RESUMEN
BACKGROUND: After prospective assessment of six homeopathic symptoms we validated some rubrics of the homeopathic repertory using Bayesian theory. In this paper we introduce statistical arguments for introducing or discarding entries from the repertory. METHODS: 4094 patients entered the prospective study and 4072 prescriptions were evaluated. After translating typeface into Likelihood Ratios (LRs), Confidence Intervals and the probability of existing repertory entries compared to our findings were calculated. OUTCOME: Our assessment yielded 121 relevant results to validate existing repertory entries. Five symptoms could be compared with Kent's original repertory; they have about the same prevalence (range 3.9-6.5%) in the whole population, but the size of the corresponding repertory rubrics varies from 3 to 103 entries. LR assessment reduced the larger rubrics and supplemented the smaller ones. Our results do not correspond with 56% of the existing repertory entries regarding five symptom-rubrics. This result cannot be generalised for the whole repertory.
Asunto(s)
Teorema de Bayes , Homeopatía , Funciones de Verosimilitud , Humanos , Estudios ProspectivosRESUMEN
The criteria for entering medicines in repertory rubrics are unclear and partly incorrect. A new repertory should be based on clear and objective criteria. Retrospective and prospective assessment of medicines and symptoms by the Dutch Committee for Methods and Validation gives an indication of the validity of existing repertory entries. Reliance on the experience of one expert is the cause of part of the shortcomings of the repertory. This experience is highly influenced by chance. Another part is due to the use of absolute rather than relative occurrence of symptoms. Yet another part is caused by not comparing prevalence in the population 'cured' by a medicine with the remainder of the population. In many cases we need better definitions of symptoms. A clear protocol and prospective research could overcome many shortcomings of the repertory. Statistics help to get more objective criteria, but we still need to reach consensus about how to handle probabilities of outcomes of our assessments.
Asunto(s)
Teorema de Bayes , Homeopatía/normas , Materia Medica/normas , Proyectos de Investigación/normas , Diagnóstico Diferencial , Prescripciones de Medicamentos/normas , Humanos , Funciones de Verosimilitud , Países Bajos , Estudios Prospectivos , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
An interim assessment of likelihood ratio of homeopathic symptoms shows that there are serious flaws in Kent's repertory. The system of expressing relationship between symptoms and expected results from medicines by type-face is unclear and unreliable. Bayesian methods can improve this and expand the possibilities of the repertory including the possibility of interpreting the absence of expected symptoms.
Asunto(s)
Teorema de Bayes , Homeopatía/normas , Funciones de Verosimilitud , Materia Medica/normas , Diagnóstico Diferencial , Prescripciones de Medicamentos/normas , Humanos , Modelos Teóricos , Extractos Vegetales/uso terapéutico , Reproducibilidad de los Resultados , Proyectos de InvestigaciónRESUMEN
Treatment outcome in a pilot study indicates that it is possible to assess likelihood ratios of homeopathic symptoms. Entries in repertory rubrics can be validated, but must still be handled carefully. Prospective research is the only acceptable way. Software to support this research must be carefully designed to export correct data.
Asunto(s)
Homeopatía/normas , Funciones de Verosimilitud , Materia Medica/normas , Humanos , Proyectos Piloto , Extractos Vegetales/uso terapéutico , Estudios Prospectivos , Reproducibilidad de los Resultados , Proyectos de Investigación/normas , Programas Informáticos , Factores de TiempoRESUMEN
If the likelihood ratio (LR) method is introduced, the repertory will gradually change as more symptoms are assessed. It will also change the use of the repertory: the most important medicines of each symptom rubric can be identified and relied on, even in large rubrics. This is also a good opportunity to correct structural shortcomings of the repertory, for instance, entries should be based on systematic analysis of materia medica instead of casual observations.
Asunto(s)
Teorema de Bayes , Homeopatía/normas , Funciones de Verosimilitud , Materia Medica/normas , Diagnóstico Diferencial , Prescripciones de Medicamentos/normas , Humanos , Proyectos Piloto , Estudios Prospectivos , Reproducibilidad de los Resultados , Proyectos de Investigación/normasRESUMEN
Clinical symptoms including homeopathic symptoms are often vague. There is reluctance to assess clinical symptoms as diagnostic instruments because they are hard to define. Still, clinical symptoms appear effective in daily practice. Expert systems and neural networks handle vague data successfully. Theoretical considerations predict the kind of problems we may expect. There is a difference between quantitative and qualitative vagueness. Vague data cause problems if we try to prove a hypothesis because of expectation bias. We assess likelihood ratio of homeopathic symptoms only to improve the method.
Asunto(s)
Homeopatía , Funciones de Verosimilitud , Materia Medica , Modelos Teóricos , Sesgo , Homeopatía/normas , Humanos , Materia Medica/normas , Proyectos de InvestigaciónRESUMEN
A pilot study was performed to investigate the possibilities and restrictions of likelihood ratio (LR) investigation using three symptoms. Qualitative vagueness and expectation bias is inherent in our method, but is, in part avoidable. It appears that experienced observers assess common homeopathic symptoms quite similarly. Clinical judgement is an essential part of our work and should be preserved during assessment of LR. The assessment does not influence clinical practice and can be maintained for a long period, provided the appropriate software is used. A limited range of symptoms seems most suitable for LR investigation.
Asunto(s)
Competencia Clínica , Homeopatía/normas , Funciones de Verosimilitud , Adolescente , Adulto , Anciano , Sesgo , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Materia Medica/normas , Persona de Mediana Edad , Modelos Teóricos , Países Bajos , Proyectos Piloto , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
Clinical symptoms including homeopathic symptoms are often vague. There is reluctance to assess clinical symptoms as diagnostic instruments because they are hard to define. Still, clinical... (AU)
Asunto(s)
Síntomatología , Signos y Síntomas , Variaciones Dependientes del Observador , HomeopatíaRESUMEN
A committee of the Dutch Association of Homeopathic Physicians is trying to validate materia medica by evaluating successful cases. These cases are presented and assessed by a group of experienced homeopathic physicians to provide indications about the prevalence of symptoms related to particular homeopathic medicines. The next logical question is whether epidemiological techniques can be applied to them. We have some ideas concerning the information these data can provide, based on epidemiological theory and limited experimental data. Theoretical investigation suggests that the epidemiological concept of likelihood ratio is well adapted to homeopathy. Researching and applying likelihood ratio will lead to more accurate materia medica and repertory. These considerations already indicate some shortcomings in the representation of rare remedies and the use of grading in the current repertories.
Asunto(s)
Prescripciones de Medicamentos/normas , Homeopatía/normas , Funciones de Verosimilitud , Materia Medica/normas , Humanos , Modelos Teóricos , Países Bajos , Proyectos de InvestigaciónRESUMEN
A committee of the Dutch Association of Homeopathic Physicians is trying to validate materia medica by evaluating successful cases. These cases are presented and assessed by a group of experienced homeopathic... (AU)