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Siewert J, Teut M, Gaertner K, Binting S, Eberhardt C, Ortiz M, Grabowska W, Reinhold T, Roll S, Stoeckigt B, Willich SN, Cramer H, Brinkhaus B. Homeopathy for seasonal allergic rhinitis: rationale, design and methods of the three-armed randomized controlled HOMEOSAR trial. BMC Complement Med Ther 2022; 22:338. [PMID: 36550537 PMCID: PMC9773622 DOI: 10.1186/s12906-022-03820-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients with seasonal allergic rhinitis (SAR) frequently use homeopathic therapy. Although there is some evidence that homeopathy may be effective in treating symptoms of SAR, there is a lack of high-quality clinical trials. Therefore, the aim of the homeopathy for SAR (HOMEOSAR) trial is to determine the efficacy of individualized or standardized homeopathic drug treatment compared to placebo regarding rhinitis-related quality of life in patients with SAR. METHODS This randomized, placebo-controlled, double-blind, three-armed intervention study will be conducted at two university hospital outpatient clinics for complementary and integrative medicine in Berlin and in 12 office-based practices specializing in homeopathic treatment in Germany. A total of 270 patients with clinical symptoms of SAR and positive allergy test to birch and grass pollen will receive homeopathic anamnesis and subsequently be randomized into (a) standardized homeopathic drug treatment with Galphimia Glauca (potency D6), (b) individualized homeopathic drug treatment (D6), or (c) placebo. All three groups can receive on-demand rescue medication as needed. Treatment will consist of two consultations and daily intake of the study medication for 4 weeks during the pollen season. The primary outcome is the mean overall score of the Rhinitis Quality of Life Questionnaire (RQLQ) in weeks 3 and 4, analyzed using analysis of covariance (adjusted for baseline RQLQ overall score and study center). A closed testing procedure will be used to control the overall type I error comparing the 3 treatment groups. Secondary outcomes include the overall RQLQ and its seven domain scores, responder status (decrease in RQLQ overall score of at least 0.5 points compared to the baseline value), use of rescue medication, intensity of total and individual SAR symptoms based on visual analog scale, generic health-related quality of life, safety, utilization of health care resources and associated costs. In addition, a qualitative data analysis is planned. CONCLUSION The results of our study will contribute to clarifying the possible therapeutic effects of homeopathic drug treatment for patients with SAR. TRIAL REGISTRATION This study has been registered in the German Clinical Trial Registry with trial ID DRKS00018081 on June 09, 2020.
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Affiliation(s)
- J. Siewert
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - M. Teut
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - K. Gaertner
- grid.412581.b0000 0000 9024 6397Institute for Integrative Medicine, University of Witten/Herdecke, Herdecke, Germany
| | - S. Binting
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - C. Eberhardt
- grid.7468.d0000 0001 2248 7639Pharmacy Department, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - M. Ortiz
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - W. Grabowska
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - T. Reinhold
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - S. Roll
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - B. Stoeckigt
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - S. N. Willich
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - H. Cramer
- grid.5718.b0000 0001 2187 5445Department of Internal and Integrative Medicine, Faculty of Medicine, Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany
| | - B. Brinkhaus
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Niederberger M, Peter L. [Mixed methods studies in the health sciences. A critical map]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2018; 133:9-23. [PMID: 29605568 DOI: 10.1016/j.zefq.2018.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 11/30/2022]
Abstract
Mixed methods studies (MMS) play an increasingly important role in the health sciences. Its potential lies in the acquisition of causal conditions and in the intersubjective understanding of diverse and new phenomena. The holistic and multi-perspective analysis strategy of MMS also allows a subject-oriented and an evidence-based approach to clinical practice. The article reviews the use of MMS in the health sciences on the basis of various reviews, and it highlights current methodological developments and research gaps.
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Affiliation(s)
- Marlen Niederberger
- Forschungsmethoden in der Gesundheitsförderung und Prävention Pädagogische Hochschule Schwäbisch Gmünd, Schwäbisch Gmünd, Deutschland.
| | - Lisa Peter
- Pädagogische Hochschule Schwäbisch Gmünd, Deutschland
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Adams M, Hoehre TC, Bucher HU. The Swiss Neonatal Quality Cycle, a monitor for clinical performance and tool for quality improvement. BMC Pediatr 2013; 13:152. [PMID: 24074151 PMCID: PMC3856669 DOI: 10.1186/1471-2431-13-152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 09/25/2013] [Indexed: 11/10/2022] Open
Abstract
Background We describe the setup of a neonatal quality improvement tool and list which peer-reviewed requirements it fulfils and which it does not. We report on the so-far observed effects, how the units can identify quality improvement potential, and how they can measure the effect of changes made to improve quality. Methods Application of a prospective longitudinal national cohort data collection that uses algorithms to ensure high data quality (i.e. checks for completeness, plausibility and reliability), and to perform data imaging (Plsek’s p-charts and standardized mortality or morbidity ratio SMR charts). The collected data allows monitoring a study collective of very low birth-weight infants born from 2009 to 2011 by applying a quality cycle following the steps ′guideline – perform - falsify – reform′. Results 2025 VLBW live-births from 2009 to 2011 representing 96.1% of all VLBW live-births in Switzerland display a similar mortality rate but better morbidity rates when compared to other networks. Data quality in general is high but subject to improvement in some units. Seven measurements display quality improvement potential in individual units. The methods used fulfil several international recommendations. Conclusions The Quality Cycle of the Swiss Neonatal Network is a helpful instrument to monitor and gradually help improve the quality of care in a region with high quality standards and low statistical discrimination capacity.
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Affiliation(s)
- Mark Adams
- Division of Neonatology, University Hospital Zurich, Zurich, Switzerland.
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[Development, appraisal and synthesis of complex interventions - a methodological challenge]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2011; 105:751-61. [PMID: 22176984 DOI: 10.1016/j.zefq.2011.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 11/02/2011] [Accepted: 11/04/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Many medical interventions are of a complex nature. They comprise interdependent components differently interacting within various complex settings, e.g., stroke units. Appraising the efficacy, benefit and harm of complex interventions is far more difficult than appraising single interventions like specific drug treatments. Detailed methodological procedures for the development, appraisal and synthesis of complex interventions are increasingly discussed internationally. METHODS Systematic inventory of methodological guidance for the development and evaluation of complex interventions through searching scientific literature databases and web resources of international institutes. Review of the current state of discussion and suggestions for the development, appraisal and synthesis of complex interventions. RESULTS Five methodological guidance papers have been identified. In particular, the UK Medical Research Council's guidance offers a structured introduction to the development and evaluation of complex interventions in health care and medicine. Synthesis of complex interventions using customary methods of systematic reviews is not satisfying. Other approaches to synthesis like realist evaluation as well as statistical procedures exploring the active components of complex interventions have been discussed. However, post hoc analytical procedures could never adequately replace careful prospective development and exploration of complex interventions and interdependencies with contextual factors. CONCLUSION Complex interventions require multi-stage development, use of different methods, reporting on all developing phases and new approaches for synthesis. Presentation of the complete evidence on a specific complex intervention might be more useful than synthesis of a variety of different complex interventions by customarily applied methods of (meta-analytical) systematic review.
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