Efficacy of individualized homeopathic treatment and fluoxetine for moderate to severe depression in peri- and postmenopausal women (HOMDEP-MENOP): study protocol for a randomized, double-dummy, double-blind, placebo-controlled trial
his study is the first trial of classical homeopathy that will evaluate the efficacy of homeopathic
individualized treatment using C-potencies versus placebo or fluoxetine in peri- and postmenopausal women with
moderate to severe depression. It is an attempt to deal with the obstacles of homeopathic research due to the
need for individual prescriptions in one of the most common psychiatric diseases.
Homeopathy for Depression - DEP-HOM: study protocol for a randomized, partial...home
Homeopathy is often sought by patients with depression. In classical homeopathy, the treatment
consists of two main elements: the case history and the prescription of an individually selected homeopathic
remedy. Previous data suggest that individualized homeopathic Q-potencies were not inferior to the antidepressant
fluoxetine in a sample of patients with moderate to severe depression. However, the question remains whether
individualized homeopathic Q-potencies and/or the type of the homeopathic case history have a specific
therapeutical effect in acute depression as this has not yet been investigated. The study aims to assess the two
components of individualized homeopathic treatment for acute depression, i.e., to investigate the specific effect of
individualized Q-potencies versus placebo and to investigate the effect of different approaches to the homeopathic
case history.
Use of Complementary and Alternative Medicine in Epilepsyhome
Complementary and alternative medicine (CAM) has
become much in vogue, and CAM practitioners have
increased in tandem with this. The trend of using
CAM for treating epilepsy does not differ from that
in other medical conditions, with nearly one half of
patients using CAM. In this article we review the major
complementary and alternative medicines used for treatment
of epilepsy. They include mind-body medicines
such as reiki and yoga; biologic-based medicine such as
herbal remedies, dietary supplements, and homeopathy;
and manipulative-based medicine such as chiropractic.
In the available literature, there is a sense of the merit
of these therapies in epilepsy, but there is a paucity of
research in these areas. Individualized therapies such
as homeopathy and reiki cannot be compared with
medicines in a conventional pharmaceutical model.
Hence, many studies are inconclusive. In a science of
double-blind, randomized controlled trials, appropriate
designs and outcome measurements need to be tailored
to CAM. This article explains the principles of the major
CAM therapies in epilepsy, and discusses peer-reviewed
literature where available. More effort needs to be
put into future trials, with the assistance of qualified
CAM professionals to ensure conformation to their
therapeutic principles.
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Homeopathy for Depression - DEP-HOM: study protocol for a randomized, partial...home
Homeopathy is often sought by patients with depression. In classical homeopathy, the treatment
consists of two main elements: the case history and the prescription of an individually selected homeopathic
remedy. Previous data suggest that individualized homeopathic Q-potencies were not inferior to the antidepressant
fluoxetine in a sample of patients with moderate to severe depression. However, the question remains whether
individualized homeopathic Q-potencies and/or the type of the homeopathic case history have a specific
therapeutical effect in acute depression as this has not yet been investigated. The study aims to assess the two
components of individualized homeopathic treatment for acute depression, i.e., to investigate the specific effect of
individualized Q-potencies versus placebo and to investigate the effect of different approaches to the homeopathic
case history.
Use of Complementary and Alternative Medicine in Epilepsyhome
Complementary and alternative medicine (CAM) has
become much in vogue, and CAM practitioners have
increased in tandem with this. The trend of using
CAM for treating epilepsy does not differ from that
in other medical conditions, with nearly one half of
patients using CAM. In this article we review the major
complementary and alternative medicines used for treatment
of epilepsy. They include mind-body medicines
such as reiki and yoga; biologic-based medicine such as
herbal remedies, dietary supplements, and homeopathy;
and manipulative-based medicine such as chiropractic.
In the available literature, there is a sense of the merit
of these therapies in epilepsy, but there is a paucity of
research in these areas. Individualized therapies such
as homeopathy and reiki cannot be compared with
medicines in a conventional pharmaceutical model.
Hence, many studies are inconclusive. In a science of
double-blind, randomized controlled trials, appropriate
designs and outcome measurements need to be tailored
to CAM. This article explains the principles of the major
CAM therapies in epilepsy, and discusses peer-reviewed
literature where available. More effort needs to be
put into future trials, with the assistance of qualified
CAM professionals to ensure conformation to their
therapeutic principles.
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
The efficacy of supplementation with the novel medical food, Souvenaid, in pa...Nutricia
The efficacy of supplementation with the novel medical food, Souvenaid, in patients with Alzheimer’s disease: A systematic review and meta-analysis of randomized clinical trials
TREATMENT RESISTANT DEPRESSION IS A AREA THAT IS NOT EXPLORED MUCH, BUT IT REALLY NEEDS LOT OF ATTENTION AS IT IS ONE OF THE MOST COMMON OBSTACLE IN ACHIEVING COMPLETE REMISSION IN DEPRESSION
Case # 29- The depressed man who thought he was out of options. .docxannandleola
Case # 29- The depressed man who thought he was out of options.
Depression has become a common mental disorder in our elderly population. This has caused a global concern for occur, geriatric patients, as depression often results in a significant burden for families as well as communities. Elderly people who suffer from depression may have an inferior baseline and record for medical assessments than those individuals without depression. Despite consistent evidence of the effectiveness of antidepressants for many with depression,
3
particularly those with more severe depression, remission rates are disappointingly low. An AHRQ-sponsored report found that only 46% of patients experienced remission from depression during 6 to 12 weeks of treatment with second-generation antidepressants. One major reason for this issue is non-adherence to medications and treatment plans. Studies have shown that patients' age, race and ethnicity are consistently associated with predictions of outcomes. (Rossom et al., 2016).
This case study involves a 69-year old man whose chief complaint is unremitting, chronic depression. After several years of medications and treatments, he feels hopeless for a recovery from his chronic depression. This assignments seeks to explore his family and social support systems, diagnostic testing, differential diagnosis and pharmacologic treatment options for this patient.
Questions for the client
How have you been sleeping lately?
How many times in the last week have you had feelings of hopelessness?
Are you having thoughts of harming yourself? Do you have a plan?
These questions are an important yet simple place to start when treating patients. Sleep disturbances plague much of the world's population and have shown to be a major indicator for mental health issues. Changes in sleep neurophysiology are often observed in depressive patients, and impaired sleep is, in many cases, the chief complaint of depression (Armitage, 2007). Depressed patients with sleep disturbance are likely to present more severe symptoms and difficulties in treatment. In addition, persistent insomnia is the most common residual symptom in depressed patients and is considered a vital predictor of depression relapse and may contribute to unpleasant clinical outcomes (Hinkelmann et al., 20120. Questions involving feelings of hopelessness and suicidal ideations with or without a plan relate to issues of patient safety. Across psychiatric disorders, hopelessness is associated with suicidal ideation and behavior. A meta-analysis of 166 longitudinal studies (sample size not reported) found that hopelessness was associated with an increased risk of ideation (Ribeiro, Huang, Fox, & Franklin, 2018).
Family and social support system
Family and social support systems are imperative for any patient in recovery. If the patient is agreeable to discussions with family members, then a discussion with his wife would be helpful. Researc.
Original ArticleDesign and implementation of a randomized.docxgerardkortney
Original Article
Design and implementation of a randomized
trial evaluating systematic care for bipolar
disorder
Abundant evidence demonstrates that treatments
for bipolar disorder can reduce the severity of
mood symptoms and improve daily functioning.
Specific pharmacotherapies have been proven effi-
cacious in the acute management of mania and
depression (1, 2) as well as in the prevention of
recurrence (1). For lithium, more intensive treat-
ment has been shown to improve both long-term
clinical outcomes and psychosocial functioning.
Promising evidence also supports the efficacy of
several disease-specific psychosocial interventions
for bipolar disorder (3, 4).
Unfortunately, treatments provided in everyday
practice fall far short of those proven in clinical
Simon GE, Ludman E, Unützer J, Bauer MS. Design and implementation
of a randomized trial evaluating systematic care for bipolar disorder.
Bipolar Disord 2002: 4: 226–236. ª Blackwell Munksgaard, 2002
Objectives: Everyday care of bipolar disorder typically falls short of
evidence-based practice. This report describes the design and
implementation of a randomized trial evaluating a systematic program to
improve quality and continuity of care for bipolar disorder.
Methods: Computerized records of a large health plan were used to
identify all patients treated for bipolar disorder. Following a baseline
diagnostic assessment, eligible and consenting patients were randomly
assigned to either continued usual care or a multifaceted intervention
program including: development of a collaborative treatment plan,
monthly telephone monitoring by a dedicated nurse care manager,
feedback of monitoring results and algorithm-based medication
recommendations to treating mental health providers, as-needed outreach
and care coordination, and a structured psychoeducational group
program (the Life Goals Program by Bauer and McBride) delivered by the
nurse care manager. Blinded assessments of clinical outcomes, functional
outcomes, and treatment process were conducted every 3 months for
24 months.
Results: A total of 441 patients (64% of those eligible) consented to
participate and 43% of enrolled patients met criteria for current major
depressive episode, manic episode, or hypomanic episode. An additional
39% reported significant subthreshold symptoms, and 18% reported
minimal or no current mood symptoms. Of patients assigned to the
intervention program, 94% participated in telephone monitoring and 70%
attended at least one group session.
Conclusions: In a population-based sample of patients treated for bipolar
disorder, approximately two-thirds agreed to participate in a randomized
trial comparing alternative treatment strategies. Nearly all patients
accepted regular telephone monitoring and over two-thirds joined a
structured group program. Future reports will describe clinical
effectiveness and cost-effectiveness of the intervention program compared
with usual care.
Gregory E Simona, Evette
Lud.
Systematic reviews of complementary therapies – an annotated bibliography. Pa...home
Complementary therapies are widespread but controversial. We aim to provide a
comprehensive collection and a summary of systematic reviews of clinical trials in three major
complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with
homeopathy. Potentially relevant reviews were searched through the register of the Cochrane
Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and
books. To be included articles had to review prospective clinical trials of homeopathy; had to
describe review methods explicitly; had to be published; and had to focus on treatment effects.
Information on conditions, interventions, methods, results and conclusions was extracted using a
pretested form and summarized descriptively.
Systematic reviews of complementary therapies – an annotated bibliography. Pa...home
Complementary therapies are widespread but controversial. We aim to provide a
comprehensive collection and a summary of systematic reviews of clinical trials in three major
complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with
homeopathy. Potentially relevant reviews were searched through the register of the Cochrane
Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and
books. To be included articles had to review prospective clinical trials of homeopathy; had to
describe review methods explicitly; had to be published; and had to focus on treatment effects.
Information on conditions, interventions, methods, results and conclusions was extracted using a
pretested form and summarized descriptively.
The efficacy of supplementation with the novel medical food, Souvenaid, in pa...Nutricia
The efficacy of supplementation with the novel medical food, Souvenaid, in patients with Alzheimer’s disease: A systematic review and meta-analysis of randomized clinical trials
TREATMENT RESISTANT DEPRESSION IS A AREA THAT IS NOT EXPLORED MUCH, BUT IT REALLY NEEDS LOT OF ATTENTION AS IT IS ONE OF THE MOST COMMON OBSTACLE IN ACHIEVING COMPLETE REMISSION IN DEPRESSION
Similar to Efficacy of individualized homeopathic treatment and fluoxetine for moderate to severe depression in peri- and postmenopausal women (HOMDEP-MENOP): study protocol for a randomized, double-dummy, double-blind, placebo-controlled trial
Case # 29- The depressed man who thought he was out of options. .docxannandleola
Case # 29- The depressed man who thought he was out of options.
Depression has become a common mental disorder in our elderly population. This has caused a global concern for occur, geriatric patients, as depression often results in a significant burden for families as well as communities. Elderly people who suffer from depression may have an inferior baseline and record for medical assessments than those individuals without depression. Despite consistent evidence of the effectiveness of antidepressants for many with depression,
3
particularly those with more severe depression, remission rates are disappointingly low. An AHRQ-sponsored report found that only 46% of patients experienced remission from depression during 6 to 12 weeks of treatment with second-generation antidepressants. One major reason for this issue is non-adherence to medications and treatment plans. Studies have shown that patients' age, race and ethnicity are consistently associated with predictions of outcomes. (Rossom et al., 2016).
This case study involves a 69-year old man whose chief complaint is unremitting, chronic depression. After several years of medications and treatments, he feels hopeless for a recovery from his chronic depression. This assignments seeks to explore his family and social support systems, diagnostic testing, differential diagnosis and pharmacologic treatment options for this patient.
Questions for the client
How have you been sleeping lately?
How many times in the last week have you had feelings of hopelessness?
Are you having thoughts of harming yourself? Do you have a plan?
These questions are an important yet simple place to start when treating patients. Sleep disturbances plague much of the world's population and have shown to be a major indicator for mental health issues. Changes in sleep neurophysiology are often observed in depressive patients, and impaired sleep is, in many cases, the chief complaint of depression (Armitage, 2007). Depressed patients with sleep disturbance are likely to present more severe symptoms and difficulties in treatment. In addition, persistent insomnia is the most common residual symptom in depressed patients and is considered a vital predictor of depression relapse and may contribute to unpleasant clinical outcomes (Hinkelmann et al., 20120. Questions involving feelings of hopelessness and suicidal ideations with or without a plan relate to issues of patient safety. Across psychiatric disorders, hopelessness is associated with suicidal ideation and behavior. A meta-analysis of 166 longitudinal studies (sample size not reported) found that hopelessness was associated with an increased risk of ideation (Ribeiro, Huang, Fox, & Franklin, 2018).
Family and social support system
Family and social support systems are imperative for any patient in recovery. If the patient is agreeable to discussions with family members, then a discussion with his wife would be helpful. Researc.
Original ArticleDesign and implementation of a randomized.docxgerardkortney
Original Article
Design and implementation of a randomized
trial evaluating systematic care for bipolar
disorder
Abundant evidence demonstrates that treatments
for bipolar disorder can reduce the severity of
mood symptoms and improve daily functioning.
Specific pharmacotherapies have been proven effi-
cacious in the acute management of mania and
depression (1, 2) as well as in the prevention of
recurrence (1). For lithium, more intensive treat-
ment has been shown to improve both long-term
clinical outcomes and psychosocial functioning.
Promising evidence also supports the efficacy of
several disease-specific psychosocial interventions
for bipolar disorder (3, 4).
Unfortunately, treatments provided in everyday
practice fall far short of those proven in clinical
Simon GE, Ludman E, Unützer J, Bauer MS. Design and implementation
of a randomized trial evaluating systematic care for bipolar disorder.
Bipolar Disord 2002: 4: 226–236. ª Blackwell Munksgaard, 2002
Objectives: Everyday care of bipolar disorder typically falls short of
evidence-based practice. This report describes the design and
implementation of a randomized trial evaluating a systematic program to
improve quality and continuity of care for bipolar disorder.
Methods: Computerized records of a large health plan were used to
identify all patients treated for bipolar disorder. Following a baseline
diagnostic assessment, eligible and consenting patients were randomly
assigned to either continued usual care or a multifaceted intervention
program including: development of a collaborative treatment plan,
monthly telephone monitoring by a dedicated nurse care manager,
feedback of monitoring results and algorithm-based medication
recommendations to treating mental health providers, as-needed outreach
and care coordination, and a structured psychoeducational group
program (the Life Goals Program by Bauer and McBride) delivered by the
nurse care manager. Blinded assessments of clinical outcomes, functional
outcomes, and treatment process were conducted every 3 months for
24 months.
Results: A total of 441 patients (64% of those eligible) consented to
participate and 43% of enrolled patients met criteria for current major
depressive episode, manic episode, or hypomanic episode. An additional
39% reported significant subthreshold symptoms, and 18% reported
minimal or no current mood symptoms. Of patients assigned to the
intervention program, 94% participated in telephone monitoring and 70%
attended at least one group session.
Conclusions: In a population-based sample of patients treated for bipolar
disorder, approximately two-thirds agreed to participate in a randomized
trial comparing alternative treatment strategies. Nearly all patients
accepted regular telephone monitoring and over two-thirds joined a
structured group program. Future reports will describe clinical
effectiveness and cost-effectiveness of the intervention program compared
with usual care.
Gregory E Simona, Evette
Lud.
Systematic reviews of complementary therapies – an annotated bibliography. Pa...home
Complementary therapies are widespread but controversial. We aim to provide a
comprehensive collection and a summary of systematic reviews of clinical trials in three major
complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with
homeopathy. Potentially relevant reviews were searched through the register of the Cochrane
Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and
books. To be included articles had to review prospective clinical trials of homeopathy; had to
describe review methods explicitly; had to be published; and had to focus on treatment effects.
Information on conditions, interventions, methods, results and conclusions was extracted using a
pretested form and summarized descriptively.
Systematic reviews of complementary therapies – an annotated bibliography. Pa...home
Complementary therapies are widespread but controversial. We aim to provide a
comprehensive collection and a summary of systematic reviews of clinical trials in three major
complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with
homeopathy. Potentially relevant reviews were searched through the register of the Cochrane
Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and
books. To be included articles had to review prospective clinical trials of homeopathy; had to
describe review methods explicitly; had to be published; and had to focus on treatment effects.
Information on conditions, interventions, methods, results and conclusions was extracted using a
pretested form and summarized descriptively.
Isolation and Characterization of a Water-soluble Disaccharide from Methanoli...BRNSS Publication Hub
The aim of this study is to isolation, identification and characterized the bioactive compounds from the rhizomes of Arisaema utile. Preliminary phytochemical screening of the rhizome extract of A. utile revealed the presence of steroids, terpenoids, flavonoids, alkaloids, saponins, carbohydrates, and fatty acids. The air-dried rhizomes were pulverized to a powder, subjected to Soxhlet extraction and compound isolation. The isolated compound was colorless crystalline, which was further subjected to IR,13CNMR, and 1HNMR for proper characterization and elucidation of the structure. The compound was concluded as water-soluble disaccharide–Sucrose (2R,3R,4S,5S,6R)-2-[(2S,3S,4S,5R)-3,4-dihydroxy-2,5-bis(hydroxymeth-yl)oxolan-2-yl]oxy-6-(hydroxymethyl)oxane-3,4,5-triol, antioxidant activity of the isolated compound was measured by 2,2-Diphenyl-1-picrylhydrazyl assay under in vitro condition. The isolated compound showed the most promising radical scavenging activity at a concentration of 10 μg/ml. Antifungal activity of the isolated compound was investigated against five fungal strains (Candida albicans, Candida glabrata, Candida paropsilosis, Candida tropicalis, and Candida krusei), using MIC80 assay. The most susceptible strains were Candida paropsilosis (MIC80 = 128 μg/mL).
Treating Insomnia in Depression Insomnia Related Factors Pred.docxturveycharlyn
Treating Insomnia in Depression: Insomnia Related Factors Predict
Long-Term Depression Trajectories
Bei Bei
Monash University and Royal Women’s Hospital, University of
Melbourne
Lauren D. Asarnow
Stanford University
Andrew Krystal
University of California, San Francisco
Jack D. Edinger
National Jewish Health, Denver, Colorado, and Duke University
Medical Center
Daniel J. Buysse
University of Pittsburgh
Rachel Manber
Stanford University
Objective: Insomnia and major depressive disorders (MDD) often co-occur, and such comorbidity has
been associated with poorer outcomes for both conditions. However, individual differences in depressive
symptom trajectories during and after treatment are poorly understood in comorbid insomnia and
depression. This study explored the heterogeneity in long-term depression change trajectories, and
examined their correlates, particularly insomnia-related characteristics. Method: Participants were 148
adults (age M � SD � 46.6 � 12.6, 73.0% female) with insomnia and MDD who received antidepressant
pharmacotherapy, and were randomized to 7-session Cognitive Behavioral Therapy for Insomnia or
control conditions over 16 weeks with 2-year follow-ups. Depression and insomnia severity were
assessed at baseline, biweekly during treatment, and every 4 months thereafter. Sleep effort and beliefs
about sleep were also assessed. Results: Growth mixture modeling revealed three trajectories: (a)
Partial-Responders (68.9%) had moderate symptom reduction during early treatment (p value � .001)
and maintained mild depression during follow-ups. (b) Initial-Responders (17.6%) had marked symptom
reduction during treatment (p values � .001) and low depression severity at posttreatment, but increased
severity over follow-up (p value � .001). (c) Optimal-Responders (13.5%) achieved most gains during
early treatment (p value � .001), continued to improve (p value � .01) and maintained minimal
depression during follow-ups. The classes did not differ significantly on baseline measures or treatment
received, but differed on insomnia-related measures after treatment began (p values � .05): Optimal-
Responders consistently endorsed the lowest insomnia severity, sleep effort, and unhelpful beliefs about
sleep. Conclusions: Three depression symptom trajectories were observed among patients with comorbid
insomnia and MDD. These trajectories were associated with insomnia-related constructs after commenc-
ing treatment. Early changes in insomnia characteristics may predict long-term depression outcomes.
What is the public health significance of this article?
This study identified three distinct depression trajectories in patients with comorbid major depression
and insomnia disorders during treatment and 2-year follow-up. Those with the largest and most
sustained improvements in depression consistently scored the lowest on postbaseline insomnia and
insomnia-related cognitions. Early changes in insomnia symptoms and insomnia-related character ...
Please I need a response to this case study.1 pagezero plagi.docxcherry686017
Please I need a response to this case study.
1 page
zero plagiarism
three references
The Case:
The sleepy woman with anxiety
This week’s discussion presents a case study involving a 44-year old woman with a chief complaint of anxiety beginning at age 15 years old. She has a long history of mental illness and continued therapies. The purpose of this discussion is to analyze her case history to determine medication and treatment effectiveness.
Client Questions
Question 1. Are you having feelings of harming yourself or harming someone else?
Rationale: This is a possibly uncomfortable yet important set of questions to ask each client. Primary care providers may be in a unique position to prevent suicide due to their frequent interactions with suicidal patients. Reviews suggest that among patients who committed suicide, 80 percent had contact with primary care clinicians within one year of their death, whereas only 25 to 30 percent of decedents had contact with psychiatric clinicians within the year of their death (Stene-Lars & Reneflot, 2017).
Question 2. What was happening in your life as a teenager when the anxiety started and you began to self-medicate?
Rationale: Per our report, this patient began suffering signs and symptoms of anxiety at 15-years old. Asking these types of questions we may gain insight into an underlying cause or triggering event. Anxiety disorders are the most common psychiatric disorders with onset in childhood, with prevalence estimates ranging from 10 to 30 percent. Nearly 37 percent of behaviorally inhibited preschool-age children had social anxiety disorder at age 15, compared with 15 percent of non- behaviorally inhibited children
.
Children with anxiety disorders are more likely to have persistent anxiety disorders into adulthood. (Rapee, 2014).
Question 3. What was happening in your life a year ago when these symptoms returned and became debilitating? Let’s discuss what the triggering events may have been.
Rationale: Self-discovery of triggering events may help the client to come to terms with the determinants of her anxiety and depression. Studies have shown that specific types of stressors were found to differentially predict increases in specific facets of anxiety sensitivity; health-related stressors predicted increases in disease-related concerns and fear of mental incapacitation, whereas stressors related to family discord predicted increases in fear of feeling unsteady, fear of mental incapacitation, and fear of having publicly observable symptoms of anxiety (McLaughlin & Hatzenbuehler, 2009).
Support System
The support system as reported by our client is her husband. She states he is supportive and has little to no contact with the family of origin. She has a few friends and a few outside interests. As PMHNP, discussing relationships with the client is one avenue to gain insight into anxiety patterns and coping mechanisms as seen by outside support. With the client’s permissio.
Depresi adalah masalah kejiwaan yang paling sering pada pasien dengan penyakit ginjal kronis dan dapat memprediksi hasil pasien dan kematian. Depresi terkait dengan kehidupan yang penuh stres yang ditandai dengan banyak kerugian dan oleh ketergantungan, yang bahkan dapat menyebabkan bunuh diri. Meskipun sejumlah besar pasien dengan penyakit ginjal kronis dan beban ekonomi mereka mewakili, hanya beberapa dari pasien ini menerima diagnosis dan terapi yang memadai. Pedoman Diagnostik dan Statistik Mental kriteria Gangguan-IV untuk depresi besar dapat membantu dalam membedakan gejala uremia dan depresi. Farmakoterapi tersedia dan antidepresan (trisiklik antidepresan dan selective serotonin re-uptake) telah berhasil digunakan dalam berbagai penelitian. Akhirnya, ada kebutuhan untuk welldesigned lanjut, membujur studi, kelangsungan hidup untuk memperjelas hubungan yang lebih baik antara depresi dan berbagai tahap disfungsi ginjal.
Background: Behavioral health conditions are prevalent among patients in inpatient medical settings and when not adequately treated contribute to diminished treatment outcomes and quality of life. Substantial evidence has demonstrated the effectiveness of psychological interventions in addressing behavioral health conditions in a range of settings but, to a lesser extent with psychologically-based interventions delivered in inpatient medical settings. Purpose: The purpose of this paper is to increase attention on psychological interventions being delivered to patients across a broad spectrum of medical specialties in inpatient medical settings to support the implementation of interventions to address increasing patient needs. Methods: This selected, brief review of the literature sought to describe published psychologically-based interventions delivered in inpatient medical settings. A search for studies catalogued on PubMed from 2007 to 2016 was examined and studies were included in the review if they were delivered within inpatient medical settings. Two reviewers independently assessed relevant studies for criteria. Results: A total of ten articles met the inclusion criteria with interventions targeting outcomes across four primary domains: 1) pain and fatigue; 2) cognition; 3) affective/emotional and; 4) self-harm. Several articles support interventions grounded in Cognitive-Behavioral Therapy and brief psychological interventions. Most studies reported favorable outcomes for the interventions relative to controls. Conclusions: Psychologically-based interventions, especially those that integrate components of cognitive-behavioral therapy and a multidisciplinary approach, can be implemented in inpatient medical settings and may promote improved patient outcomes. However, the quality of this evidence requires formal assessment, requiring more comprehensive reviews are needed to replicate findings and clarify effectiveness of interventions.
Similar to Efficacy of individualized homeopathic treatment and fluoxetine for moderate to severe depression in peri- and postmenopausal women (HOMDEP-MENOP): study protocol for a randomized, double-dummy, double-blind, placebo-controlled trial (20)
Homeopahty, el proyecto de un Sistema de Salud, protagonistas, fundadores, ideólogos históricos, las iniciativas de Medicina Alternativa Complementaria CAM.
Homeopathy—quackery or a key to the future of medicine?home
When cholera first invaded Europe in 1831, the
mortality throughout Europe was generally between
40% and 60%. To the surprise of many, mortality
rates reported by homeopathic physicians was generally
below 10%, and commonly under 4%. Let me
present two typical cholera reports, which have a
stamp of officialdom. The first one comes from the
territory of Raab in Hungary where in 1831 a
Dr Joseph Bakody treated 223 patients with mild to
severe cholera, 14 of which were in a state of collapse .
He lost a total of 8 patients, a mortality of 3.6%. A
similar situation occurred in Cincinnati in 1849. The
Board of Health issued an order calling for physicians
to report all cases of cholera. Reports of a high
mortality rate were received by the Board from the city
hospital and allopathic physicians. However, six
homeopathic physicians attracted national attention
when they reported not a single death out of their first
350 cases of cholera. Two of these homeopathic
physicians, Dr Pulte and Ehrmann would eventually
report treating 2646 cases with 35 deaths, or a
mortality rate of 1.3%. Allopaths reported fatal
outcomes in about 50% of their cases.
Homeopathy in the treatment of fibromyalgia A comprehensive literature-review...home
Given the low number and included trials and the lowmethodological quality, any conclusion based on the resultsof this review have to be regarded as preliminary. However,as single case studies and clinical trials indicate a positiveeffect, homeopathy could be considered a complementarytreatment for patients with fibromyalgia
Homeopathy as replacement to antibiotics in the case of Escherichia coli diar...home
The use of antibiotics in the livestock sector is increasing to such an extent
that it threatens negative consequences for human health, animal health and the environment.
Homeopathy might be an alternative to antibiotics. It has therefore been tested in
a randomised placebo-controlled trial to prevent Escherichia coli diarrhoea in neonatal
piglets.
Multidrugresistant tuberculosis
Among the most menacing forms of MDR is multidrug
resistant tuberculosis (MDR-TB). WHO estimates that
were about 450,000 new cases and 170,000 deaths from
MDR-TB in 2012. The number of cases reported to
WHO rose by an alarming 35% between 2011 and 2012,
although this probably mostly reflects increased recognition
and reporting. Over half the new cases were in India,
China or the Russian Federation.3
This issue of Homeopathy features a paper by Dr Kusum
Chand and colleagues reporting a randomized, double blind,
placebo-controlled clinical trial of individualized homeopathic
treatment or placebo in addition to standard antituberculous
chemotherapy as specified by the Indian Revised
National Tuberculosis Control Program, for MDR-TB
articleHealth professionals’ and families’ understanding of the role ofindivi...home
This paper draws on a mixed methods study that examined the feasibility of conducting a randomised controlled trial of individualisedhomeopathy plus usual care, compared to usual care alone, for children aged 7–14 with moderate to severe asthma recruited from secondary care.It draws on qualitative interviews with participants in the feasibility study that investigated families’ and professionals’ views and experiences ofasthma, homeopathy and study participation
Cutting Edge Research in Homeopathy: HRI’s second international research conf...home
Rome, 3rde5th June 2015, was the setting for the Homeopathy Research Institute’s (HRI)
second conference with the theme ‘Cutting Edge Research in Homeopathy’. Attended by
over 250 delegates from 39 countries, this event provided an intense two and a half day
programme of presentations and a forum for the sharing of ideas and the creation of international
scientific collaborations. With 35 oral presentations from leaders in the field,
the scientific calibre of the programme was high and the content diverse. This report
summarises the key themes underpinning the cutting edge data presented by the
speakers, including six key-note presentations, covering advancements in both basic
and clinical research. Given the clear commitment of the global homeopathic community
to high quality research, the resounding success of both Barcelona 2013 and
Rome 2015 HRI conferences, and the dedicated support of colleagues, the HRI moves
confidently forward towards the next biennial conference
CORE-Hom: A powerful and exhaustive database of clinical trials in homeopathyhome
The CORE-Hom database was created to answer the need for a reliable and publicly available
source of information in the field of clinical research in homeopathy. As of May 2014
it held 1048 entries of clinical trials, observational studies and surveys in the field of homeopathy,
including second publications and re-analyses. 352 of the trials referenced in
the database were published in peer reviewed journals, 198 of which were randomised
controlled trials. The most often used remedies were Arnica montana (n = 103) and
Traumeel (n = 40). The most studied medical conditions were respiratory tract infections
(n = 126) and traumatic injuries (n = 110). The aim of this article is to introduce
the database to the public, describing and explaining the interface, features and content
of the CORE-Hom database.
Observations about controlled clinical trials expressed by Max Haidvogl
in the book Ultra High Dilution (1994) have been appraised from a perspective two
decades later. The present commentary briefly examines changes in homeopathy
research evidence since 1994 as regards: the published number of randomised controlled
trials (RCTs), the use of individualised homeopathic intervention, the ‘proven efficacy of
homeopathy’, and the quality of the evidence.
Clinical trial of homeopathy in rheumatoid arthritishome
The conclusion of the study that the effect was due to
‘consultation’ and not to the homeopathic remedy appears
to be biased for two reasons:
There was no substantial amelioration of the pathology
in any group to compare and on which to base conclusions.
The placebo effect in such deep pathology cases is superficial
and transient as the patient remains in essence with
the same frame of pathology.
Blisters and homeopathy: case reports and differential diagnosishome
Blisters are skin lesions characterized by accumulation of fluid between the layers of the
skin. Their severity varies from the common blisters caused by friction to severe autoimmune
and congenital bullous disorders, some of themcurrently without treatment in conventional
medicine or requiring drugs with potentially severe side-effects. This article
reports cases of blistering diseases successfully treated with homeopathic medicines,
which represent an alternative for the treatment of such disorders.
A short history of the development of homeopathy in Indiahome
Homeopathy was introduced in India the early 19th century. It flourished in Bengal at first,
and then spread all over India. In the beginning, the system was extensively practised by
amateurs in the civil and military services and others. Mahendra Lal Sircar was the first
Indian who became a homeopathic physician. A number of allopathic doctors started
homeopathic practice following Sircar’s lead. The ‘Calcutta Homeopathic Medical
College’, the first homeopathic medical college was established in 1881. This institution
took on a major role in popularising homeopathy in India.
In 1973, the Government of India recognised homeopathy as one of the national systems of
medicine and set up the Central Council of Homeopathy (CCH) to regulate its education
and practice. Now, only qualified registered homeopaths can practice homeopathy in
India. At present, in India, homeopathy is the third most popular method of medical treatment
after allopathy and Ayurveda. There are over 200,000 registered homeopathic doctors
currently, with approximately 12,000 more being added every year.
Utilization of complementary and alternative medicine (CAM) among children fr...home
A homeopathy user utilized on average homeopathic remedies worth EUR 15.28. The corresponding figure for herbal
drug users was EUR 16.02, and EUR 18.72 for overall medicinal CAM users.
CAM use among 15-year-old children in the GINIplus cohort is popular, but decreased noticeably compared
with children from the same cohort at the age of 10 years. This is possibly mainly because German health legislation
normally covers CAM for children younger than 12 years only.
Complementary medical health services: a cross sectional descriptive analysis...home
The clinic attracts people from a wide area in the metropolitan Toronto and surrounding region with
health concerns and diagnoses that are consistent with primary care, providing health education and addressing
acute and chronic health conditions. Further explorations into health services delivery from the broader
naturopathic or other complementary/alternative medical professions would provide greater context to these
findings and expand understanding of the patients and type of care being provided by these health professionals.
Prayer-for-health and complementary alternative medicine use among Malaysian ...home
CAM use was prevalent among breast cancer patients. Excluding PFH from the definition of CAM
reduced the prevalence of overall CAM use. Overall, CAM use was associated with higher education levels and
household incomes, advanced cancer and lower chemotherapy schedule compliance. Many patients perceived
MBP to be beneficial for improving overall well-being during chemotherapy. These findings, while preliminary,
clearly indicate the differences in CAM use when PFH is included in, and excluded from, the definition of CAM
Extreme sensitivity of gene expression in human SH-SY5Y neurocytes to ultra-l...home
The study shows that Gelsemium s., a medicinal plant used in traditional remedies and
homeopathy, modulates a series of genes involved in neuronal function. A small, but statistically significant,
response was detected even to very low doses/high dilutions (up to 30c), indicating that the human neurocyte
genome is extremely sensitive to this regulation.
Calcarea carbonica induces apoptosis in cancer cells in p53-dependent manner ...home
These observations delineate the significance of immuno-modulatory circuit during calcarea carbonicamediated
tumor apoptosis. The molecular mechanism identified may serve as a platform for involving calcarea
carbonica into immunotherapeutic strategies for effective tumor regression
P05.39. Clinical experiences of homeopaths participating in a study of the ho...home
Homeopathic medications and dietary protocols were
found to be easily adapted for use in a clinical trial. These
observations provide insights for future research in the
area of homeopathic treatment (for ADHD in particular
and of homeopathy in general) and provide insights for
the potential integration of homeopathic practice into conventional
settings.
P04.71. Acupuncture, self-care homeopathy, and practitioner-based homeopathy:...home
The relationship between acupuncture use and depression
deserves further investigation. Given high levels of
concern about overuse of antibiotics in respiratory infections,
further research into the efficacy and cost-effectiveness
of homeopathy for these conditions is
warranted. Hopefully, future versions of NHIS-CAM
will provide more realistic estimates of expenditures.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Efficacy of individualized homeopathic treatment and fluoxetine for moderate to severe depression in peri- and postmenopausal women (HOMDEP-MENOP): study protocol for a randomized, double-dummy, double-blind, placebo-controlled trial
2. (Continued from previous page)
Discussion: This study is the first trial of classical homeopathy that will evaluate the efficacy of homeopathic
individualized treatment using C-potencies versus placebo or fluoxetine in peri- and postmenopausal women with
moderate to severe depression. It is an attempt to deal with the obstacles of homeopathic research due to the
need for individual prescriptions in one of the most common psychiatric diseases.
Trial registration: ClinicalTrials.gov Identifier: NCT01635218.
Keywords: Perimenopause, Postmenopause, Depression, Homeopathy, Fluoxetine, Hamilton Rating Scale for
Depression, Beck Depression Inventory
Background
Major depressive disorder (MDD) is the fourth most disab-
ling medical condition worldwide and it is expected to be
ranked second by the year 2020 [1,2]. It is typically recur-
rent and often chronic [3,4]. MDD is associated with high
health care costs [5]. Women are approximately twice as
likely to develop MDD as men [4,6]. The perimenopausal
period refers to the interval when women’s menstrual
cycles become irregular, which generally occurs above the
age of 40. Transition to menopause has long been consid-
ered a period of increased risk for depressive symptoms, as
was demonstrated in the Harvard Study of Moods and
Cycles, a population-based prospective study that exam-
ined the association between lifetime history of major de-
pression and the decline in ovarian function [6]. According
to the Stages of Reproductive Aging Workshop (STRAW),
transition to menopause is the period that precedes meno-
pause and it is characterized by variations in cycle length
(>7 days different from baseline or ≥2 skipped cycles and
an interval of amenorrhea ≥60 days) [7]. The postmeno-
pausal stage is the period that continues after 12 months
or more of amenorrhea. Depressive symptoms increase
during the transition to menopause [8]. A significant in-
verse association of follicle stimulating hormone (FSH)
with depressive symptoms provides strong corroborating
evidence that the changing hormonal milieu contributes to
dysphoric mood in this transition period [9]. With meno-
pause, seric levels of FSH usually exceed 40 mU/ml al-
though, given the variability of individual hormone levels,
the determination of menopausal status is generally made
by clinical history rather than laboratory parameters.
Furthermore, other hormones also change their serum
concentrations. The decline in estrogen levels that is
associated with menopause results in a wide range of
symptoms, which include vasomotor symptoms (hot
flushes and night sweats) [10].
The Hamilton Rating Scale of Depression (HRSD) and
the Beck Depression Inventory (BDI) are two well-known
standardized scales to assess depression severity used in
trials worldwide. The Greene Climacteric Scale (GS) is
also a standardized scale used in the Mexican population.
It is intended specifically to be a brief and standard meas-
ure of core climacteric symptoms or complaints to be
used for comparative and replicative purposes across dif-
ferent types of studies whether they are medical, psycho-
logical, sociological or epidemiological in nature. Three
separate sub-scales measure vasomotor symptoms, som-
atic symptoms, psychological symptoms, and an additional
probe is related to sexual function. Psychological symp-
toms can be further sub-divided to measure anxiety and
depression [11,12].
Meta-analyses of antidepressant medications have reported
only modest benefits over placebo treatment and, when
unpublished trial data are included, the benefit falls
below accepted criteria for clinical significance [13,14].
Specifically, a meta-analysis of clinical trial data submit-
ted to the US Food and Drug Administration (FDA) re-
vealed a mean drug-placebo difference in improvement
scores of 1.8 points on the HRSD [15], whereas the Na-
tional Institute for Clinical Excellence (NICE) used a
drug-placebo difference of three points as a criterion
for clinical significance when establishing guidelines for
the treatment of depression in the UK. Antidepressants
may be effective for severely depressed patients, but not
for moderately depressed ones. Moreover, only about
50% of patients with MDD show a response (>50% re-
duction in baseline symptoms) and only about one in
three attain remission (virtual absence of symptoms)
within the first eight weeks of treatment [4,16-18].
Homeopathy is one of the most frequently used and
controversial systems of medicine. It is based on the
‘principle of similars’; highly diluted preparations of sub-
stances that cause symptoms in healthy individuals are
used to stimulate healing in patients who have similar
symptoms when ill [19]. When a single homeopathic rem-
edy is selected based on a patient’s symptoms picture, it is
called ‘classical’ homeopathy [20]. In classical homeopathy,
the treatment consists of two main elements: the case his-
tory and the prescription of an individually selected
homeopathic remedy. The purpose of the homeopathic
case history is to ascertain the totality of signs and symp-
toms of each patient, enabling the selection of an individu-
alized homeopathic medicine [21].
Homeopathic medicines are produced through se-
quential agitated dilutions in Decimal (D), Centesimal (C)
or Quinquagintamillesimal (Q or LM) potencies [21].
Macías-Cortés et al. Trials 2013, 14:105 Page 2 of 8
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3. C-potencies are prepared by diluting a drop of a parent
substance in 99 drops of ethanol followed by agitation
of the solution (1 C). This procedure is repeated in
consecutive agitated dilutions (2 C, 3 C, 4 C, and so
on). Generally, high potencies are prescribed for mental
symptoms.
Use of homeopathy to treat psychiatric and menopausal
problems is widespread, and the need for more high-
quality controlled trials has been identified [22,23]. Meta-
analyses and systematic reviews have drawn mixed
conclusions as to whether homeopathy is more effective
than placebo in general medicine [20,24-28]. The database
on studies of homeopathy and placebo in psychiatry is
very limited, but results do not preclude the possibility of
some benefit. Homeopathy efficacy was found for fibro-
myalgia and chronic fatigue syndrome, for example [22].
Bordet et al. conducted a multi-national prospective
non-comparative observational study of homeopathic
treatments for hot flushes and suggest that further inves-
tigation is justified [29]. Jacobs et al. conducted a ran-
domized, double-blind study versus placebo performed
over one year with 83 women suffering from breast can-
cer; patients received either individualized homeopathic
treatment or a homeopathic complex or a placebo. This
study did not show any significant difference between
the three patient groups relative to the severity and fre-
quency of hot flushes although there was a trend in the
‘individualized homeopathic treatment’ group during the
first three months of the study [30]. Although depression
is one of the most common symptoms in peri- and post-
menopause, there is no controlled study of the homeo-
pathic use of individualized treatment in depressive
disorders in women at this stage.
Recently, results from a randomized, controlled,
double-blind trial indicated that individualized homeo-
pathic Q-potencies were non-inferior to the antidepres-
sant fluoxetine in a sample of patients with moderate to
severe depression [21,31]. Responder rates (defined as a
decrease of at least 50% from baseline on the Montgom-
ery and Asberg Depression Rating Scale) were higher
(homeopathy 84.6%, fluoxetine 82.8%) than those usually
found for antidepressants in clinical trials (43% to 75%)
[21,31]. However, the efficacy of the individualized
homeopathic C-potencies for peri- and postmenopausal
women with depression has not been investigated.
Aims
The primary aim of the study is to assess the efficacy of
individualized homeopathic treatment (IHT) versus fluox-
etine and placebo, and fluoxetine versus placebo in peri-
and postmenopausal women with moderate to severe
depression scored by the 17-item HRSD.
Secondary aims are: (1) to assess the efficacy of IHT
versus fluoxetine and placebo, and fluoxetine versus
placebo using the BDI and GS’s score; and (2) to deter-
mine the safety of IHT versus fluoxetine and placebo,
and fluoxetine versus placebo in peri- and postmeno-
pausal women with moderate to severe depression.
Methods/design
Study design
The study will be a randomized, placebo-controlled,
double-blind, double-dummy, three-arm parallel, super-
iority trial with a six-week study duration.
Study setting
The study will be conducted in a public, academic and re-
search hospital in Mexico City, the Juárez de México Hos-
pital (JMH), which belongs to the Ministry of Health
(MoH), the central authority in charge of health policies
and design programs. The MoH provides health care to
people without social security. JMH is an academic special-
ized hospital. Homeopathy is part of the National Health
System regularized by the MoH. The outpatient service of
homeopathy was established in JMH in 2004 and provides
health care for climacteric stage women daily.
Participant recruitment
The recruitment methods will include advertisements
through the internet, local media and community
groups, and liaisons with general practitioners, gynecolo-
gists, psychologists and allied health professionals. Post-
ers with information about the study protocol will be
posted at the study site; brochures will be distributed
among the hospital population. Participants are cur-
rently being recruited starting in March 2012. The study
is planned to end in December 2013.
Eligibility criteria
The entry criteria for the study will be: (1) 40 to 65 years
of age; (2) diagnosis of major depression according to
the Diagnostic and Statistical Manual of Mental Disor-
ders, 4th edition (DSM-IV); (3) moderate to severe de-
pression according to the 17-item HRSD (14 to 24
score); (4) no current use of homeopathic treatment for
depression or antidepressants or anxiolytic drugs for
three months prior to study entry; (5) not taking psycho-
therapy for at least three months before screening; (6)
no use of estrogens or other medications known to
affect ovarian function for at least three months before
screening; (7) early transition to menopause, defined by
a change in cycle length of seven days or longer in either
direction from the participant’s own baseline for at least
two cycles; or late transition to menopause, defined as
three to eleven months of amenorrhea; (8) postmeno-
pausal stage defined by 12 months or more of amenor-
rhea; and (9) capability and willingness to give informed
consent and to comply with the study procedures.
Macías-Cortés et al. Trials 2013, 14:105 Page 3 of 8
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4. Exclusion criteria include: (1) pregnancy or breastfeeding;
(2) other psychiatric disorders different from moderate to
severe depression (severe depression, schizophrenia, psych-
otic disorders, bipolar affective disorders, suicide attempt,
and so on); (3) alcohol or other substance abuse; (4) known
allergy to fluoxetine; and (5) cancer or hepatic diseases.
Types of interventions
After inclusion, patients will be randomly assigned to ei-
ther one of three groups illustrated in Figure 1: (1) IHT
plus fluoxetine dummy-loaded; (2) fluoxetine (20 mg/day)
plus IHT dummy-loaded; and (3) fluoxetine placebo plus
IHT placebo.
The selection of the individualized remedy will be car-
ried out after the case history by a certified medical doc-
tor, specialized in homeopathy with 18 years’ experience
in classical homeopathy. The case history will be based
on Hahnemann’s methodology described in paragraphs
83 to 104 of Organon of Medicine, 6th edition. A
complete medical history with clinical examination will
also be done. All patients will have a full homeopathic
case-taking including the collection of all the facts
pertaining to the patient which may help in determining
the totality of the symptomatology: past and present
physical and emotional symptoms, family environment
since childhood, stressful life events, marital satisfaction.
The symptoms will be organized by hierarchy: mental,
general and physical. In the first place, the strategy to
choose the individualized remedy will be based on the
most characteristic and clear mental symptoms. Sec-
ondly, general symptoms will be taken into account. A
computerized version of the Synthesis Homeopathic
Repertory 9.1 (Radar version 10) will be used to facilitate
the prescription. Only one remedy will be prescribed at
a time but it could be changed at every follow-up
according to the patient’s symptoms.
C-potencies will be provided by Laboratorio Similia
(Mexico City) and are manufactured according to the
Mexican Homeopathic Pharmacopoeia and Hahnemann’s
methodology. Each individualized homeopathic remedy
will be prescribed in C-potencies (Appendix 1). Higher ini-
tial potencies will be tried, ranging from 30 to 200 C. The
factors that influence the selection of the potency will in-
clude: clarity of mental symptoms, patient’s vitality and
sensitivity, nature and kingdom (source) of medicine,
chronicity and presence of any pathological disorder. A
single dose of the individualized homeopathic remedy
selected will be dissolved in a 60 ml bottle of 30% alcohol-
distilled water. Patients will receive 15 drops PO two times
per day following agitation for 10 days, plus fluoxetine-
dummy loaded prescribed PO daily. A double-dummy
technique with matching placebos for each active treat-
ment will be applied, thus both placebos will seem identical
to their corresponding verum formulations. Follow-up will
be at weeks four and six after the first clinical interview.
Patients in the fluoxetine group will receive 20 mg/day
PO plus IHT-dummy loaded. IHT-dummy loaded will
be repeated at week four. Capsules of a generic fluoxet-
ine will be provided by Laboratorio Similia (Mexico
City). Placebo capsules will contain sucrose micro glob-
ules. Homeopathic placebo bottles will be filled with the
same amount of 30% alcohol-distilled water. Patients will
receive 15 drops PO of this solution two times per day
following agitation for 10 days. The homeopathic pla-
cebo will be repeated at week four.
The third group will receive both fluoxetine and IHT
placebos, as previously described.
Criteria for discontinuing or modifying allocated
interventions
Some adverse effects have been observed during fluoxet-
ine treatment: lack of interest in sex, sexual dysfunction,
nausea, insomnia, somnolence, anorexia, anxiety, asthe-
nia, tremor, allergic skin reactions. If they are serious
and/or result in interruption of treatment, they will be
reported as adverse events.
During the IHT participants could have one of these re-
actions: (1) temporary intensification of symptoms before
the condition improves, which is named ‘homeopathic ag-
gravation.’ If it occurs at all it is usually mild and simply
an indication that the body is resolving the problem in a
natural and healthy way. If aggravation is too distressing it
will be lessened by using frequent doses of the same rem-
edy in a lower potency; (2) improving symptoms without
aggravation; and (3) the appearance of new symptoms dif-
ferent from those on which the prescription was based.
They will be reported as adverse events. They are rarely
serious, but in that case, the IHT will be stopped. If the
participant experiences the same symptoms of the remedy,
the corresponding antidote will be prescribed.
Each participant will receive a report form on which
to write daily any adverse event observed during the trial
Figure 1 Flow chart of the study groups.
Macías-Cortés et al. Trials 2013, 14:105 Page 4 of 8
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5. duration. Study participants will be retained in the trial
whenever possible to enable follow-up data collection
and prevent missing data.
Adherence to interventions
To enhance the validity of the data, participants will re-
turn the unused capsules and bottles at each follow-up
visit. Unused capsules will be counted and recorded on
the appropriate case report form. Participants will be
asked about any problems they are having taking their
study treatment.
Concomitant interventions
Some medications are prohibited during the study dur-
ation: triptans, tramadol, anxiolytic drugs, other seroto-
nergic agents or antidepressants, as well as hormone
replacement therapy. Psychotherapy is also forbidden
during the study duration. Medication for diabetes and
hypertension is allowed. The rescue intervention in case
of a lack of efficacy in the IHT and placebo groups will
be fluoxetine 20 mg/day; in the fluoxetine group, the
rescue medication will be sertraline 25 mg/day.
Participant retention
Plans to promote participant retention and complete
follow-up will include: scheduling appointments and
contacting patients by telephone.
Outcomes
The primary efficacy outcome is the change from base-
line in mean total depression score using the 17-item
version of the HRSD at weeks four and six. The severity
of symptoms will be assessed by a blinded investigator
(clinical psychologist) from the JMH. The secondary out-
comes are: change from baseline in mean total depres-
sion score using BDI (a self-reported scale) at weeks
four and six; change from baseline in mean total score
of GS at weeks four and six; responder rates (response
rate: decrease of 50% or more from baseline score; re-
mission rate: HRSD ≤7). The number and severity of all
adverse events and homeopathic aggravations during the
study period and 15 days after the final dose will be col-
lected to determine the safety of fluoxetine and homeo-
pathic medicines. An adverse event will be defined as
any untoward medical occurrence in a subject without
regard to the possibility of a causal relationship. Adverse
events will be collected after participants have given
consent and enrolled in the study and 15 days after
study completion.
Randomization
Participants are simple randomized in a 1:1:1 ratio using
a computer-generated random allocation sequence, by a
statistician not further involved in the study. Participants
will be assigned in sequential order to the treatment
groups. The randomization list will be kept strictly
confidential.
Allocation
Concealment mechanism and implementation
The principal investigator will enroll participants. Follow-
ing inclusion, all patients will go through a full homeo-
pathic case-taking and will receive a prescription of the
individualized homeopathic medicine. Only one-third of
the participants will actually receive a prescription. The
research pharmacist will randomly deliver the treatment
according to the allocation sequence in one of the three
groups previously described. The randomization list will
be sent to the research pharmacist at the start of the study.
In case of emergency interventions, clinical worsening or
adverse events, the pharmacist will inform the homeo-
pathic doctor if the individual patient is taking homeop-
athy, fluoxetine or placebo, without disclosing the code.
Blinding
Participants, the homeopathic doctor, the psychologist
and the statistician will remain blinded to the identity of
the three treatment groups until the end of the study.
The psychologist will assess the severity of the symp-
toms and will keep the HRSD scores strictly confidential
in a closed envelope at every follow-up until the end of
the study.
Sample size calculation
Sample size calculation was estimated using G*Power
(available at the University of Dusseldorf: http://www.psy-
cho.uni-dusseldorf.de/aap/projects/gpower/). The sample
size calculation is based on a previous study protocol for a
randomized controlled trial of homeopathy for depression
published by Adler et al. [21]. We assumed that verum
treatment is better than placebo by 2.7 ± 6.0 (mean ± stand-
ard deviation) HRSD score points after six weeks [21], cor-
responding to an effect size = 0.45 (largest difference
between any two groups to be detected/expected within
group standard deviation = diff/de). To detect an effect
size = 0.45, in a three-group design (1:1:1), using F-Test,
with a 5% risk of type 1 error (α) and 83% power, 63 pa-
tients per group are required considering also a 10% drop-
out rate.
Data collection
Study data will be collected at baseline, at every follow-
up and 15 days after the completion of the study. Data
will be collected from different sources: medical records,
questionnaires (HRSD, BDI, GS) and report forms where
participants will write daily any adverse event.
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6. Data management
All data will be entered electronically on data sheets
designed for the study. The original study forms will be
entered and kept on file at the JMH. Participant files are
to be stored in numerical order in a secure and accessible
place and manner. Participant files will be maintained in
storage for a period of five years after completion of the
study. All forms related to the study data will be kept in
locked cabinets. Access to the study data will be restricted.
A complete back-up of the data will be performed every
month.
Statistical analysis
All patients under randomization will be included in the
primary efficacy population (intention-to-treat popula-
tion), regardless whether or not they adhered to the
treatment protocol or provided complete data sets. Only
patients who withdraw their consent to use their per-
sonal data will be excluded from the analysis. The flow
of participants through the trial will be presented in a
Consolidate Standards of Reporting Trials (CONSORT)
diagram.
First, the three groups will be compared in order to
verify that there are no significant differences among
them at baseline to confirm they are comparable after
randomization. Demographic characteristics will be
summarized using means and standard deviation for
continuous data (that is, age) and relative frequencies for
qualitative data (that is, marital status, comorbidities).
The baseline demographic characteristics among groups
will be compared with the use of the chi square test or
by one-way independent measures of analysis of variance
(ANOVA) as required.
We will compare: (1) IHT versus placebo; (2) fluoxet-
ine versus placebo; and (3) IHT versus fluoxetine. The
main statistical analysis will compare primary and sec-
ondary outcome measurements among groups at weeks
four and six. The primary outcome (change in mean
HRSD score) and secondary outcomes (change in mean
BDI and GS scores) among groups at baseline and weeks
four and six, will be analyzed by one-way ANOVA to
provide a statistical test of whether or not the means of
the three groups are all equal. The statistically significant
one-way ANOVA result (P <0.05) suggests rejecting the
global null hypothesis H0 (that the means are the same
across IHT, fluoxetine and placebo groups). The
Bonferroni post-hoc test will be used to determine which
means differ among the groups. Responder rates will be
compared among the groups using the chi square test.
Statistical significance will be set at P <0.05 level for all
analysis. Missing data will be handled by sensitivity
analysis.
All patients who received at least one dose of the study
drugs will be considered in the safety analysis. Adverse
events will be translated to Medical Dictionary for Regu-
latory Activities terms (MeDRa terms), quantified and
compared among the groups using the chi square test.
Homeopathic aggravation will be compared among the
groups also using the chi square test.
Auditing
The Research and Ethics Committee of JMH, which is
not involved in the study, will review the trial process
every three months.
Confidentiality
All study-related information will be stored securely at
the study site. Participants’ study information will not be
released outside of the study without the written permis-
sion of the participant.
Regulatory and ethical approval
The trial protocol has been reviewed and approved by
the Research and Ethics Committee of the Juárez de
México Hospital (Submission Nº HJM 2030/12-A). This
study is in compliance with the Helsinki Declaration and
with the International Conference on Harmonisation
(ICH) – Good Clinical Practice. Prior to undertaking
any study related procedures, each participant will re-
ceive a verbal and written explanation of study aims,
methods, potential hazards, and benefits from investiga-
tors and will provide written informed consent.
Post-trial care
In the case of adverse events and after the completion of
the study, participants may continue receiving health
care at JMH.
Discussion
For the first time this study evaluates both the specific
effect of IHT using C-potencies versus fluoxetine and
placebo in peri- and postmenopausal women with mod-
erate to severe depression. Besides comparing homeo-
pathic medicines versus placebo, the fluoxetine-arm will
give more useful information about the effect of IHT
versus an efficacious treatment for depression in a ran-
domized controlled trial. It is an attempt to deal with
the obstacles of homeopathic research due to the need
of individual prescriptions in one of the most common
psychiatric disorders. Homeopathy is frequently pre-
scribed for climacteric symptoms including depression
as it has been proven in some observational studies, but
there is a lack of high-quality trials to prove its efficacy.
This study protocol is based on: (1) CONSORT guide-
lines for reporting randomized trials with parallel
groups; (2) the reporting data on homeopathic treat-
ments (RedHot) supplement to CONSORT [32,33]; and
(3) the Standard Protocol Items: Recommendations for
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7. Interventional Trials (SPIRIT) 2013 guidance for proto-
cols of clinical trials [34].
It has been reported that the homeopathic consult-
ation is in itself a therapeutic intervention working inde-
pendently of the prescribed remedy [35], so all study
participants will go through the same full homeopathic
case-taking regardless of group allocation. Because pla-
cebo interventions are associated with mean response or
remission rates of 35% [36,37], this trial includes a
placebo-arm, so placebo effect can be ruled out.
Gibbons et al. reported that patients in all age and anti-
depressant groups have significantly greater improvement
relative to placebo controls; and fluoxetine has been
proven to be efficacious for depression in adults after six
weeks of treatment [38], so it is expected that the
fluoxetine-arm will result in significant differences versus
placebo in this study. However, Kirsch et al. reported that,
at present, it is becoming more difficult to prove that anti-
depressants actually work better than placebo in moderate
to severe depression. It also has to be taken into consider-
ation that the antidepressant-placebo difference seems to
be smaller in the trials with moderately depressed partici-
pants [13]. Therefore, a fluoxetine-arm will allow us to de-
tect if in Mexican women in the climacteric stage with
moderate to severe depression, the difference in HRSD
score between fluoxetine and placebo is as small as it has
been shown in some meta-analysis [13].
Otherwise, different scenarios can result if no signifi-
cant differences between IHT and placebo groups are
found. In classical homeopathy, recovery requires the
prescription of the individualized remedy at the ad-
equate potency and dosage, so this is an important factor
to be taken into consideration during the trial process
because results may be biased. A negative result could
be due to a mistaken election of the remedy and not be-
cause the IHT is inefficacious. Follow-up duration is also
important. The selection of a suitable, individualized
homeopathic medicine will not always be accomplished
during six weeks of treatment, especially under double-
blind conditions [21]. It has not been proved that six
weeks of IHT is enough time to find a clinically relevant
response in climacteric women with depression. In rou-
tine homeopathic consultation, a patient may require
more than six weeks to recover from depression. How-
ever, for ethical reasons a longer follow-up is not possible
because of the placebo group. Furthermore, homeopathic
prescriptions may need to be modified depending on a
patient’s individual response after homeopathic treatment
is initiated. Once again, this could be problematic under
double-blind conditions.
For ethical reasons women with severe depression will
be excluded, so data of this trial will be able to prove an
effective treatment in Mexican climacteric women with
moderate to severe depression. Depression severity will
be scored by the 17-item HRSD, which is a standardized
instrument that has been used in many other clinical trials
for depression. Another self-administered instrument, the
BDI will also be used, so the results of the study might
provide useful information in clarifying the controversy
over the efficacy of homeopathy in depression. Use of
these standardized instruments enables us to compare re-
sults with other trials published worldwide.
Trial status
Participant recruitment began in March 2012.
Appendix 1
C-potencies will be stored at Juárez de México Hospital.
Medicines not listed can optionally be ordered and pre-
scribed, as needed.
Actea racemosa, Aurum metallicum, Calcarea carbonica,
Conium maculatum, Coffea cruda, Gelsemium sempervirens,
Glonoinum, Helonias dioica, Kali carbonicum, Kali phospho-
ricum, Lachesis trigonocephalus, Lilium tigrinum, Lycopo-
dium clavatum, Murex purpurea, Natrum muriaticum, Nux
vomica, Phosphoricum acidum, Phosphorus, Platina, Pul-
satilla nigricans, Sanguinaria canadensis, Sepia officinalis,
Spigelia, Staphysagria.
Abbreviations
ANOVA: analysis of variance; BDI: Beck Depression Inventory;
CONSORT: Consolidated Standards of Reporting Trials; C-
potencies: centesimal potencies; D-potencies: decimal potencies; DSM-
IV: Diagnostic and Statistical Manual of Mental Disorders, fourth edition;
FSH: follicle stimulating hormone; GS: Greene Climacteric Scale;
HRSD: Hamilton Rating Scale for Depression; ICH: International Conference
on Harmonisation; IHT: individualized homeopathic treatment; JMH: Juárez
de México Hospital; MDD: major depressive disorder; MeDRa terms: Medical
Dictionary for Regulatory Activities Terms; NICE: National Institute for Clinical
Excellence; Q or LM potencies: quinquagintamillesimal; STRAW: Stages of
Reproductive Aging Workshop.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
ECMC, JAB and LAF participated in the design of the study. ECMC and JAB
reviewed and discussed data for moderate depression, fluoxetine and
homeopathy. ECMC, JAB and LAF made important contributions to the
design of the trial, were substantially involved in drafting and revising the
manuscript, and gave final approval of the submitted version of the
document. All authors read and approved the final manuscript.
Authors’ information
ECMC is a Homeopathic MD, MSc of Escuela Superior de Medicina, Instituto
Politécnico Nacional. She was responsible for initiating the outpatient service
of homeopathy in Juárez de México Hospital. JAB and LAF are full time
professors and investigators of Escuela Superior de Medicina, Instituto
Politécnico Nacional.
Acknowledgements
We thank Gustavo Aguilar-Velázquez, MD, PhD, Laboratorio Similia for
donating kindly and unconditionally C-potencies, fluoxetine and placebos;
Imelda Hernández-Marín, MD, Department of Biology of Reproduction, Juárez
de México Hospital, who provided technical and medical advice in the study
design. We also thank María Elena Monterde-Coronel, MSc, who will provide
advertising on the website www.homeopatía.com.mx.
Macías-Cortés et al. Trials 2013, 14:105 Page 7 of 8
http://www.trialsjournal.com/content/14/1/105
8. Funding
No external funding will be provided for this trial. The study is being
performed with the JMH’s own resources and no amount of money was
given to the investigators. Homeopathic medicines, fluoxetine and placebo
will be kindly donated by Laboratorio Similia.
Received: 9 August 2012 Accepted: 9 April 2013
Published: 23 April 2013
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Cite this article as: Macías-Cortés et al.: Efficacy of individualized
homeopathic treatment and fluoxetine for moderate to severe
depression in peri- and postmenopausal women (HOMDEP-
MENOP): study protocol for a randomized, double-dummy, double-
blind, placebo-controlled trial. Trials 2013 14:105.
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