Efficacy of Arsenicum album 30cH in preventing febrile episodes following DPT-HepB-Polio vaccination - a randomized, double-blind, placebo-controlled clinical trial.

BACKGROUND: Among the post-immunization adverse events, especially of Diphtheria-Pertusis-Tetanus (DPT), fever is a common systemic reaction. There is anecdotal support for the use of the homeopathic medicine Arsenicum album in preventing post-vaccination fever. The investigators intended to evaluate its efficacy in preventing febrile episodes following vaccination. METHODS: In the community medicine out-patient of Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, West Bengal, India, between August 2014 and January 2017, a double-blind, randomized, placebo-controlled trial was conducted on 120 children (verum: 60, placebo: 60) who presented for the 2nd and 3rd dose of DPT-HepB-Polio vaccination and reported febrile episodes following the 1st dose. Intervention used was Arsenicum album 30cH 6 doses or placebo (indistinguishable from verum), thrice daily for two subsequent days. Parents were advised to report any event of febrile attacks within 48h of vaccination, either directly or over telephone. RESULTS: The groups were comparable at baseline. Children reporting fever after the 2nd dose was 29.8% and 30.4% respectively for the homeopathy group and control group respectively [Relative Risk (RR)=1.008] with no significant difference (P=0.951) between groups. Again after the 3rd dose, children reporting fever were 31.5% and 28.3% respectively for the homeopathy group and control group respectively (RR=0.956) with no significant difference (P=0.719) between groups. CONCLUSION: Empirically selected Arsenicum album 30cH could not produce differentiable effect from placebo in preventing febrile episodes following DPT-HepB-Polio vaccination. [Trial registration: CTRI/2017/02/007939].

Patients' Preference for Integrating Homoeopathy Services within the Secondary Health Care Settings in India: The Part 3 (PPIH-3) Study.

Indian patients' preference for integrated homoeopathy services remains underresearched. Two earlier surveys revealed favorable attitude toward and satisfaction from integrated services. The objectives of this study were to examine knowledge, attitudes, and practice of homoeopathy and to evaluate preference toward its integration into secondary-level health care. A cross-sectional survey was conducted during May to October 2015 among 659 adult patients visiting randomly selected secondary-level conventional health care setups in Kolkata, Mumbai, Kottayam, and New Delhi (India) using a self-administered 24-item questionnaire in 4 local vernaculars (Bengali, Marathi, Malayalam, and Hindi). Knowledge and practice scores were compromised; attitude scores toward integration and legal regulation were high. Respondents were uncertain regarding side effects of homoeopathy and concurrent use and interactions with conventional medicines. A total of 82.40% (95% confidence interval = 79.23, 85.19) of the participants were in favor of integrating homoeopathy services. Preference was significantly higher in Delhi and lower in Kottayam. Probable strategic measures for further development of integrated models are discussed.

Treatment of hemorrhoids with individualized homeopathy: An open observational pilot study.

AIM: Controversies and disagreement exist on conventional treatment strategies of hemorrhoids due to relapse, inefficacy, and complications. We intend to evaluate the role of individualized homeopathic treatment in hemorrhoids. MATERIALS AND METHODS: In this prospective, open, observational trial, hemorrhoids patients were treated using five standardized scales measuring complaints severity and anoscopic score. It was conducted at two homeopathic hospitals in India, during from mid-July 2014 to mid-July 2015. Patients were intervened as per individualized homeopathic principles and followed up every month up to 6 months. RESULTS: Total 73 were screened, 52 enrolled, 38 completed, 14 dropped out. Intention to treat population (n: = 52) was analyzed in the end. Statistically significant reductions of mean bleeding (month 3: -21.8, 95% confidence interval [CI]: -30.3, -13.3, P: < 0.00001, d = 0.787; month 6: -25.5, 95% CI -35.4, -15.6, P: < 0.00001, d = 0.775), pain (month 3: -21.3, 95% CI -28.6, -14.0, P: < 0.00001, d = 0.851; month 6: -27.6, 95% CI -35.6, -19.6, P: < 0.00001, d = 1.003), heaviness visual analog scales (VASs) (month 3: -8.1, 95% CI -13.9, -2.3, P: = 0.008, d = 0.609; month 6: -12.1, 95% CI -19.1, -5.1, P: = 0.001, d = 0.693), and anoscopic score (month 3: -0.4, 95% CI -0.6, -0.2, P: < 0.0001, d = 0.760; month 6: -0.5, 95% CI -0.7, -0.3, P: < 0.0001, d = 0.703) were achieved. Itching VASs reduced significantly only after 6 months (-8.1, 95% CI -14.6, -1.6, P: = 0.017, d = 0.586). No significant lowering of discharge VASs was achieved after 3 and 6 months. CONCLUSION: Under classical homeopathic treatment, hemorrhoids patients improved considerably in symptoms severity and anoscopic scores. However, being observational trial, our study cannot provide efficacy data. Controlled studies are required. Trial Reg. CTRI/2015/07/005958.

Patient-Assessed Chronic Illness Care (PACIC) scenario in an Indian homeopathic hospital.

Homeopathy research has focused on chronic conditions; however, the extent to which current homeopathic care is compliant with the Chronic Care Model (CCM) has been sparsely shown. As the Bengali Patient-Assessed Chronic Illness Care (PACIC)-20 was not available, the English questionnaire was translated and evaluated in a government homeopathic hospital in West Bengal, India. The translation was done in six steps, and approved by an expert committee. Face validity was tested by 15 people for comprehension. Test/retest reliability (reproducibility) was tested on 30 patients with chronic conditions. Internal consistency was tested in 377 patients suffering from various chronic conditions. The questionnaire showed acceptable test/retest reliability [intraclass correlation coefficient (ICC) 0.57-0.75; positive to strong positive correlations; p < 0.0001] for all domains and the total score, strong internal consistency (Cronbach's α = 0.86 overall and 0.65-0.82 for individual subscales), and large responsiveness (1.11). The overall mean score percentage seemed to be moderate at 69.5 ± 8.8%. Gender and presence of chronic conditions did not seem to vary significantly with PACIC-20 subscale scores (p > 0.05); however, monthly household income had a significant influence (p < 0.05) on the subscales except for "delivery system or practice design." Overall, chronic illness care appeared to be quite promising and CCM-compliant. The psychometric properties of the Bengali PACIC-20 were satisfactory, rendering it a valid and reliable instrument for assessing chronic illness care among the patients attending a homeopathic hospital.

A validation study of homeopathic prescribing and patient care indicators.

A preliminary version of the homeopathic prescribing and patient care indicators was available. The instrument was modified further in this study with an intention to address formally its validity and reliability, audit prescriptions, identify areas of sub-optimal prescribing, and highlight target areas for improving the quality of practices. A cross-sectional study with record analysis was conducted on systematically sampled 377 patients of Mahesh Bhattacharyya Homeopathic Medical College and Hospital (MBHMC and H), Howrah, West Bengal, India. The outcome measures were homeopathic prescribing indicators (6 items) and patient care indicators (5 items). Individualized homeopathic prescriptions predominated in the encounters. Areas demanding immediate attention were extremely poor labeling of drugs dispensed from the hospital pharmacy, improper record of case history and disease diagnosis, ongoing therapies, and investigational findings in the prescriptions. Internal consistency of the overall instrument was estimated to be good (Cronbach's alpha: Prescribing indicators 0.752 and patient care indicators 0.791). The prescribing indicators, except items 1 and 3, reflected acceptable item-corrected total correlations - Pearson's r from 0.58 (95% CI: 0.52-0.65) to 0.74 (95% CI: 0.69-0.78). The patient care indicators, except item 2, showed acceptable correlations - Pearson's r from 0.40 (95% CI: 0.31-0.48) to 0.82 (95% CI: 0.78-0.85). The instrument also showed high discriminant validity (prescribing indicators P < 0.0001 and patient care indicators P < 0.0001). Improper prescribing practice was quite rampant and corrective measures are warranted. The developed indicators appeared to be validated and reliable; however, they are amendable for further development.

Patient activation measures in a government homeopathic hospital in India.

The American Patient Activation Measure-22 questionnaire (PAM-22) quantifies the knowledge, skills, and confidence essential to manage own health and health care. It is a central concept in chronic illness care models, but studied sparsely in homeopathic hospitals. PAM-22 was translated into Bengali and a cross-sectional study was undertaken in chronically ill 417 patients visiting the outpatient clinic of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, India. Response rate was 90.41%. Data were analyzed using Rasch rating scale model with Winsteps. Activation score was 54.7 ± 8.04 or 62.13% of maximum score. PAM scores differed significantly by age, education, income, and health status (P < .05). The items had good data quality fit statistics and good range of difficulty. The construct unidimensionality was confirmed by good model fits for Rasch model and principal component analysis of residuals found no meaning structure. The questionnaire showed acceptable psychometrics. Patient activation was moderate and needs to be improved.

Access to and utilization of the health services among the patients in a government homeopathic hospital in West Bengal, India: a cross-sectional study.

Accessibility to and utilization of the hospital health services is a complex and multifaceted issue. This study aimed to assess the knowledge of the patients of health services, current level of access to and utilization of services and to identify barriers and socioeconomic disparities in an Indian homeopathic hospital. A cross-sectional survey was conducted in December 2013 on systematically sampled 377 patients. Responses were analyzed using descriptive statistics and univariate logistic regression. Mean knowledge score and perceived mean difficulties in access to and utilization of services were 68.4% and 78.5%, respectively. Knowledge of the services was influenced by age, residence, education, speaking and reading of Bengali language, and income status (P < .05). Difficulty in access to and utilization of the health services were influenced by residence, understanding of Bengali language, and monthly household income (P < .05). Overall, health service access and utilization appeared promising, but needs improvement.

Evaluación de la satisfacción de los pacientes en un hospital homeopático gubernamental en Bengala Occidental, India / Assessment of patient satisfaction in a government homeopathic hospital in West Bengal, India

Introducción y objetivos: la determinación del grado de satisfacción de los pa¬cientes de un hospital homeopático puede producir un impacto sustancial en los esfuerzos para mejorar el estado de salud y la calidad de la atención proporcionada. En este trabajo, los investigadores evaluaron el grado de satisfacción de los pacientes después de recibir consulta médica, al igual que la validez y la confiabilidad del interrogatorio al que se sometieron. Métodos: estudio transversal con diseño observacional realizado en febre¬ro de 2013, con 390 voluntarios, en cinco unidades de consulta externa de la Facultad y Hospital de Medicina Homeopática Mahesh Bhattacharyya, perteneciente a la red pública de Bengala Occidental (Howrah, India). Fue auto-aplicado un breve cuestionario de satisfacción con consultas médicas, elaborado en Japón y traduci¬do al bengalí, con 12 ítems de respuesta múltiple en una escala tipo Likert de cinco puntos. El cuestionario generó cinco subescalas: satisfacción general, examen completo, cuidado completo de la persona, duración de la consulta y centralidad en el paciente. Las respuestas de cada ítem y sub-escala también incluían una escala visual analógica (EVA) de 100 mm. Resultados: el cuestionario se mostró válido y confiable. Su consistencia interna fue comprobada por valores entre 0.7 y 0.9 del coeficiente alfa de Cronbach (α), y la confiabilidad test-retest por el coeficiente kappa de Cohen (κ), cuyo valor fue superior a 0.7 en todos los ítems. La validez concurrente del coeficiente r de Pearson correspondiente al puntaje total del cuestionario y las EVA fue de 0.60, p<0.001; puntaje de cada escala 0.8 < r < 0.9, p<0.0001, y puntaje de cada ítem 0.8 < r < 0.9, p<0.0001.[...] En general, los pacientes reportaron alta satisfacción. Nuevos estudios son necesarios para adaptar el cuestionario utilizado en este trabajo a otros idiomas para uso global.

Discovering the degree of patient satisfaction in a homeopathic hospital setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a five-point Likert scale was used. The questionnaire generated five subscales - overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100 mm were provided with each single question item and each subscale. The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s alpha (α) were between 0.7-0.9 and test-retest reliability Cohen’s kappa (κ) was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, p<0.001; each subscale scores 0.8 < r < 0.9, p<0.0001, and each question score 0.8 < r < 0.9, p<0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (p< 0.05, df=4.95% CI) establishing discriminant validity. Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages.

Evaluación de la satisfacción de los pacientes en un hospital homeopático gubernamental en Bengala Occidental, India / Assessment of patient satisfaction in a government homeopathic hospital in West Bengal, India

Introducción y objetivos: la determinación del grado de satisfacción de los pa¬cientes de un hospital homeopático puede producir un impacto sustancial en los esfuerzos para mejorar el estado de salud y la calidad de la atención proporcionada. En este trabajo, los investigadores evaluaron el grado de satisfacción de los pacientes después de recibir consulta médica, al igual que la validez y la confiabilidad del interrogatorio al que se sometieron. Métodos: estudio transversal con diseño observacional realizado en febre¬ro de 2013, con 390 voluntarios, en cinco unidades de consulta externa de la Facultad y Hospital de Medicina Homeopática Mahesh Bhattacharyya, perteneciente a la red pública de Bengala Occidental (Howrah, India). Fue auto-aplicado un breve cuestionario de satisfacción con consultas médicas, elaborado en Japón y traduci¬do al bengalí, con 12 ítems de respuesta múltiple en una escala tipo Likert de cinco puntos. El cuestionario generó cinco subescalas: satisfacción general, examen completo, cuidado completo de la persona, duración de la consulta y centralidad en el paciente. Las respuestas de cada ítem y sub-escala también incluían una escala visual analógica (EVA) de 100 mm. Resultados: el cuestionario se mostró válido y confiable. Su consistencia interna fue comprobada por valores entre 0.7 y 0.9 del coeficiente alfa de Cronbach (α), y la confiabilidad test-retest por el coeficiente kappa de Cohen (κ), cuyo valor fue superior a 0.7 en todos los ítems. La validez concurrente del coeficiente r de Pearson correspondiente al puntaje total del cuestionario y las EVA fue de 0.60, p<0.001; puntaje de cada escala 0.8 < r < 0.9, p<0.0001, y puntaje de cada ítem 0.8 < r < 0.9, p<0.0001.[...] En general, los pacientes reportaron alta satisfacción. Nuevos estudios son necesarios para adaptar el cuestionario utilizado en este trabajo a otros idiomas para uso global. (AU)

Discovering the degree of patient satisfaction in a homeopathic hospital setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a five-point Likert scale was used. The questionnaire generated five subscales - overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100 mm were provided with each single question item and each subscale. The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s alpha (α) were between 0.7-0.9 and test-retest reliability Cohen’s kappa (κ) was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, p<0.001; each subscale scores 0.8 < r < 0.9, p<0.0001, and each question score 0.8 < r < 0.9, p<0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (p< 0.05, df=4.95% CI) establishing discriminant validity. Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages. (AU)

Tratamiento homeopático para el vitiligo: un estudio piloto abierto observacional / Homoeopathic treatment of vitiligo: an open observational pilot study

Antecedentes: El vitiligo es un trastorno común de hipopigmentación que genera un impacto psicológico muy importante. En una clínica de atención ambulatoria en Bengala Occidental, India, se realizó una evaluación del tratamiento homeopático en individuos con vitiligo. Métodos: Se reclutaron 30 pacientes (edad media de 27 años; 57% femeninos) para un estudio piloto prospectivo abierto, y se manejaron con tratamiento homeopático individualizado durante seis meses. Se evaluó La eficacia del tratamiento a los tres y seis meses, utilizando el Índice de Puntuación del Área con Vitiligo (Vitiligo Area Scoring Index, VASI), la escala de la Comisión Europea de Vitiligo (Vitiligo European Task Force, VETF) y el Índice de Calidad de Vida en Dermatología (Dermatological Life Quality Index, DLQI), los cuales validaron el índice de mejoría tomando en cuenta el área, la intensidad, la extensión de La despigmentación de las lesiones de vitiligo y la calidad de vida (QoL). Resultados: Un total de 27 pacientes completaron el estudio; tres desertaron. Después de seis meses de tratamiento, la medida media de VASI mejoró significativamente en 0.1 unidades (p=0.003), de 0.8 (0.5, 1.5) a 0.7 (0.3, 0.8) en una escala de 0 (sin despigmentación) y 100 (completamente despigmentada). Del mismo modo, la media del VETF mejoró su puntuación por 2 unidades (p=0.0001), de 1 (0.1) a -1 (-1.0), y el marcador de estadificación varió de 1 (1.2) a 1 (0.1), p=0.002. La media de La puntuación total de DLQI disminuyó de 21 (17, 22) a 13.6 (10, 17), con variación de 7.4 (p=0.0001); dicha variación también fue corroborada por los componentes del DLQI. Conclusiones: El tratamiento homeopático individualizado se asoció con una mejoría significativa de las puntuaciones en VASI, VETF y DLQI. La premisa de que los efectos observados se deben a placebo se debe aclarar en futuros ensayos clínicos aleatorios doble ciego, precedidos por estudios de viabilidad.

Background: Vitiligo is a common hypopigmentation disorder with significant psychological impact. An evaluation of homeopathic treatment was performed in individuals with vitiligo in a hospital outpatient clinic in West Bengal, India. Methods: 30 participants (median age 27 years old, 57% female) were recruitedfor a prospective open-label pilot study and treated with individualized homeopathic medicines for six months. Efficacy was assessed after three months and six months using Vitiligo Area Scoring Index (VASI) score, Vitiligo European Task Force (VETF)score, and Dermatological Life Quality Index (DLQI) score, which are validatedoutcome measures evaluating the area, intensity, spread of depigmentation ofvitiligo lesions, and quality of life (QoL). Results: A total of 27 participants completed the trial; 3 dropped out. After 6 months of treatment, the median VASI total score improved significantly by 0.1 units (p=0.003), from 0.8 (0.5, 1.5) to 0.7 (0.3, 0.8) on a scale from 0 (no depigmentation) to 100 (completely depigmented). Similarly, the VETF median score improved by 2 units (p=0.0001) from 1 (0, 1) to -1 (-1, 0) and the staging score changed from 1 (1, 2) to 1 (0, 1), p=0.002. The total DLQI median score exhibited significant reduction from 21 (17, 22) to 13.6 (10, 17), change 7.4 (p=0.0001), as also did its components. Conclusions: Individualized homeopathictreatment associated with significant improvement of VASI, VETF and DLQI scores. The extent to which the observed effects were due to placebo needs clarificationin future randomized double-blind clinical studies preceded by feasibility studies.

Tratamiento homeopático para el vitiligo: un estudio piloto abierto observacional / Homoeopathic treatment of vitiligo: an open observational pilot study

Antecedentes: El vitiligo es un trastorno común de hipopigmentación que genera un impacto psicológico muy importante. En una clínica de atención ambulatoria en Bengala Occidental, India, se realizó una evaluación del tratamiento homeopático en individuos con vitiligo. Métodos: Se reclutaron 30 pacientes (edad media de 27 años; 57% femeninos) para un estudio piloto prospectivo abierto, y se manejaron con tratamiento homeopático individualizado durante seis meses. Se evaluó La eficacia del tratamiento a los tres y seis meses, utilizando el Índice de Puntuación del Área con Vitiligo (Vitiligo Area Scoring Index, VASI), la escala de la Comisión Europea de Vitiligo (Vitiligo European Task Force, VETF) y el Índice de Calidad de Vida en Dermatología (Dermatological Life Quality Index, DLQI), los cuales validaron el índice de mejoría tomando en cuenta el área, la intensidad, la extensión de La despigmentación de las lesiones de vitiligo y la calidad de vida (QoL). Resultados: Un total de 27 pacientes completaron el estudio; tres desertaron. Después de seis meses de tratamiento, la medida media de VASI mejoró significativamente en 0.1 unidades (p=0.003), de 0.8 (0.5, 1.5) a 0.7 (0.3, 0.8) en una escala de 0 (sin despigmentación) y 100 (completamente despigmentada). Del mismo modo, la media del VETF mejoró su puntuación por 2 unidades (p=0.0001), de 1 (0.1) a -1 (-1.0), y el marcador de estadificación varió de 1 (1.2) a 1 (0.1), p=0.002. La media de La puntuación total de DLQI disminuyó de 21 (17, 22) a 13.6 (10, 17), con variación de 7.4 (p=0.0001); dicha variación también fue corroborada por los componentes del DLQI. Conclusiones: El tratamiento homeopático individualizado se asoció con una mejoría significativa de las puntuaciones en VASI, VETF y DLQI. La premisa de que los efectos observados se deben a placebo se debe aclarar en futuros ensayos clínicos aleatorios doble ciego, precedidos por estudios de viabilidad. (AU)

Background: Vitiligo is a common hypopigmentation disorder with significant psychological impact. An evaluation of homeopathic treatment was performed in individuals with vitiligo in a hospital outpatient clinic in West Bengal, India. Methods: 30 participants (median age 27 years old, 57% female) were recruitedfor a prospective open-label pilot study and treated with individualized homeopathic medicines for six months. Efficacy was assessed after three months and six months using Vitiligo Area Scoring Index (VASI) score, Vitiligo European Task Force (VETF)score, and Dermatological Life Quality Index (DLQI) score, which are validatedoutcome measures evaluating the area, intensity, spread of depigmentation ofvitiligo lesions, and quality of life (QoL). Results: A total of 27 participants completed the trial; 3 dropped out. After 6 months of treatment, the median VASI total score improved significantly by 0.1 units (p=0.003), from 0.8 (0.5, 1.5) to 0.7 (0.3, 0.8) on a scale from 0 (no depigmentation) to 100 (completely depigmented). Similarly, the VETF median score improved by 2 units (p=0.0001) from 1 (0, 1) to -1 (-1, 0) and the staging score changed from 1 (1, 2) to 1 (0, 1), p=0.002. The total DLQI median score exhibited significant reduction from 21 (17, 22) to 13.6 (10, 17), change 7.4 (p=0.0001), as also did its components. Conclusions: Individualized homeopathictreatment associated with significant improvement of VASI, VETF and DLQI scores. The extent to which the observed effects were due to placebo needs clarificationin future randomized double-blind clinical studies preceded by feasibility studies. (AU)

Understanding of biostatistics among the homeopathic fresh graduates and post-graduate trainees in West Bengal, India

Background: A basic understanding of biostatistics is essential, both for designing quality research and evaluating medical literature. We evaluated the understanding of biostatistics and interpretation of research results among homeopathic fresh graduates’ (House Staffs; HSs) and postgraduate trainees’ (PGTs) in West Bengal, India. Methods: A cross-sectional survey of homeopathic HSs and PGTs in the four government homeopathic schools in West Bengal, India, using a pre-tested, valid and reliable biostatistics multiple choice knowledge, confidence and attitude test questionnaire. Results: Internal consistency of the used questionnaires was acceptable (Cronbach’s á = 0.611 – 0.672). Response rate was only 55.6%. Research journal reading habit was seriously lacking. No one had ever taken any research courses or possessed any advanced degrees or diplomas. The overall mean% correct on statistical knowledge was very poor, 1.0% (95% CI 0.1 – 1.9%) vs. 10.0% (95% CI 8.6 – 11.6%) for HSs and PGTs (P < 0.0001). Comparatively, higher knowledge scores were found in respondents from Mahesh Bhattacharyya Homeopathic Medical College and Hospital (P = 0.003). No one could interpret an unadjusted odds ratio, Kaplan-Meier analysis results, and determine strength of evidence for risk factors. Percentages of correct answers for all other knowledge-based questions ranged between only 2.7 – 9.5%. Respondents’ self-assessed confidence in ability to understand biostatistics ranged between 41 – 60%. Positive attitude towards biostatistics was elicited in 16 – 63% respondents. Conclusions: The respondents seriously lacked knowledge in biostatistics needed to interpret research results. Training programs needs to undergo massive and immediate transformation to include more effective biostatistics training in curricula to encourage meaningful research.

Understanding of biostatistics among the homeopathic fresh graduates and post-graduate trainees in West Bengal, India

Background: A basic understanding of biostatistics is essential, both for designing quality research and evaluating medical literature. We evaluated the understanding of biostatistics and interpretation of research results among homeopathic fresh graduates’ (House Staffs; HSs) and postgraduate trainees’ (PGTs) in West Bengal, India. Methods: A cross-sectional survey of homeopathic HSs and PGTs in the four government homeopathic schools in West Bengal, India, using a pre-tested, valid and reliable biostatistics multiple choice knowledge, confidence and attitude test questionnaire. Results: Internal consistency of the used questionnaires was acceptable (Cronbach’s á = 0.611 – 0.672). Response rate was only 55.6%. Research journal reading habit was seriously lacking. No one had ever taken any research courses or possessed any advanced degrees or diplomas. The overall mean% correct on statistical knowledge was very poor, 1.0% (95% CI 0.1 – 1.9%) vs. 10.0% (95% CI 8.6 – 11.6%) for HSs and PGTs (P < 0.0001). Comparatively, higher knowledge scores were found in respondents from Mahesh Bhattacharyya Homeopathic Medical College and Hospital (P = 0.003). No one could interpret an unadjusted odds ratio, Kaplan-Meier analysis results, and determine strength of evidence for risk factors. Percentages of correct answers for all other knowledge-based questions ranged between only 2.7 – 9.5%. Respondents’ self-assessed confidence in ability to understand biostatistics ranged between 41 – 60%. Positive attitude towards biostatistics was elicited in 16 – 63% respondents. Conclusions: The respondents seriously lacked knowledge in biostatistics needed to interpret research results. Training programs needs to undergo massive and immediate transformation to include more effective biostatistics training in curricula to encourage meaningful research.(AU)

A study on drug utilization and prescription habits of physicians in a government homeopathic hospital in West Bengal, India.

OBJECTIVE: Improper prescribing habits and inappropriate drug use lead to serious health and economic consequences. This study was undertaken to evaluate drug utilization services and prescription patterns of homeopathic doctors in a government homeopathic teaching hospital in India. METHODS: No standardized homeopathic drug use indicators are available. The researchers used indicators for health care setting (drug availability)-modified prescribing indicators and patient care indicators, based on World Health Organization's core drug use indicators. A cross-sectional, prospective, institutional, observational study of 2-month duration with record analysis was conducted on 600 patients visiting seven different outpatient departments (OPDs) for the first time at Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Howrah, West Bengal, India, using the developed indicators. RESULTS: Overall availability of prescribed drugs was quite satisfactory (92.28%). Centesimal potencies accounted for the majority of prescriptions (74.76%). There was a poor record of diagnosis (39.17%) except in the OPDs of Gynecology and Obstetrics (68.48%, P < 0.01) and Dermatology (64.58%, P < 0.01). Records of investigational findings and ongoing therapies, if any, were also poor except OPDs of Gynecology and Obstetrics, and Pediatrics. Structure of prescriptions was maintained satisfactorily in all the OPDs. Though tendency of using 'individualized homeopathy' predominated, there also existed the use of 'polypharmacy'. Mean consultation time was 5.9 min. Labeling was extremely poor and is an area needing improvement. The prescriptions were highly legible. CONCLUSION: This was a preliminary study, conducted for the first time in homeopathy using newly developed indicators that yield meaningful results. Further studies are necessary in order to evaluate the different factors involved and to plan future interventions to improve the quality of care in healthcare settings.

A study on drug utilization and prescription habits of physicians in a government homeopathic hospital in West Bengal, India / 中西医结合学报

Improper prescribing habits and inappropriate drug use lead to serious health and economic consequences. This study was undertaken to evaluate drug utilization services and prescription patterns of homeopathic doctors in a government homeopathic teaching hospital in India.

A survey on perception of homoeopathic undergraduate students towards learning environment in an Indian scenario

Background and aims – This research was an attempt to understand the views of students of homoeopathic undergraduate schools in West Bengal, India and to identify areas of strength and weakness in the learning environment. Methodology – An institutional, cross-sectional, observational study was carried out involving 430 students in May, 2013 in two Government homoeopathic medical colleges in West Bengal, India. A seven-item close-ended questionnaire with four point Likert scale was used to determine students’ perceptions of the learning environment, intellectual climate and teacher-student relationship in homoeopathic schools. The questionnaire generated seven subscales – flexibility, student to student interaction, emotional climate, supportiveness, meaningful experience, organization, and breadth of interest. Results – 46.5% of students belonged to rural areas and Bengali was the mother tongue of 93.7% students. 39.5% preferred Bengali as the medium of instruction and group study was preferable to 77.9% students. 47.7% students were dissatisfied with the teaching process and 79.8% preferred the use of multimedia over conventional classroom teaching. Flexibility remained low (mean=1.9, SD=0.9); meaningful experience (theoretical teaching) score was high (mean=2.6, SD=0.9). Scores did not vary significantly (P>0.05) across the pre-clinical and clinical students, but few subscales produced significant differences individually among students of different years. Internal consistency scores of the scale remained questionable (Cronbach’s α 0.310-0.446); however, the scale showed acceptable test-retest reliability (Cohen’s κ 0.680-0.838). Conclusions – This study emphasized the areas requiring improvement in homoeopathic school environment based on students’ perspective. Changes in curriculum, faculty and infrastructure should be planned to improve students’ satisfaction.

Introdução e objetivo: Este estudo buscou entender a percepção de estudantes de faculdades homeopáticas em Bengala Ocidental, Índia, e identificar os pontos fortes e fracos do ambiente de aprendizagem. Métodos: Estudo transversal com desenho observacional realizado en maio de 2013 com 430 voluntários em duas faculdades públicas de medicina homeopática em Bengala Ocidental, Índia. Um questionário com 7 itens respondidos em uma escala tipo Likert de 4 pontos foi aplicada para determinar a percepção dos voluntários a respeito de seu ambiente de aprendizagem, clima intelectual e relação aluno-professor. O questionário gerou 7 sub-escalas –flexibilidade, interação entre Estudantes, clima emocional, suporte, experiência significativa, organização e amplitude de interesses. Cerca de 46,5% dos estudantes procedía de áreas rurais, a língua materna de 93,7% era bengalí, 39,5% preferia que se falasse bengalí nas aulas, 77,9% preferia trabalhar em grupo, 47,7% se manifestaram insatisfeitos com o modelo de ensino e 79,8% preferíam as técnicas multimídias comparadas às convencionais. A flexibilidade foi baixa (media= 1,9, desvio padrão DE = 0,9); a pontuação da experiência significativa (ensino teórico) foi elevada (média= 2,6, DE= 0,9). As pontuações não apresentaram diferenças significativas (p>0,05) entre os estudiantes em fase preclínica e clínica, porém, algumas sub-escalas individuais apresentaram diferenças significativas entre os estudantes dos diversos cursos. A consistência interna do questionário é duvidosea (coeficiente α de Cronbach: 0,310-0,446), porém, a confiabilidade do teste-reteste se mostrou aceitável ( de Cohen: 0,680-0,838). Conclusões: Este estudo assinala as áreas que devem ser melhoradas na aprendizagem da homeopatía desde a perspectiva dos estudantes. Mudanças nos programas de estudos, corpo docente e infraestructura são necessárias para melhoras a satisfação dos alunos.

Evaluation of patient satisfaction in a Government Homeopathic Hospital in West Bengal, India

Background and aims – Discovering the degree of patient satisfaction in a medical practice setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. Methodology – An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a 5-point Likert scale was used. The questionnaire generated 5 subscales – overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100mm were provided with each single question item and each subscale. Results – The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s α were between 0.7-0.9 and test-retest reliability Cohen’s κ was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, P < 0.001; each subscale scores 0.8 < r < 0.9, P < 0.0001, and each question score 0.8 < r < 0.9, P < 0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (P < 0.05, df = 4, 95% CI) establishing discriminant validity. Conclusions – Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages.

Introdução e objetivos: A determinação do grau de satisfação dos pacientes de um hospital homeopático, pode producir impacto substancial nos esforços para melhorar o o estado de saúde e a qualidade da atenção proporcionada. Neste estudo, avaliamos o grau de satisfação dos pacientes, depois das consultas médicas, bem como a validade e confiabilidade do questionário utilizado. Métodos: Estudo transversal com desenho observacional realizado em fevereiro de 2013 com 390 voluntários em 5 ambulatórios da Facultade e Hospital de Medicina Homeopática Mahesh Bhattacharyya, pertencente a rede pública Bengala Ocidental, Howrah, India. Foi autoaplicado um breve questionário japonês de satisfação com as consultas médicas, traduzido para o bengalí, com 12 ítems respondidos em uma escala tipo Likert de 5 pontos. O questionario gerou 5 sub-escalas: satisfação global; exame completo; atenção do paciente como um todo; duração da consulta; foco no paciente. As respostas de cada ítem e sub-escala também incluíam uma escala visual analógica de 100 mm. Resultados: O questionário se mostrou válido e confiável. Sua consistência interna foi comprovada por valores entre 0,7 e 0,9 do coeficiente α de Cronbach, e a confiabilidade teste-reteste pelo coeficiente kappa de Cohen, cujo valor foi superior a 0,7 em todos os ítens. A validez concorrente do coeficiente r de Pearson correspondente a pontuação total do questionário a as EVAs foram de 0,60, p<0,001; pontuação de cada escala 0,8 < r < 0,9, p<0,0001, e pontuação de cada ítem 0,8 < r < 0,9, p<0,0001. A comparação das pontuações médias das 5 subescalas correspondentes aos 5 ambulatorios resultaram en valores de razão F de 4,3-9,8 (p<0,05, df = 4, intervalo de confiança de 95%), comprovando a validez discriminante do questionário. Em geral, os pacientes reportaram alta satisfação. Novos estudos são necessários para adaptar o questionário utilizado neste estudo a outros idiomas, para uso global.

Homoeopathic treatment of vitiligo: an open observational pilot study

Background: Vitiligo is a common hypopigmentation disorder with significant psychological impact. An evaluation of homeopathic treatment was performed in individuals with vitiligo in a hospital outpatient clinic in West Bengal, India. Methods: Thirty participants (median age 27 years old, 57% female) were recruited for a prospective open-label pilot study and treated with individualized homeopathic medicines for 6 months. Efficacy was assessed after 3 months and 6 months using Vitiligo Area Scoring Index (VASI) score, Vitiligo European Task Force (VETF) score, and Dermatological Life Quality Index (DLQI) score, which are validated outcome measures evaluating the area, intensity, spread of depigmentation of vitiligo lesions, and quality of life (QoL). Results: A total of 27 participants completed the trial; 3 dropped out. After 6 months of treatment, the median VASI total score improved significantly by 0.1 units (p=0.003), from 0.8 (0.5, 1.5) to 0.7 (0.3, 0.8) on a scale from 0 (no depigmentation) to 100 (completely depigmented). Similarly, the VETF median score improved by 2 units (p=0.0001) from 1 (0, 1) to –1 (–1, 0) and the staging score changed from 1 (1, 2) to 1 (0, 1), p=0.002. The total DLQI median score exhibited significant reduction from 21 (17, 22) to 13.6 (10, 17), change 7.4 (p=0.0001), as also did its components. Conclusions: Individualized homeopathic treatment associated with significant improvement of VASI, VETF and DLQI scores. The extent to which the observed effects were due to placebo needs clarification in future randomized double-blind clinical studies preceded by feasibility studies.

Introdução: Vitiligo é uma desordem de hipopigmentação de ocorrência comum, com impacto psicológico significativo. Foi avaliado o tratamento homeopático de indivíduos com vitiligo no ambulatório de um hospital em Bengala Ocidental, Índia. Métodos: Trinta participantes (idade mediana 27 anos, sendo 57% do gênero feminino) foram recrutados para o presente estudo piloto prospectivo aberto e tratados com medicamentos homeopáticos individualizados por 6 meses. A eficácia do tratamento foi avaliada aos 3 e 6 meses mediante Vitiligo Area Scoring Index (VASI) score, Vitiligo European Task Force (VETF), e Dermatological Life Quality Index (DLQI), que são medidas validadas de desfecho correspondendo à área, intensidade e disseminação da depigmentação causada por vitiligo, assim como a qualidade de vida (QV). Resultados: Um total de 27 participantes completou o estudo, sendo que 3 abandonaram. Depois de 6 meses de tratamento, a mediana do escore total do VASI apresentou melhora significativa de 0,1 unidade (p=0,003) passando de 0,8 (0,5, 1,5) para 0,7 (0,3, 0,8), numa escala de 0 (sem depigmentação) a 100 (depigmentação completa). De modo similar, a mediana do escore VETF de disseminação melhorou em 2 unidades (p=0,0001) de 1 (0, 1) a –1 (–1, 0), e o escore de estadiamento variou de 1 (1, 2) para 1 (0, 1), p=0,002. O escore total mediano de DLQI diminuiu de 21 (17, 22) a 13,6 (10, 17), com uma variação de 7,4 (p=0,0001); variação também foi constatada nos componentes de DLQI. Conclusões: O tratamento homeopático individualizado se associou com melhora significativa nos escores de VASI, VETF e DLQI. A parte dos efeitos possivelmente devida a efeito placebo precisa ser determinada em futuros estudos clínicos randomizados e duplo cego, após a realização de estudos de factibilidade.

Evaluation of patient satisfaction in a Government Homeopathic Hospital in West Bengal, India

Background and aims – Discovering the degree of patient satisfaction in a medical practice setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. Methodology – An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a 5-point Likert scale was used. The questionnaire generated 5 subscales – overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100mm were provided with each single question item and each subscale. Results – The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s α were between 0.7-0.9 and test-retest reliability Cohen’s κ was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, P < 0.001; each subscale scores 0.8 < r < 0.9, P < 0.0001, and each question score 0.8 < r < 0.9, P < 0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (P < 0.05, df = 4, 95% CI) establishing discriminant validity. Conclusions – Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages. (AU)

Introdução e objetivos: A determinação do grau de satisfação dos pacientes de um hospital homeopático, pode producir impacto substancial nos esforços para melhorar o o estado de saúde e a qualidade da atenção proporcionada. Neste estudo, avaliamos o grau de satisfação dos pacientes, depois das consultas médicas, bem como a validade e confiabilidade do questionário utilizado. Métodos: Estudo transversal com desenho observacional realizado em fevereiro de 2013 com 390 voluntários em 5 ambulatórios da Facultade e Hospital de Medicina Homeopática Mahesh Bhattacharyya, pertencente a rede pública Bengala Ocidental, Howrah, India. Foi autoaplicado um breve questionário japonês de satisfação com as consultas médicas, traduzido para o bengalí, com 12 ítems respondidos em uma escala tipo Likert de 5 pontos. O questionario gerou 5 sub-escalas: satisfação global; exame completo; atenção do paciente como um todo; duração da consulta; foco no paciente. As respostas de cada ítem e sub-escala também incluíam uma escala visual analógica de 100 mm. Resultados: O questionário se mostrou válido e confiável. Sua consistência interna foi comprovada por valores entre 0,7 e 0,9 do coeficiente α de Cronbach, e a confiabilidade teste-reteste pelo coeficiente kappa de Cohen, cujo valor foi superior a 0,7 em todos os ítens. A validez concorrente do coeficiente r de Pearson correspondente a pontuação total do questionário a as EVAs foram de 0,60, p<0,001; pontuação de cada escala 0,8 < r < 0,9, p<0,0001, e pontuação de cada ítem 0,8 < r < 0,9, p<0,0001. A comparação das pontuações médias das 5 subescalas correspondentes aos 5 ambulatorios resultaram en valores de razão F de 4,3-9,8 (p<0,05, df = 4, intervalo de confiança de 95%), comprovando a validez discriminante do questionário. Em geral, os pacientes reportaram alta satisfação. Novos estudos são necessários para adaptar o questionário utilizado neste estudo a outros idiomas, para uso global. (AU)

A survey on perception of homoeopathic undergraduate students towards learning environment in an Indian scenario

Background and aims – This research was an attempt to understand the views of students of homoeopathic undergraduate schools in West Bengal, India and to identify areas of strength and weakness in the learning environment. Methodology – An institutional, cross-sectional, observational study was carried out involving 430 students in May, 2013 in two Government homoeopathic medical colleges in West Bengal, India. A seven-item close-ended questionnaire with four point Likert scale was used to determine students’ perceptions of the learning environment, intellectual climate and teacher-student relationship in homoeopathic schools. The questionnaire generated seven subscales – flexibility, student to student interaction, emotional climate, supportiveness, meaningful experience, organization, and breadth of interest. Results – 46.5% of students belonged to rural areas and Bengali was the mother tongue of 93.7% students. 39.5% preferred Bengali as the medium of instruction and group study was preferable to 77.9% students. 47.7% students were dissatisfied with the teaching process and 79.8% preferred the use of multimedia over conventional classroom teaching. Flexibility remained low (mean=1.9, SD=0.9); meaningful experience (theoretical teaching) score was high (mean=2.6, SD=0.9). Scores did not vary significantly (P>0.05) across the pre-clinical and clinical students, but few subscales produced significant differences individually among students of different years. Internal consistency scores of the scale remained questionable (Cronbach’s α 0.310-0.446); however, the scale showed acceptable test-retest reliability (Cohen’s κ 0.680-0.838). Conclusions – This study emphasized the areas requiring improvement in homoeopathic school environment based on students’ perspective. Changes in curriculum, faculty and infrastructure should be planned to improve students’ satisfaction. (AU)

Introdução e objetivo: Este estudo buscou entender a percepção de estudantes de faculdades homeopáticas em Bengala Ocidental, Índia, e identificar os pontos fortes e fracos do ambiente de aprendizagem. Métodos: Estudo transversal com desenho observacional realizado en maio de 2013 com 430 voluntários em duas faculdades públicas de medicina homeopática em Bengala Ocidental, Índia. Um questionário com 7 itens respondidos em uma escala tipo Likert de 4 pontos foi aplicada para determinar a percepção dos voluntários a respeito de seu ambiente de aprendizagem, clima intelectual e relação aluno-professor. O questionário gerou 7 sub-escalas –flexibilidade, interação entre Estudantes, clima emocional, suporte, experiência significativa, organização e amplitude de interesses. Cerca de 46,5% dos estudantes procedía de áreas rurais, a língua materna de 93,7% era bengalí, 39,5% preferia que se falasse bengalí nas aulas, 77,9% preferia trabalhar em grupo, 47,7% se manifestaram insatisfeitos com o modelo de ensino e 79,8% preferíam as técnicas multimídias comparadas às convencionais. A flexibilidade foi baixa (media= 1,9, desvio padrão DE = 0,9); a pontuação da experiência significativa (ensino teórico) foi elevada (média= 2,6, DE= 0,9). As pontuações não apresentaram diferenças significativas (p>0,05) entre os estudiantes em fase preclínica e clínica, porém, algumas sub-escalas individuais apresentaram diferenças significativas entre os estudantes dos diversos cursos. A consistência interna do questionário é duvidosea (coeficiente α de Cronbach: 0,310-0,446), porém, a confiabilidade do teste-reteste se mostrou aceitável ( de Cohen: 0,680-0,838). Conclusões: Este estudo assinala as áreas que devem ser melhoradas na aprendizagem da homeopatía desde a perspectiva dos estudantes. Mudanças nos programas de estudos, corpo docente e infraestructura são necessárias para melhoras a satisfação dos alunos. (AU)