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.

A survey exploring research perception of homeopathic undergraduate students in West Bengal, India

Background: Prioritizing undergraduate research is emphasized to develop critical analytical skills and thinking, independent writing, future clinical practice, enhanced employability, and improved research productivity. Despite far reaching consequences, research perception of homeopathic undergraduate students has barely been investigated to date. Poor participation of homeopathic undergraduates in research is reflected by a single MEDLINE indexed publication with adequate students’ contribution in the last decade. We aimed to assess their knowledge and attitude towards research and to identify barriers towards successful conduct of research. Methods: Institutional cross-sectional survey was carried out during August-September, 2013 in the four Government undergraduate homeopathic schools in West Bengal, India involving 902 participants. A semi-structured questionnaire was developed for the purpose depending on earlier studies on medical undergraduates. 364 completed responses were analyzed in the end. Results: Study sample mostly spanned 18-25 years of age group (94%), belonged to urban families (44.8%), with no gender differences (almost 1:1) and no physicians in family (73.1%). Maximum complete responses were obtained from 3rd year students (61.5%) and students of Calcutta Homeopathic Medical College and Hospital (51.2%). In spite of willingness to participate and keeping a positive attitude towards research, current involvement, training, knowledge and awareness remained quite unsatisfactory. Lack of infrastructure was identified as the chief barrier towards research. Conclusion: Undergraduates had a positive attitude towards homeopathic research, but need a realistic understanding of the research process. Opportunities for research skill development are underdeveloped.

Introdução: Estimular a pesquisa no nível de graduação é considerado um recurso importante para o desenvolvimento da capacidade de análise e pensamento críticos, redação independente, prática clínica futura, melhorar as possibilidades de inserção no mercado de trabalho e a produtividade em pesquisa. Apesar dessas consequências de amplo alcance, a percepção sobre pesquisa de estudantes de graduação em homeopatia tem sido raramente investigada. A escassa participação em pesquisas de estudantes de graduação em homeopatia é evidenciado pelo achado de um único trabalho indexado em MedLine com expressiva participação de estudantes nos últimos 10 anos. O nosso objetivo consistiu em avaliar o conhecimento e atitude em relação à pesquisa e identificar as barreiras que impedem o sucesso na realização de pesquisas. Métodos: Um estudo transversal foi realizado entre agosto e setembro de 2013 nas quatro faculdades públicas de homeopatia na Bengala Ocidental, Índia, com um total de 902 participantes. Um questionário semiestruturado foi desenvolvido especificamente para este estudo baseado nos resultados de estudos anteriores realizados com estudantes de medicina. Um total de 364 questionários completos foi incluído na análise. Resultados: A maioria dos participantes tinha entre 18 e 25 anos de idade (94%), residia em áreas urbanas (44.8%) e não incluía médicos na família (73,1%). A amostra apresentou homogeneidade em relação ao sexo (quase 1:1). O maior número de questionários completos correspondeu a estudantes do 3o ano (61,5%) e da Faculdade e Hospital Homeopático de Calcutá (51,2%) [...] Conclusão: Os estudantes manifestaram atitude positiva em relação à pesquisa em homeopatia, porém precisam adquirir uma compreensão mais realista do processo de pesquisa. As oportunidades para desenvolvimento de competências de pesquisa são muito escassas.

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.

Medicine prescription practices of homeopathic undergraduate students in West Bengal, India / 中西医结合学报

To our knowledge, prescription of homeopathic medicines by homeopathic undergraduate students has not been studied before though it may possess serious implications. We aimed to determine the practice and attitudes of prescription by homeopathic undergraduate students.

Qualitative systematic review of homeopathic outcome studies in patients with HIV/AIDS

Background and aims: Systematic reviews of high-quality randomized controlled trials (RCTs) are crucial in evidence-based medicine (EBM). The aim of the present review was to investigate whether there is enough evidence on the efficacy of homeopathy in individuals with HIV/AIDS based on clinical trials. Methods: The present is a criteria-based systematic review of cumulative research, and assessment of the methodological quality of published studies. The quality of the trials was evaluated using a list of validated and predefined criteria, and their outcomes were interpreted based on their quality. The main outcome measure was the methodological quality of the studies in terms of the threats to external, internal, construct, and statistical conclusion validity. Results: Among the 6 clinical outcome studies located, 3 were open-label, non-randomized, non-controlled trials, 2 were RCTs, and one was a single-set replication study. The trials were too few in number, and did not exhibit very high quality. The results showed a positive trend regardless of the quality of the trials, or the variety of homeopathic treatment used. The results of the present review may be complicated by publication bias. Conclusion: The currently available evidences do not suffice to infer definitive conclusions. Therefore, further evaluation of homeopathic treatment by means of appropriate RCTs with high methodological quality is required.

As revisões sistemáticas de estudos randomizados controlados (RCTs) são essenciais na medicina baseada em evidências (MBE). O objetivo deste estudo foi estabelecer se há evidência suficiente a favor da eficácia da homeopatia em pacientes com HIV/AIDS a partir de ensaios clínicos. Trata-se de uma revisão sistemática da pesquisa acumulada baseada em critérios, com avaliação daqualidade metodológica dos estudos publicados. A qualidade dos estudos foi avaliada medianteuma lista de critérios validados e predefinidos e os resultados foram interpretados a partir de suaqualidade. O desfecho principal analisado foi a qualidade metodológica dos estudos nos termos das ameaças a sua validade externa, interna, de construto e conclusão estatística.Dos 6 estudos clínicos informando resultados que foram localizados, 3 eram ensaios abertos, não randomizados e não controlados, 2 eram RCTs e um era um estudo de replicação com um único grupo. O número de ensaios clínicos localizados foi muito pequeno e de qualidade não muito alta. Os resultadosapontaram uma tendência positiva independentemente da qualidade dos ensaios e do tipo de tratamento homeopático utilizado. Os resultados desta revisão podem sofrer de viés depublicação. As evidências disponíveis atualmente são insuficientes para conclusões definitivas.Portanto, o tratamento homeopático ainda precisa de maior avaliação, através de RCTs adequados e de alta qualidade metodológica.

Las revisiones sistemáticas de estudios controlados aleatorizados(ECC) son esenciales en la medicina basada en evidencia (MBE). El objetivo de este estudio fue evaluar si hay evidenciasuficiente a favor de la eficacia de la homeopatía en pacientes con VIH/SIDA a partir de ensayosclínicos. Se trata de una revisión sistemática basada en criterios de la investigación acumulada,con evaluación de la calidad metodológica de los estudios publicados. La calidad de los estudiosfue evaluada mediante una lista de criterios validados y predefinidos ylos resultados fueron interpretados a partir de su calidad .El principal resultado medido fue la calidad metodológica de los estudios expresa como amenazas a su validez externa, interna, de constructo y conclusiónestadística. De los 6 estudios clínicos de resultados localizados, 3 eran ensayos abiertos, no aleatorizados y no controlados, 2 eran ECC y uno un estudio de replicación con un único grupo. El número de estudios clínicos localizados fue muy bajo y su calidad no muy alta. Los resultados indican una tendencia positiva independiente de la calidad de los estudios y el tipo de tratamiento homeopático efectuado. Los resultados de esta revisión pueden adolecer de sesgo de publicación. La evidencia actualmente disponible no permite inferir conclusiones definitivas. El tratamiento homeopático necesita mayor evaluación mediante ECC adecuados y de alta calidad metodológica.

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.

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.