A service-user digital intervention to collect real-time safety information on acute, adult mental health wards: the WardSonar mixed-methods study.

Background: Acute inpatient mental health services report high levels of safety incidents. The application of patient safety theory has been sparse, particularly concerning interventions that proactively seek patient perspectives. Objective(s): Develop and evaluate a theoretically based, digital monitoring tool to collect real-time information from patients on acute adult mental health wards about their perceptions of ward safety. Design: Theory-informed mixed-methods study. A prototype digital monitoring tool was developed from a co-design approach, implemented in hospital settings, and subjected to qualitative and quantitative evaluation. Setting and methods: Phase 1: scoping review of the literature on patient involvement in safety interventions in acute mental health care; evidence scan of digital technology in mental health contexts; qualitative interviews with mental health patients and staff about perspectives on ward safety. This, alongside stakeholder engagement with advisory groups, service users and health professionals, informed the development processes. Most data collection was virtual. Phase 1 resulted in the technical development of a theoretically based digital monitoring tool that collected patient feedback for proactive safety monitoring. Phase 2: implementation of the tool in six adult acute mental health wards across two UK NHS trusts; evaluation via focused ethnography and qualitative interviews. Statistical analysis of WardSonar data and routine ward data involving construction of an hour-by-hour data set per ward, permitting detailed analysis of the use of the WardSonar tool. Participants: A total of 8 patients and 13 mental health professionals participated in Phase 1 interviews; 33 staff and 34 patients participated in Phase 2 interviews. Interventions: Patients could use a web application (the WardSonar tool) to record real-time perceptions of ward safety. Staff could access aggregated, anonymous data to inform timely interventions. Results: Coronavirus disease 2019 restrictions greatly impacted the study. Stakeholder engagement permeated the project. Phase 1 delivered a theory-based, collaboratively designed digital tool for proactive patient safety monitoring. Phase 2 showed that the tool was user friendly and broadly acceptable to patients and staff. The aggregated safety data were infrequently used by staff. Feasibility depended on engaged staff and embedding use of the tool in ward routines. There is strong evidence that an incident leads to increased probability of further incidents within the next 4 hours. This puts a measure on the extent to which social/behavioural contagion persists. There is weak evidence to suggest that an incident leads to a greater use of the WardSonar tool in the following hour, but none to suggest that ward atmosphere predicts future incidents. Therefore, how often patients use the tool seems to send a stronger signal about potential incidents than patients' real-time reports about ward atmosphere. Limitations: Implementation was limited to two NHS trusts. Coronavirus disease 2019 impacted design processes including stakeholder engagement; implementation; and evaluation of the monitoring tool in routine clinical practice. Higher uptake could enhance validity of the results. Conclusions: WardSonar has the potential to provide a valuable route for patients to communicate safety concerns. The WardSonar monitoring tool has a strong patient perspective and uses proactive real-time safety monitoring rather than traditional retrospective data review. Future work: The WardSonar tool can be refined and tested further in a post Coronavirus disease 2019 context. Study registration: This study is registered as ISRCTN14470430. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128070) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.

Mental health wards can feel unsafe. We know that patients and staff have different ideas about what makes a hospital ward safe or unsafe. Patients are often the first to know when the atmosphere on a ward becomes tense but, often, no one asks them for input or feedback at the time. We worked with service users and staff to develop new technology to make it easy for patients to tell staff about changes in the ward atmosphere. We put everyone's ideas together and some technical developers then built a digital safety tool to use on a tablet computer. Patients put in anonymous information about the ward atmosphere and staff can read it straight away. We tested it on six adult acute mental health wards for 10 weeks. We asked patients and staff what they thought about the tool and we looked at how it was being used. Patients and staff liked the look of the tool on the tablet computer. Some staff said they did not need it because they could tell how patients were feeling, but patients told us that staff did not talk with them much and did not always know when patients were feeling tense. Coronavirus disease 2019 made life difficult on the wards. Most ward managers said the tool could be helpful, but they had not had time to get used to it on the wards. Occasionally, the tablet computers were out of action. Many staff tried hard to use the tool. Most patient information was gathered when it was calm, perhaps because staff were not too busy to help them. We found that this tool could help staff know about tensions on the ward, but they need to get used to it and bring it into ward routines.

Implementing and evaluating patient-focused safety technology on adult acute mental health wards.

WHAT IS KNOWN ON THE SUBJECT: Mental health wards can feel unsafe. We know that patients and staff have different ideas about what makes a hospital ward safe or unsafe. Patients are often the first to know when the atmosphere on a ward becomes tense, but often, no one asks them for their views. Patients and staff are experts and should be included in discussions about how to make wards safer. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: We got together with some service users and staff, and made an app that helps patients to tell staff when they are not feeling safe on a mental health ward. We tried it out on six wards and we asked patients and staff what they thought. The app was easy to use and most people liked the look of it. Patients said staff did not talk with them enough and so they liked using the app. However, some staff said they could tell how patients were feeling without an app and so they did not need it. Ward managers told us that staff were often very busy and did not always have time to use the app. WHAT ARE THE IMPLICATIONS FOR PRACTICE: This app could help staff know straightaway when patients do not feel safe on the ward, so that they can act quickly to calm things down. To make the most of the app, staff need to get used to it and bring it into ward routines. ABSTRACT: INTRODUCTION: Safety improvement on mental health wards is of international concern. It should incorporate patient perspectives. AIM: Implementation and evaluation of 'WardSonar', a digital safety-monitoring tool for adult acute mental health wards, developed with stakeholders to communicate patients' real-time safety perceptions to staff. METHOD: Six acute adult mental health wards in England implemented the tool in 2022. Evaluation over 10 weeks involved qualitative interviews (34 patients, 33 staff), 39 focused ethnographic observations, and analysis of pen portraits. RESULTS: Implementation and evaluation of the WardSonar tool was feasible despite challenging conditions. Most patients valued the opportunity to communicate their immediate safety concerns, stating that staff had a poor understanding of them. Some staff said the WardSonar tool could help enhanced ward safety but recognised a need to incorporate its use into daily routines. Others said they did not need the tool to understand patients' safety concerns. DISCUSSION: Foreseeable challenges, including staff ambivalence and practical issues, appeared intensified by the post-COVID-19 context. IMPLICATIONS FOR PRACTICE: The WardSonar tool could improve ward safety, especially from patients' perspectives. Future implementation could support staff to use the real-time data to inform proactive safety interventions.

Continuing bonds following stillbirth: protective and risk factors associated with parental bereavement adaptation.

OBJECTIVE: To investigate any association between expressions of parents' continuing bond with their stillborn baby and bereavement adaptation. BACKGROUND: Continuing bonds theory suggests that bereaved parents adapt to the loss of their child by sharing and transforming mental representations of the child, allowing them to be integrated into parents' everyday lives. Little is known about the mental health benefits of expressing continuing bonds following stillbirth. This study examined any association between aspects of parents' relationship with their stillborn baby, social support for the relationship, and bereavement adaptation. METHODS: Cross-sectional questionnaire study. Parents of stillborn babies (N=170) completed an online questionnaire examining engagement in continuing bonds expressions; characteristics of parents' relationship with their stillborn baby and their experience of sharing it; social support, and meaning-making. Measures of mental health were included to quantify bereavement adaptation. RESULTS: Regression analyses showed that time since death, meaning-making, engaging with nature, and legacy building are positively linked to bereavement adaptation. Risk factors included inadequate social support for the relationship, a greater desire to share it more freely, an increased sense of integration with baby, and societal pressure to move on. CONCLUSION: Key aspects of parents' ongoing relationship with their stillborn baby and the social context are related to bereavement adaptation.

To what extent are patients involved in researching safety in acute mental healthcare?

BACKGROUND: There is a growing need to involve patients in the development of patient safety interventions. Mental health services, despite their strong history of patient involvement, have been slow to develop patient safety interventions, particularly in inpatient settings. METHODS: A systematic search was undertaken of both academic and grey literature. Whilst no lay member of the team worked directly on the review, they were part of the project steering group which provided oversight throughout the review process. This included people with lived experience of mental health services. From a research perspective the main focus for lay members was in co-producing the digital technology, the key project output. Smits et al.'s (Res Involv Engagem 6:1-30, 2020) Involvement Matrix was used to taxonomise levels of patient involvement. Studies were included if they were set in any inpatient mental health care context regardless of design. The quality of all selected studies was appraised using Mixed Methods Appraisal Methodology (MMAT). RESULTS: Fifty-two studies were classified, synthesised and their levels of patient involvement in the research and development of patient safety interventions were taxonomised. Almost two-thirds of studies (n = 33) researched reducing restrictive practices. Only four studies reported engaging patients in the research process as decision-makers, with the remaining studies divided almost equally between engaging patients in the research process as partners, advisors and co-thinkers. Just under half of all studies engaged patients in just one stage of the research process. CONCLUSION: Involvement of patients in researching patient safety and developing interventions in an inpatient mental health context seems diverse in its nature. Researchers need to both more fully consider and better describe their approaches to involving patients in safety research in inpatient mental health. Doing so will likely lead to the development of higher quality safety interventions.

We know that inpatient mental health settings are not safe. By getting patients to help us research and develop interventions to improve safety they are more likely to work. We searched for articles and papers which described doing this. By using a matrix we were able to understand how many research studies involved patients. We found 52 studies, but few really involved patients in the entire research and intervention development process. Most of the research focus was on helping staff to use less restrictive interventions like restraint and seclusion. Only four studies really treated patients as equals in terms of decision making in the research process, and about half of the studies involved patients in only one of the possible three stages of research. There have been lots of ways patients have been asked to be involved in research but we really need to improve the way we involve patients in order for our knowledge about patient safety and the interventions that follow from this to be truly co-produced.

Talking therapy: The allopathic nihilation of homoeopathy through conceptual translation and a new medical language.

The 19th century saw the development of an eclectic medical marketplace in both the United Kingdom and the United States, with mesmerists, herbalists and hydrotherapists amongst the plethora of medical 'sectarians' offering mainstream (or 'allopathic') medicine stiff competition. Foremost amongst these competitors were homoeopaths, a group of practitioners who followed Samuel Hahnemann (1982[1810]) in prescribing highly dilute doses of single-drug substances at infrequent intervals according to the 'law of similars' (like cures like). The theoretical sophistication of homoeopathy, compared to other medical sectarian systems, alongside its institutional growth after the mid-19th-century cholera epidemics, led to homoeopathy presenting a challenge to allopathy that the latter could not ignore. Whilst the subsequent decline of homoeopathy at the beginning of the 20th century was the result of multiple factors, including developments within medical education, the Progressive movement, and wider socio-economic changes, this article focuses on allopathy's response to homoeopathy's conceptual challenge. Using the theoretical framework of Berger and Luckmann (1991[1966]) and taking a Tory historiographical approach (Fuller, 2002) to recover more fully 19th-century homoeopathic knowledge, this article demonstrates how increasingly sophisticated 'nihilative' strategies were ultimately successful in neutralising homoeopathy and that homoeopaths were defeated by allopaths (rather than disproven) at the conceptual level. In this process, the therapeutic use of 'nosodes' (live disease products) and the language of bacteriology were pivotal. For their part, homoeopaths failed to mount a counter-attack against allopaths with an explanatory framework available to them.

Supporting patients with unlicensed medicine use: Analysing the script schemas for prescribing, pharmaceutical assessment and supply.

Unlicensed medicines (ULMs) are those which have not received authorisation from a regulator, as such they do not have the same reassurances around safety and efficacy as licensed medicines. This study aimed to explore the use of ULMs from the perspectives of prescribers, pharmacists and patients within the UK National Health Service (NHS) setting. Grounded theory was used as a framework, conducting 28 semi-structured qualitative interviews with prescribers, pharmacists and patients across both primary and secondary care settings. Participants were identified from their known use of ULMs where possible and a theoretical sampling approach was used to support recruitment of participants based on the emergent analysis. Analysis followed a constructivist inductive approach, using constant comparison to develop initial themes. This was followed by two focus groups, one with patients and one with professionals where initial analytic findings were presented to participants to further support the development of themes. All interviews were audio recorded and transcribed verbatim. Three sequential schema scripts were identified and used as a framework to explain our findings: ULM prescribing, pharmaceutical assessment of an ULM and ULM supply. Common and divergent events within these scripts were identified and analysed in an attempt to explain similarities and differences across primary and secondary care and between actors. The analysis identified issues around healthcare professional awareness of using ULMs, perceptions of ULM safety, challenges around what information should be provided to patients and by whom and adds to the debate around the place of ULMs in treatment pathways. This study highlights the need for a multidisciplinary conversation about how ULMs should be used in the NHS.

The acceptability of addressing alcohol consumption as a modifiable risk factor for breast cancer: a mixed method study within breast screening services and symptomatic breast clinics.

OBJECTIVES: Potentially modifiable risk factors account for approximately 23% of breast cancers, with obesity and alcohol being the two greatest. Breast screening and symptomatic clinical attendances provide opportunities ('teachable moments') to link health promotion and breast cancer-prevention advice within established clinical pathways. This study explored knowledge and attitudes towards alcohol as a risk factor for breast cancer, and potential challenges inherent in incorporating advice about alcohol health risks into breast clinics and screening appointments. DESIGN: A mixed-method study including a survey on risk factors for breast cancer and understanding of alcohol content. Survey results were explored in a series of five focus groups with women and eight semi-structured interviews with health professionals. SETTING: Women attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in those settings. PARTICIPANTS: 205 women were recruited (102 NHSBSP attenders and 103 symptomatic breast clinic attenders) and 33 NHS Staff. RESULTS: Alcohol was identified as a breast cancer risk factor by 40/205 (19.5%) of attenders and 16/33 (48.5%) of staff. Overall 66.5% of attenders drank alcohol, and 56.6% could not estimate correctly the alcohol content of any of four commonly consumed alcoholic drinks. All women agreed that including a prevention-focussed intervention would not reduce the likelihood of their attendance at screening mammograms or breast clinics. Qualitative data highlighted concerns in both women and staff of how to talk about alcohol and risk factors for breast cancer in a non-stigmatising way, as well as ambivalence from specialist staff as to their role in health promotion. CONCLUSIONS: Levels of alcohol health literacy and numeracy were low. Adding prevention interventions to screening and/or symptomatic clinics appears acceptable to attendees, highlighting the potential for using these opportunities as 'teachable moments'. However, there are substantial cultural and systemic challenges to overcome if this is to be implemented successfully.

Unlicensed medicines use: a UK guideline analysis using AGREE II.

OBJECTIVES: There is widespread use of unlicensed medicines within primary and secondary care but little information is available around how these medicines are used. This analysis examines and evaluates the content and quality of relevant guidance documentation currently in use within the UK. METHODS: Guidance documents were identified through a literature search as well as email requests to pharmacy organisations throughout the UK. Unlicensed medicine documentation suitable for inclusion in the analysis underwent thematic analysis and quality assessment using the AGREE II tool. KEY FINDINGS: Thematic analysis of 52 guidelines revealed four parent themes: (1) Professional responsibility (2) Usage practicalities (3) Risk versus benefit (4) Controlling use. There was variability in scores across the AGREE II domains with areas covering Scope and Purpose and Clarity of Presentation scoring well. Conversely, an area needing attention was Rigour of Development. CONCLUSION: Healthcare organisations would benefit from agreeing a 'core content' for the development of unlicensed medicines guidelines to ensure consistency and the presence of robust operating systems to deliver safe, effective treatment to all NHS patients.

Supporting parents through stillbirth: A qualitative study exploring the views of health professionals and health care staff in three hospitals in England.

OBJECTIVE: To investigate the views of a range of hospital based health professionals and health care staff involved in the management of stillbirth. STUDY DESIGN: A qualitative pilot study informed by grounded theory conducted in three hospital trusts in the North East of England. In total, 21 consultant obstetricians, 3 trainees (including 1 senior trainee), 29 midwives, 3 midwife sonographers and 4 chaplains took part in six focus groups and two semi-structured interviews. RESULTS: Two different approaches in stillbirth management could be detected in our study. One approach emphasised the existing evidence-base and patient directed choice whilst the other emphasised tradition and profession-directed care. These differences were particularly apparent in choices over mode of delivery, and the location of women as well as the time interval between diagnosis of an IUD and delivery. The existence of these two approaches was underscored by a lack of high quality evidence. CONCLUSION: Robust, high quality evidence is needed regarding the longer term psychological and emotional sequelae of different modes of delivery and varying time intervals and locations of women between diagnosis and delivery in stillbirth. If the competing discourses demonstrated here are found elsewhere then such need to be considered in any future policy development, evidence implementation and training programmes.

Exploring the Role of Key Workers in Cancer Care: Patient and Staff Perspectives.

PURPOSE/AIMS: The key worker role in cancer services was established in England to improve the continuity of care for patients. We examined how the role has been implemented by clinical nurse specialists and how both cancer patients and nursing staff viewed its effectiveness to inform debate about the transfer of patients between clinical nurse specialists during cancer care. DESIGN: This study was questionnaire based, with separate surveys developed for patients and staff. METHOD: The questionnaires explored issues including implementation of the key worker role, modifications to it, and where the role was felt to have most impact. The questionnaires were completed by 101 staff members and 46 patients. The data were analyzed descriptively. RESULTS: Perspectives on the key worker role differed between nursing staff respondents and patient respondents. Overall, patient respondents were very positive, whereas staff respondents were less so. The following is a key difference related to patient handover: 71% of patient respondents wanted the same key worker throughout their treatment, but only 28% of staff respondents did. Staff respondents wanted more training to clarify the role. CONCLUSION: Continuity of care through an assigned key worker was highly valued by patients. Successful implementation could be better achieved through improved communication with both nursing staff and allied health professions. Where possible, cancer patients should be assigned a dedicated key worker at initial diagnosis.

Habitus of home and traditional drinking: a qualitative analysis of reported middle-class alcohol use.

There is evidence that alcohol consumption among those in middle-class occupations consistently exceeds safe levels, yet there has been little research into why this occurs. This article explores the meanings associated with alcohol use among professional, managerial and clerical workers. Qualitative data were collected from five focus groups of male and female employees aged 21-55 (N =49: 32 male, 17 female). Each focus group was conducted on the premises of a medium-scale or large-scale employer, four public sector and one private sector, in the north-east of England. Using Bourdieu's concepts of 'habitus', 'capitals' and 'fields' we found that, among these middle-class occupational groups, alcohol use was associated with two habitus: a 'home drinking' habitus and a 'traditional drinking' habitus. Those of the home drinking habitus particularly used wine as a source of cultural capital and a means of distinction, whereas those in the traditional habitus consumed lager, beer and spirits to have fun in social settings. A small minority appeared to belong to a third, omnivorous, habitus where a wide range of alcoholic drinks were consumed in a variety of contexts. Existing public health initiatives to reduce alcohol consumption may require modification to accommodate a range of drinking cultures.

Stillbirth and stigma: the spoiling and repair of multiple social identities.

This study investigated mothers' experiences surrounding stillbirth in the United Kingdom, their memory making and sharing opportunities, and the effect these opportunities had on them. Qualitative data were generated from free text responses to open-ended questions. Thematic content analysis revealed that "stigma" was experienced by most women and Goffman's (1963) work on stigma was subsequently used as an analytical framework. Results suggest that stillbirth can spoil the identities of "patient," "mother," and "full citizen." Stigma was reported as arising from interactions with professionals, family, friends, work colleagues, and even casual acquaintances. Stillbirth produces common learning experiences often requiring "identity work" (Murphy, 2012). Memory making and sharing may be important in this work and further research is needed. Stigma can reduce the memory sharing opportunities for women after stillbirth and this may explain some of the differential mental health effects of memory making after stillbirth that is documented in the literature.

The 'other' in patterns of drinking: a qualitative study of attitudes towards alcohol use among professional, managerial and clerical workers.

BACKGROUND: Recent evidence shows that workers in white collar roles consume more alcohol than other groups within the workforce, yet little is known about their views of drinking. METHODS: Focus groups were conducted in five workplaces to examine the views of white collar workers regarding the effect of alcohol use on personal and professional lives, drinking patterns and perceived norms. Analysis followed the method of constant comparison. RESULTS: Alcohol use was part of everyday routine. Acceptable consumption and 'excess' were framed around personal experience and ability to function rather than quantity of alcohol consumed. Public health messages or the risk of adverse health consequences had little impact on views of alcohol consumption or reported drinking. CONCLUSIONS: When developing public health alcohol interventions it is important to consider the views of differing groups within the population. Our sample considered public health messages to be of no relevance to them, rather they reinforced perceptions that their own alcohol use was controlled and acceptable. To develop effective public health alcohol interventions the views of this group should be examined in more detail.

Boundaries or bridges: what should Homeopathy?s relationship be with mainstream medicine? / Fronteiras ou pontes: como devem ser as relações da homeopatia com a medicina convencional? / Fronteras o puentes: ¿cuál debe ser la relación entre la homeopatía y la medicina convencional?

When Samuel Hahnemann devised homoeopathy he constructed multiple arguments that both vehemently supported his new system and criticized the conventional medical practice of his day. At the end of the 19th century when homeopathy had grown within Britain and America, homeopaths failed to make use of some of Hahnemann?s most successful arguments. Instead, homeopaths found themselves lose significant cognitive ground to their long time conventional rivals with the dawn of the 20th century, a ground they have not yet recovered. This paper uses the theoretical framework of Berger and Luckmann to analyse the dynamics of the arguments used against homeopathy and suggests that homeopaths failed to adopt a universalizing medical explanation that was available to them: the reverse action of drugs. Had they used this argument homoeopaths could have explained conventional medicine successes within their own universe of meaning and thus neutralized the impact of conventional on their practice. The implications of these conclusions for the future survival and success of homoeopathy are considered.

Quando Samuel Hahnemann formulou a Homeopatia, ele construiu uma série de argumentos que tanto apoiavam seu novo sistema como criticavam a prática alopática da época. No final do século 19, quando a homeopatia já estava estabelecida na Grã-Bretanha e América, os homeopatas falharam por não fazer uso de alguns dos bem elaborados argumentos de Hahnemann. Além disso, os homeopatas não desenvolveram uma base conceitual adequada, distanciando-se ainda mais, com o alvorecer do século 20, dos rivais alopatas, distância essa que ainda não foi recuperada. Este trabalho utiliza o referencial teórico de Berger e Luckmann para analisar a dinâmica dos argumentos utilizados contra a homeopatia e sugere que os homeopatas falharam por não conseguirem adotar uma explicação médica universal que estava disponível para eles: a ação reversa de drogas. Se tivessem usado este conceito, os homeopatas poderiam ter explicado os bem sucedidos resultados alopáticos dentro de seu próprio marco conceitual e, assim, neutralizar o impacto da alopatia sobre a sua prática. As implicações destas conclusões para a sobrevivência e sucesso da homeopatia são consideradas.

Cuando Samuel Hahnemann formuló la homeopatía, desarrolló diversos argumentos que tanto fundamentaban vehementemente su nuevo sistema como criticaban la práctica médica de su época. Sin embargo, al final del siglo XIX, cuando la homeopatía ya se había desarrollado en Gran Bretaña y los Estados Unidos, los homeópatas dejaron de lado los argumentos más sólidos de Hahnemann y, al contrario, perdieron una parte significativa de su base cognitiva comparados a sus tradicionales rivales de la medicina convencional, siendo que esta situación persiste hasta la actualidad. Este artículo utiliza el marco referencial teórico propuesto por Berger y Luckmann para analizar la dinámica del discurso contra la homeopatía y concluye que los homeópatas dejaron de utilizar un argumento científico fundamental ya disponible, el de la acción opuesta (fenómeno rebote, acción paradojal) de las drogas. Si lo hubieran utilizado, podrían haber explicado el éxito de la medicina convencional dentro del propio marco referencial de la homeopatía y consecuentemente, neutralizado su impacto. Finalmente, son discutidas las implicaciones de estas conclusiones en el sentido de la futura supervivencia y éxito de la homeopatía.

Boundaries or bridges: what should Homeopathy?s relationship be with mainstream medicine? / Fronteiras ou pontes: como devem ser as relações da homeopatia com a medicina convencional? / Fronteras o puentes: ¿cuál debe ser la relación entre la homeopatía y la medicina convencional?

When Samuel Hahnemann devised homoeopathy he constructed multiple arguments that both vehemently supported his new system and criticized the conventional medical practice of his day. At the end of the 19th century when homeopathy had grown within Britain and America, homeopaths failed to make use of some of Hahnemann?s most successful arguments. Instead, homeopaths found themselves lose significant cognitive ground to their long time conventional rivals with the dawn of the 20th century, a ground they have not yet recovered. This paper uses the theoretical framework of Berger and Luckmann to analyse the dynamics of the arguments used against homeopathy and suggests that homeopaths failed to adopt a universalizing medical explanation that was available to them: the reverse action of drugs. Had they used this argument homoeopaths could have explained conventional medicine successes within their own universe of meaning and thus neutralized the impact of conventional on their practice. The implications of these conclusions for the future survival and success of homoeopathy are considered.(AU)

Quando Samuel Hahnemann formulou a Homeopatia, ele construiu uma série de argumentos que tanto apoiavam seu novo sistema como criticavam a prática alopática da época. No final do século 19, quando a homeopatia já estava estabelecida na Grã-Bretanha e América, os homeopatas falharam por não fazer uso de alguns dos bem elaborados argumentos de Hahnemann. Além disso, os homeopatas não desenvolveram uma base conceitual adequada, distanciando-se ainda mais, com o alvorecer do século 20, dos rivais alopatas, distância essa que ainda não foi recuperada. Este trabalho utiliza o referencial teórico de Berger e Luckmann para analisar a dinâmica dos argumentos utilizados contra a homeopatia e sugere que os homeopatas falharam por não conseguirem adotar uma explicação médica universal que estava disponível para eles: a ação reversa de drogas. Se tivessem usado este conceito, os homeopatas poderiam ter explicado os bem sucedidos resultados alopáticos dentro de seu próprio marco conceitual e, assim, neutralizar o impacto da alopatia sobre a sua prática. As implicações destas conclusões para a sobrevivência e sucesso da homeopatia são consideradas.(AU)

Cuando Samuel Hahnemann formuló la homeopatía, desarrolló diversos argumentos que tanto fundamentaban vehementemente su nuevo sistema como criticaban la práctica médica de su época. Sin embargo, al final del siglo XIX, cuando la homeopatía ya se había desarrollado en Gran Bretaña y los Estados Unidos, los homeópatas dejaron de lado los argumentos más sólidos de Hahnemann y, al contrario, perdieron una parte significativa de su base cognitiva comparados a sus tradicionales rivales de la medicina convencional, siendo que esta situación persiste hasta la actualidad. Este artículo utiliza el marco referencial teórico propuesto por Berger y Luckmann para analizar la dinámica del discurso contra la homeopatía y concluye que los homeópatas dejaron de utilizar un argumento científico fundamental ya disponible, el de la acción opuesta (fenómeno rebote, acción paradojal) de las drogas. Si lo hubieran utilizado, podrían haber explicado el éxito de la medicina convencional dentro del propio marco referencial de la homeopatía y consecuentemente, neutralizado su impacto. Finalmente, son discutidas las implicaciones de estas conclusiones en el sentido de la futura supervivencia y éxito de la homeopatía.(AU)