingly common in cancer communities around the world. However, few integrative medicine programs have included psycho-oncology providers in order to systematically evaluate and treat psychological and behavioral health factors affecting adjustment to cancer. METHODS: A pilot program was initiated at a large academic medical center to explore benefits of a collaborative clinic visit conducted with psycho-oncology and integrative medicine within an existing supportive oncology clinic. Collaborative medical and psychological interventions were provided to enhance patient quality of life and reduce symptom burden. RESULTS: Forty-nine patients were seen via the dyadic consultation model. Sixty-eight percent of patients rated their emotional distress at or above clinical cutoffs, indicating unmet supportive care needs. The majority of patients seen were White, non-Hispanic, and female. CONCLUSIONS: Many cancer patients and survivors report persistent emotional distress and chronic physical problems associated with their diagnosis and treatment. The types of patients seen in this pilot program raise concern about ongoing inequalities in access to integrative medicine and psycho-oncology services, which may contribute to downstream health disparities and poorer clinical outcomes. Future directions will explore billing practices, financial sustainability, and methods to increase access to this type of program for demographically diverse individuals across cancer populations.

Spatial distribution of health consultations in the past two weeks by provider type and district: Pakistan Social and Living Standards Measurement Survey 2014-15.

Place is a nexus between epidemiology and Geographic Information System. In this study, the Pakistan Social and Living Standards Measurement survey 2014-15 data on percent distribution of health consultations, in the past 2-weeks by type of healthcare provider were mapped cumulatively, as well as disaggregated by urban and rural areas, using a GIS programme to visualize spatial distribution in the country by district. Private sector is the main and preferred provider for healthcare services when Pakistanis get sick or injured. Differences between and within provinces - at the district level - exist, but in spite of significant investment by the government in public sector health and nutrition services; most people prefer going to private dispensaries and hospitals. Harnessing the visualization power of GIS for better decision making in health sector is contingent upon easy availability of up-to-date GIS shapefiles to analyze and depict health data on maps.

A patient reported outcome measure in homeopathic clinical practice for long-term conditions.

BACKGROUND: This study was initiated as part of a quality improvement audit process to create standards around goal setting with our patients to understand and improve outcomes of homeopathic treatment. METHOD: We used the Measure Yourself Medical Outcome Profile (MYMOP2) as a tool to assist clinicians in setting the treatment goals across a wide range of diagnoses and other complaints in routine clinical practice at the Bristol Homeopathic Hospital. The data collected from the MYMOP2 is of significance in its own right and the results are now reported in this paper. RESULTS: A total of 198 patients with a wide range of complaints attended one to five consultations with 20 homeopathic doctors. Diagnostic categories were most commonly neoplasms (16.7%), psychological (13.9%) and genitourinary complaints (12.3%), with 66.7% suffering from these problems for at least one year. The three symptoms that bothered patients the most were pain, mental symptoms and tiredness/fatigue. A paired-samples t-test using an intention-to-treat analysis showed that the MYMOP2 profile score improved from 4.25 (IQR 3.50-5.00), with a mean change of 1.24 (95% CI 1.04, 1.44) from the first to the last consultation (p<0.001). Results were statistically significant both for completers (n=91) (p<0.001) and non-completers (n=107) (p<0.001) using last-observation-carried-forward, although completers did better than non-completers (p<0.001). The overall clinical significance of improvements was at least moderate. A repeated measures ANOVA test also showed statistically significant improvements (p<0.001). CONCLUSION: The MYMOP2 results add to a growing body of observational data which demonstrates that when patients with long term conditions come under homeopathic care their presenting symptoms and wellbeing often improve. Offering a low cost high impact intervention to extend the range of choice to patients and to support self-care could be an important part of the NHS.

Motivations of patients seeking supportive care for cancer from physicians prescribing homeopathic or conventional medicines: results of an observational cross-sectional study.

BACKGROUND & AIMS: The motivations of patients who consult a homeopathic (GP-Ho) or conventional (GP-CM) general practitioner for supportive care during cancer treatment have not been widely studied. We investigated the reasons why cancer patients consult a GP-Ho versus a GP-CM for supportive care and the GPs' motivations for their prescriptions. METHODS: This observational survey was carried out in France between October 2008 and October 2011. GPs across France were randomly selected and asked to recruit four cancer patients each. At inclusion, the sociodemographic and clinical (including psychological) characteristics and medical history of the patients were recorded by the GPs and the patients noted their quality of life (QoL) and anxiety/depression using the Quality of Life Questionnaire-C30 (QLQ-C30) and Hospital Anxiety and Depression Scale (HADS) self-questionnaires. The main motivations of the patients regarding the type of GP consultation and the main reasons for the GPs' prescriptions were recorded. RESULTS: Six hundred and forty four patients were included in the analysis: 399 consulted a GP-CM (n = 112) and 245 a GP-Ho (n = 73). Patients consulting a GP-Ho were more often female [OR = 1.93; 95%CI: 1.11-3.35; p = 0.02], employed in a professional capacity [OR = 6.57; 95%CI: 1.96-21.99; p = 0.002], have a shorter time since cancer diagnosis [OR = 2.19; 95%CI: 1.24-3.87; p = 0.007], have received targeted anticancer therapy [OR = 3.70; 95%CI: 1.67-8.18; p = 0.001] and have a high QLQ-C30 score for constipation [OR = 1.01; 95%CI: 1.00-1.02; p = 0.001]. Patients mainly consulted a GP-Ho to receive overall care (73.5% vs. 64.9%; p = 0.024) and medicines to prevent anticancer treatment-related side-effects (63.7% vs. 41.4%; p < 0.0001). In contrast, patients consulted a GP-CM to receive psychological care (50.1% vs. 40.8%; p = 0.021) and more information regarding the oncologists' strategic decisions (p < 0.0001). There was a significantly greater prescription of psychotropic drugs by GP-CM (53.7% vs. 22.4%, p < 0.0001). CONCLUSIONS: Patients consulting a GP-Ho or GP-CM had different motivations for seeking supportive care. There was a significantly greater prescription of psychotropic drugs by GP-CM.

Complementary and alternative medicine (CAM) in obstetrics and gynaecology: a survey of office-based obstetricians and gynaecologists regarding attitudes towards CAM, its provision and cooperation with other CAM providers in the state of Hesse, Germany.

PURPOSE: Whereas we have some information on complementary medicine in the field of oncology, little is known about complementary medicine in the field of obstetrics and gynaecology especially outside of hospitals. METHODS: All office-based obstetricians and gynaecologists in the state of Hesse, Germany, were contacted and asked to fill in an assessment form regarding cooperation in the field of complementary and alternative medicine (CAM), as well as the perceived efficacy of various CAM methods for a number of pathological conditions in the field of obstetrics and gynaecology. RESULTS: It was found that more than half of Hessian office-based obstetricians and gynaecologists had existing cooperation regarding CAM, especially with colleagues, but also midwives, pharmacists, physiotherapists, and health practitioners. The probability of cooperation was significantly inversely associated with age. It was found that the probability for advising CAM differed between various health problems. The following CAM methods were considered reasonable for the treatment of different conditions: phytotherapy for climacteric complaints and premenstrual syndrome; homoeopathy for puerperal problems; acupuncture and traditional Chinese medicine for complaints during pregnancy; and dietary supplements for the side effects of cancer therapy. CONCLUSIONS: The analysis shows that there is much cooperation in the field of CAM. Comparison between physicians' perceived efficacy of CAM methods and objective findings shows that there is a need for the provision of valid information in the field.

Characteristics of patients consulting their regular primary care physician according to their prescribing preferences for homeopathy and complementary medicine.

BACKGROUND: Homeopathic care has not been well documented in terms of its impact on patients' utilization of drugs or other complementary and alternative medicines (CAM). The objective of this study was to describe and compare patients who visit physicians in general practice (GPs) who prescribe only conventional medicines (GP-CM), regularly prescribe homeopathy within a mixed practice (GP-Mx), or are certified homeopathic GPs (GP-Ho). MATERIAL AND METHODS: The EPI3-LASER study was a nationwide observational survey of a representative sample of GPs and their patients from across France. Physicians recorded their diagnoses and prescriptions on participating patients who completed a self-questionnaire on socio-demographics, lifestyle, quality of life Short Form 12 (SF-12) and the complementary and alternative medicine beliefs inventory (CAMBI). RESULTS: A total of 6379 patients (participation rate 73.1%) recruited from 804 GP practices participated in this survey. Patients attending a GP-Ho were slightly more often female with higher education than in the GP-CM group and had markedly healthier lifestyle. They did not differ greatly in their comorbidities or quality of life but exhibited large differences in their beliefs in holistic medicine and natural treatments, and in their attitude toward participating to their own care. Similar but less striking observations were made in patients of the GP-Mx group. CONCLUSION: Patients seeking care with a homeopathic GP did not differ greatly in their socio-demographic characteristics but more so by their healthier lifestyle and positive attitude toward CAM. Further research is needed to explore the directionality of those associations and to assess the potential economic benefits of homeopathic management in primary care.

Homeopathy in rural Australian primary health care: a survey of general practitioner referral and practice in rural and regional New South Wales, Australia.

INTRODUCTION: Homeopathy has attracted considerable recent attention from the Australian conventional medical community. However, despite such increased attention there has been little exploration of the interface between homeopathy and Australian conventional medical practice. This article addresses this research gap by exploring homeopathic practice and referral by rural and regional Australian general practitioners (GPs). MATERIALS AND METHODS: A 27-item questionnaire was sent to all 1486 GPs currently practising in rural and regional New South Wales, Australia (response rate 40.7%). RESULTS: Few GPs in this study utilised homeopathy in their personal practice, with only 0.5% of GPs prescribing homeopathy in the past 12 months, and 8.5% referring patients for homeopathic treatment at least a few times over the past 12 months. Nearly two-thirds of GPs (63.9%) reported that they would not refer for homeopathy under any circumstances. Being in a remote location, receiving patient requests for homeopathy, observing positive responses from homeopathy previously, using complementary and alternative medicine (CAM) practitioners as information sources, higher levels of knowledge of homeopathy, and being interested in increasing CAM knowledge were all independently predictive of increased referral to homeopathy amongst GPs in this study. GPs in this study were less likely to refer to homeopathy if they used peer-reviewed literature as the major source of their information on CAM. CONCLUSIONS: Homeopathy is not integrated significantly in rural general practice either via GP utilisation or referral. There is significant opposition to homeopathy referral amongst rural and regional GPs, though some level of interaction with homeopathic providers exists.

Attitudes toward integrative paediatrics: a national survey among youth health are physicians in The Netherlands.

BACKGROUND: Integrative Medicine (IM) is an emerging field in paediatrics, especially in the USA. The purpose of the present study was to assess the attitudes and beliefs of Youth Health Care (YHC) physicians in the Netherlands toward IM in paediatrics. METHODS: In October 2010, a link to an anonymous, self-reporting, 30-item web-based questionnaire was mailed to all members of the Dutch Organisation of YHC physicians. The questionnaire included questions on familiarity with IM, attitudes towards Integrative Paediatrics (IP), use and knowledge of Complementary and Alternative Medicine (CAM), demographic and practice characteristics. RESULTS: A total of 276 YHC physicians (response rate of 27%) responded to the survey. Of the respondents, 52% was familiar with IM and 56% had used some kind of CAM therapy during the past 2 years, of which self-medicated herbal and/or homeopathic remedies (61%) and supplements (50%) were most frequently mentioned. Most of the YHC physicians (62%) seldom asked parents of clients about CAM use. One third of the YHC physicians recommended CAM to their clients. In general, about 50% or more of the respondents had little knowledge of CAM therapies. Predictors for a positive attitude towards IP were familiarity with IM, own CAM use, asking their clients about CAM use and practising one or more forms of CAM therapy. Logistic regression analysis showed that the following factors were associated with a higher recommendation to CAM therapies: own CAM use (odds ratio (OR) = 3.8; 95% confidence interval (CI) = 2.1-6.9, p = 0.001) and practising CAM (OR 4.4; 95% CI = 1.6-11.7, p = 0.003). CONCLUSIONS: In general Dutch YHC physicians have a relative positive attitude towards IP; more than half of the respondents used one or more forms of CAM and one third recommended CAM therapies. However, the majority of YHC physicians did not ask their clients about CAM use and seemed to have a lack of knowledge regarding CAM.

[Why consult a homoeopath? A medical practice in Münster/Westphalia in the 19th century]. / Warum besucht man einen Homöopathen? Eine Praxis in Münster im 19. Jahrhundert.

The physician Friedrich von Bönninghausen (1828-1910) practiced from 1864 until his death as a homoeopath in Münster/Westphalia. The article locates this "alternative" practice in its medical surrounding. It is shown which cures the patients had already used before they turned to the method of Hahnemann and which motives are given in the records for their decision to consult the homoeopath.

Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy: a randomized controlled clinical trial.

OBJECTIVES: To assess whether any benefits from adjunctive homeopathic intervention in patients with RA are due to the homeopathic consultation, homeopathic remedies or both. METHODS: Exploratory double-blind, randomized placebo-controlled trial conducted from January 2008 to July 2008, in patients with active stable RA receiving conventional therapy. Eighty-three participants from three secondary care UK outpatient clinics were randomized to 24 weeks of treatment with either homeopathic consultation (further randomized to individualized homeopathy, complex homeopathy or placebo) or non-homeopathic consultation (further randomized to complex homeopathy or placebo). Co-primary outcomes: ACR 20% improvement (ACR20) criteria and patient monthly global assessment (GA). SECONDARY OUTCOMES: 28-joint DAS (DAS-28), tender and swollen joint count, disease severity, pain, weekly patient and physician GA and pain, and inflammatory markers. RESULTS: Fifty-six completed treatment phase. No significant differences were observed for either primary outcome. There was no clear effect due to remedy type. Receiving a homeopathic consultation significantly improved DAS-28 [mean difference 0.623; 95% CI 0.1860, 1.060; P = 0.005; effect size (ES) 0.70], swollen joint count (mean difference 3.04; 95% CI 1.055, 5.030; P = 0.003; ES 0.83), current pain (mean difference 9.12; 95% CI 0.521, 17.718; P = 0.038; ES 0.48), weekly pain (mean difference 6.017; 95% CI 0.140, 11.894; P = 0.045; ES 0.30), weekly patient GA (mean difference 6.260; 95% CI 0.411, 12.169; P = 0.036; ES 0.31) and negative mood (mean difference - 4.497; 95% CI -8.071, -0.923; P = 0.015; ES 0.90). CONCLUSION: Homeopathic consultations but not homeopathic remedies are associated with clinically relevant benefits for patients with active but relatively stable RA. TRIAL REGISTRATION: Current controlled trials, http://www.controlled-trials.com/, ISRCTN09712705.

Attitudes toward complementary and alternative medicine: a national survey among paediatricians in the Netherlands.

The purpose of the present survey was to assess attitudes, beliefs, experience, referral patterns and desire for education regarding complementary and alternative medicine (CAM) therapies of paediatricians in the Netherlands. In 2009, the link to an anonymous, self-reporting, 30-item web-based questionnaire was mailed to all members of the Dutch Association of Paediatrics. The questionnaire included questions about demographics and practice characteristics, use of CAM by the paediatrician and/or his family, attitudes towards and knowledge of CAM, and inquiries about CAM use in their practice. A total of 343 (24%) paediatricians responded to the survey: 39% had used some kind of CAM therapy themselves during the past 2 years, of which supplements (64%) and herbal and/or homeopathic remedies (30%) were most frequently mentioned. The majority of the paediatricians (62%) seldom asked parents of patients about CAM use. Referrals to CAM doctors were made by approximately 30% of the paediatricians. In general, more than 50% of the surveyed paediatricians had little knowledge of CAM therapies. Predictors for a positive attitude towards CAM were own CAM use (p < 0.0001), age >45 years (p = 0.02) and perceived knowledge level of CAM (p < 0.005). In conclusion, a significant group of Dutch paediatricians has a positive attitude towards CAM and refers patients to CAM therapies. The majority of paediatricians, however, do not ask patients about CAM use and seem to lack sufficient knowledge on CAM.

Alternative health care consultations in Ontario, Canada: A geographic and socio-demographic analysis.

BACKGROUND: An important but understudied component of Canada's health system is alternative care. The objective of this paper is to examine the geographic and socio-demographic characteristics of alternative care consultation in Ontario, Canada's largest province. METHODS: Data is drawn from the Canadian Community Health Survey (CCHS Cycle 3.1, 2005) for people aged 18 or over (n = 32,598) who had a consultation with an alternative health care provider. Four groups of consultations are examined: (1) all consultations (2) massage therapy (3) acupuncture, and (4) homeopath/naturopath. Descriptive statistics, mapping and logistic regression modeling are employed to analyze the data and to compare modalities of alternative health care use. RESULTS: In 2005, more than 1.2 million adults aged 18 or over consulted an alternative health care provider, representing about 13% of the total population of Ontario. The analysis revealed a varied geographic pattern of consultations across the province. Consultations were fairly even across the urban to rural continuum and rural residents were just as likely to consult a provider as their urban counterparts. From a health perspective, people with a chronic condition, lower health status and self-perceived unmet health care needs were more likely to see an alternative health provider. Women with chronic conditions such as fibromyalgia, high blood pressure, chronic fatigue syndrome and chemical sensitivities were more likely to see an alternative provider if they felt their health care needs were not being met. CONCLUSIONS: The analysis revealed that geography is not a factor in determining alternative health care consultations in Ontario. By contrast, there is a strong association between these consultations and socio-demographic characteristics particularly age, sex, education, health and self-perceived unmet health care needs. The results underscore the importance of women's health needs as related to alternative care use. The paper concludes that there is a need for more place-specific research that explores the reasons why people use specific types of alternative health care as tied to socio-economic status, health, place of residence, and knowledge of these treatments.

Pharmacists' actions when patients use complementary and alternative medicine with medications: A look at Texas-Mexico border cities.

OBJECTIVES: To determine how often pharmacists inquire about patients' complementary and alternative medicine (CAM) use, actions taken in response to patients' CAM use, and demographic or professional characteristics that predict differences in pharmacists' actions. METHODS: A survey was mailed to 400 randomly selected community pharmacists who resided in Texas-Mexico border cities. RESULTS: Most (63.8%) pharmacists had encountered patients who were using CAM. They documented CAM use in 9.8% of cases and monitored for drug-related problems in 39.4%. Among users, pharmacists sometimes to usually (3.4 ± 1.4 [mean ± SD]) took actions such as referring patients to their physicians. Pharmacists were not particularly comfortable (3.2 ± 1.0) with responding to CAM inquiries but believed patients needed adequate CAM knowledge. Pharmacists rarely to sometimes (2.6 ± 1.2) asked patients about their CAM use. Inquiry about CAM use was greater when information could be documented in profiles (F = 4.29, P = 0.02) and when pharmacists had additional training in CAM (t = -2.59, P = 0.01). Also, in pharmacies that stocked herbal or homeopathic products, pharmacists were more likely to recommend other CAM therapies appropriate for patients' conditions (t = -3.27, P < 0.01). CONCLUSION: Pharmacists were not very proactive in inquiring about CAM use, and their actions (e.g., referral to physician) were somewhat passive. More routine inquiry and documentation are needed. Pharmacists should routinely ask about and document CAM use by patients in order to optimize drug therapy outcomes.

The frequency of dietary references in homeopathic consultations.

A retrospective quantitative study on dietary references found in medical records of 2753 patients attending consultations from 10/1/1994 to 5/31/2007 was conducted. The symptoms found in the rubrics relating to food and drink aggravation and amelioration, aversion and craving of homeopathic repertories reflect diets at different places and times and do not correspond fully, to contemporary gastronomy. Desires for sweet and spicy foods were statistically more frequent, revealing the prevailing taste for such food among the studied population. Food cravings should be carefully analyzed before considering them as indications for choosing homeopathic therapy, they are less significant than aversions, aggravations and ameliorations.

Consultation with health care professionals and influenza immunization among women in contact with young children.

OBJECTIVE: Primary health providers serve an important role in providing and promoting annual influenza immunization to high-risk groups and their close contacts. The purpose of this analysis was to determine whether consultation with a medical professional increases the likelihood of receiving a flu shot among women who have given birth in the past five years and to determine whether this association differs by type of medical professional. METHODS: Data were obtained from the Canadian Community Health Survey (2005), Cycle 3.1. Logistic regression was used to examine the association between receiving a flu shot in the past 12 months and consulting with family doctors, specialists, nurses, chiropractors, or homeopaths/naturopaths. RESULTS: Among the 6,925 women included in our sample, 1,847 (28.4%) reported receiving a flu shot in the past 12 months. After adjustment for socio-demographic characteristics and province of residence, women who received flu shots in the past 12 months were significantly more likely to consult with a family doctor (AOR 1.56, 95% CI 1.34-1.83) and significantly less likely to consult with a chiropractor (AOR 0.76, 95% CI 0.64-0.90) or a homeopath/naturopath (AOR 0.72, 95% CI 0.54-0.97) over the same time period. CONCLUSION: Consultation with family doctors was found to have the strongest association with annual flu shots among women in contact with young children, whereas consultation with alternative care providers was found to have an independent inverse association. Given the influenza-associated health risks for young children, medical professionals should promote immunization at the time of consultation for household contacts of young children, including pregnant women.

Diabetic retinopathy screening uptake after health education with or without retinal imaging within the facility in two AYUSH hospitals in Hyderabad, India: A nonrandomized pilot study.

Purpose: In India, people with diabetes (PwDM) often seek care in the government-approved alternative medicine system, AYUSH (Ayurveda, Yoga and naturopathy, Unani, Siddha and Homeopathy). The purpose of this pilot study was to assess whether health education plus retinal imaging for diabetic retinopathy (DR) within an AYUSH hospital increased the uptake of screening for DR compared with health education and referral. Methods: The study was a nonrandomized pilot conducted in two AYUSH hospitals. Both hospitals received intervention on educating the AYUSH practitioners about DR screening and distributing health education materials to diabetic patients. In one hospital in addition to education, retinal imaging by a trained technician with remote grading by an ophthalmologist was provided, while in another hospital PwDM were referred to nearby eye hospitals for screening. The uptake of screening was assessed through registers and phone calls. Results: At baseline, only 10.7% of 178 PwDM were aware of DR and only 8% had undergone DR screening. After the intervention, in the hospital where screening was provided, all (100%) eligible patients (101) underwent digital imaging, whereas in the other hospital only 25% of 77 eligible patients underwent screening in eye hospitals (P < 0.001). Conclusion: AYUSH hospitals could provide a feasible and acceptable location for providing DR screening services. Further studies are required to assess scale-up of such intervention.

How do parents of child patients compare consultations with homeopaths and physicians? A qualitative study.

OBJECTIVE: How do parents of child patients experience and compare consultations with homeopaths and physicians, and how do they describe an ideal consultation. METHODS: A qualitative study with interviews of parents to 16 children who had consulted both a homeopaths and a physicians. RESULTS: Comparing consultations with physicians and homeopaths, the parents experienced the homeopathic consultations to a greater extent to have a whole person approach, also described as a core factor in an ideal consultation. This approach included exhaustive questioning, longer consultations, more interaction with the child and looking for the underlying cause. CONCLUSION: The parents in this study perceived that the homeopathic consultation had a whole person approach while consultations with most physicians focused on the symptoms. The homeopathic consultation was said to be more in line with what the parents perceived to be an ideal consultation for their children than consultation with physicians. PRACTICE IMPLICATIONS: Treatment philosophy and the aim of the consultation are likely to play a larger part than the technical aspects in determining the form and content of a consultation. Training in communication could benefit from including discussions on how the practitioner's treatment philosophy influences the consultation behavior.

Polarity analysis, a new approach to increase the precision of homeopathic prescriptions.

INTRODUCTION: The Swiss randomised controlled trial of homeopathy for attention deficit hyperactivity disorder (ADHD) was a rigorous test of homeopathy. In each of its three phases it delivered evidence for a specific effect of homeopathic treatment, but it also unmasked weaknesses of the method. Misleading reports of sensations and mind symptoms by parents were frequent, while modalities and polar symptoms usually proved to be reliable information for repertorisation. The problem of cases with a paucity of symptoms was resolved by reintroduction of (pathognomonic) perception symptoms into the repertorisation. Additionally polarity analysis, a further development of Boenninghausen's concept of contraindications, was tested and introduced. It allows a precise differential diagnosis of possible homeopathic medicines. Increasing the rate of optimal prescriptions by 20%, polarity analysis turned out to be the most efficient modification to case analysis. This paper describes the transfer of the new insights to the treatment of other diseases and as the evaluation of this process. METHODS: Polarity analysis was tested and applied in acute diseases by completing patient histories with repertory specific checklists, mainly based on modalities and polar symptoms. The checklists encompassed eleven different complaints. Treatment results were compared with results reached by conventional homeopathic case analysis methods. The same procedure was applied in chronic diseases with repertory-specific questionnaires. Again, eleven different areas were covered. Treatment results for chronic diseases were also compared with a conventional case analysis approach. RESULTS: Polarity analysis, checklists and questionnaires led to an increase in optimal prescriptions of 22% in acute diseases and 16% in chronic diseases. In addition, the average improvement rates in chronic disease were 9% higher than with conventional homeopathic procedures. The new method is demonstrated by a case example with a verified clinical cure, and its impacts on homeopathy are discussed. CONCLUSION: The use of polarity analysis as an integral part of case analysis and differential diagnosis of possible remedies together with an increased awareness for assessing the reliability of symptoms in repertorisation lead to a substantial improvement in the precision of homeopathic prescriptions.