Development and validation of Susceptibility Assessment Tool in Homoeopathy (SATH) in homoeopathic clinical practice

In this paper I begin by discussing the reinforcement offered to ontological dualism by biomedicine. It then describes some parallels between the development of feminist health activism and that of professional, non‐medically qualified homoeopathy, going on to ask whether alternative medicine can offer a ‘political’ challenge to ontological dualism. Three aspects of the feminist critique of biomedicine are discussed in relation to contemporary, feminist, homoeopathy. They include the power dynamics within the clinical encounter, the degree to which social and environmental issues are incorporated within medical diagnosis and treatment, and the manner in which the patient’s subjective experience is used during case‐taking. I conclude that contemporary feminist homoeopathy does address the concerns relating to dualism and power raised by the health activists of second wave feminism; it therefore must be considered a ‘feminist’ form of medicine. However, its very success in this regard raises a new set of difficulties and tensions. Although holistic forms of medicine do have the potential to address the ontological dualism which is inherent to biomedicine, they may also increase the capacity practitioners have to construct and enforce normative forms of behaviour through their clinical practice. In addressing one set of feminist concerns relating to biomedicine, homoeopathic practice may actually intensify the dangers relating to a second set of feminist concerns.

Practitioners are under increased pressure to demonstrate effectiveness and to do so in as short a time as possible. In addition, evidence-based practice calls for practitioners to take into consideration not only best research evidence but also the wants and preferences of patients, and their own clinical expertise. In light of these demands, standardized assessment tools are likely to become increasingly central in clinical practice in a variety of health care fields, such as nursing, social work, psychiatry, psychology, and medicine. In this article, the author uses two case studies to show how qualitative methods can contribute to the development and evaluation of clinical assessment tools that are responsive to contemporary pressures. She also shows that evaluations of clinical instruments are incomplete if they do not include a qualitative component.

World Health Assembly Resolution 60.22 and Its Importance as a Health Care Policy Tool for Improving Emergency Care Access and Availability Globally

This study addresses the lack of a short Communicative Development Inventory (CDI) form tailored to Saudi Arabic, specifically designed based on local norms, for assessing early communicative skills in toddlers. The JISH Arabic CDI: Words and Sentences Short-Form (JACDI: WS-SF) is introduced to meet this need. This tool is particularly useful in contexts of low parental literacy and is designed to offer a culturally relevant and efficient assessment of early language development in Saudi Arabic-speaking children. The JACDI: WS-SF was developed using a cross-sectional study design. Participants were toddlers aged 16 to 36 months and their parents, who provided data on language development through this newly developed tool. Preliminary findings indicate that the JACDI: WS-SF effectively captures essential aspects of early communicative development, aligning with local linguistic and cultural norms. The tool proves to be accessible to parents with varying literacy levels and sensitive to the linguistic context of Saudi Arabic. Notably, the study highlighted a significant association between children's ability to combine words and their vocabulary size, emphasising the need for considering language complexity in early interventions. Gender differences in vocabulary size were also noted, calling for equitable support in language assessment and intervention. The JACDI: WS-SF effectively fills a significant gap in developmental assessment tools in the region, confirming its efficacy in initial testing. The outcomes support the tool's utility and cultural relevance, enhancing its potential to expedite language disorder diagnoses, facilitate rigorous and comparable early language development studies, and broaden accessibility to language assessments. These results underscore the importance of the tool in both research and clinical practice, especially for advancing early intervention strategies. What is already known on this subject Previous studies have established the utility of MacArthur-Bates Communicative Development Inventories (CDIs) for assessing early communicative skills in infants and toddlers, with over 100 adaptations in various languages and dialects globally. However, the existing Saudi Arabic version is lengthy, exceeding the length of most long-form CDIs, and includes outdated items. This highlights the need for updated, culturally appropriate tools that accurately reflect current language and cultural experiences. What this paper adds to the existing knowledge This study introduces the JISH Arabic CDI: Words and Sentences Short-Form (JACDI: WS-SF), a culturally and linguistically updated short-form inventory tailored for Saudi Arabic-speaking children. This new tool is designed to be accessible to parents with varying literacy levels and provides a valid and efficient method for assessing early language development. It addresses the need for updated vocabulary reflecting modern Saudi Arabic-speaking children's environments and supports rapid, reliable developmental assessments. What are the potential or actual clinical implications for this work? The JACDI: WS-SF fills a critical void in the assessment toolkit for clinicians working with Saudi Arabic-speaking infants and toddlers. By providing a culturally relevant and efficient means of evaluating early language development, this tool enables more accurate and timely diagnoses of language disorders, ultimately enhancing clinical assessment practices. Its streamlined format is particularly advantageous for use in busy clinical settings and benefits parents with lower literacy levels. By facilitating accurate and timely interventions, the JACDI: WS-SF supports improved developmental outcomes for children across Saudi Arabia.

Purpose The assessment and diagnosis of apraxia of speech (AOS) have been well studied in the English context, yet there is limited understanding of the clinical practice in speakers of other languages, like Cantonese. This study aimed to obtain information about the clinical practice of assessment methods and diagnostic criteria used, and confidence in diagnosing, AOS in Cantonese speakers. Method An online survey constructed with Google Forms was completed by 27 speech-language pathologists (SLPs) in Hong Kong. The questionnaire comprised 12 questions covering (a) demographic information, (b) experience working with speakers with AOS, (c) confidence in making AOS diagnosis in Cantonese speakers, (d) assessment tasks or methods used for assessing AOS in Cantonese speakers, (e) clinical features used for diagnostic purposes, and (f) assessment tasks used to determine the presence of clinical features for diagnostic purposes. Result All respondents (100%) made AOS diagnoses based on the observed clinical features, while no respondents made diagnoses using only standardised tests or quantitative measures. Six clinical features were commonly used by most of the respondents: articulatory groping (100%), inconsistent articulatory errors (100%), length effects (85.2%), difficulty initiating speech (81.5%), automaticity effects (81.5%), and sound distortions (77.8%). More than half of the respondents collected connected speech samples (64%), and conducted diadochokinesis (64%) and repetition tasks (64%). The average confidence level of the respondents for making AOS diagnoses was fair (3.63/5). Conclusion The SLPs in Hong Kong make AOS diagnoses based on the observed clinical features that have been reported in the English literature. Although some of the clinical features have been updated as non-discriminatory for AOS, they are still being used for AOS diagnosis in Cantonese speakers. Tendencies were observed with respect to the assessment tasks selected. The fair diagnostic confidence level suggests a need for future investigations of AOS in Cantonese speakers and the development of assessment tools.

BackgroundDespite the increasing interventions to support family caregivers of people with dementia, service planning and delivery is still not effective.ObjectiveOur study aimed to develop a digitally-supported needs assessment tool for family caregivers of people with dementia that is feasible, time-efficient, understood by users, and can be self-completed in the primary care setting.MethodsThe development of the unmet needs assessment tool was part of a cluster-randomized controlled trial examining the effectiveness of a digitally supported care management programme to reduce unmet needs of family caregivers of people with dementia (GAIN [Gesund Angehörige Pflegen]) and was conducted in 3 phases. Using an iterative participatory approach with informal caregivers, health care professionals including general practitioners, neurologists, psychologists, psychiatrists, nurses, and Alzheimer Society representatives, we developed a digital self-completion unmet needs assessment tool focusing on informal caregivers’ biopsychosocial health und quality of life in connection to their caregiver responsibilities. Data were collected through group discussions, written feedback, protocols, think-aloud protocols, and interviews, and analyzed thematically.ResultsData from 27 caregivers, including caregivers of people with dementia (n=18), health care professionals (n=7), and Alzheimer Society representatives (n=2) were collected. Thematic analysis identified 2 main themes: content of the assessment tool and usability and handling of the digital tablet-based assessment tool. The feedback provided by the stakeholders led to new aspects and changes to make the tool comprehensive, easy to read, and easy to handle. The overall mean completion time was reduced from the initial 37 minutes to 18 minutes, which renders the assessment tool fit to be self-completed in waiting rooms of primary care practices or other settings.ConclusionsThe input of the 3 stakeholder groups has supported the development of the assessment tool ensuring that all aspects considered important were covered and understood and the completion of the assessment procedure was time-efficient and practically feasible. Further validation of the assessment tool will be performed with the data generated as part of the GAIN trial.

To describe the development of an assessment tool for antenatal psychosocial risk factors associated with poor postpartum outcomes. A survey of Ontario family physicians established a need for an antenatal psychosocial health assessment (ALPHA) form. A critical literature review identified important antenatal factors for inclusion on the form. Focus groups of obstetrical care providers indicated acceptance of the provider-completed ALPHA; their feedback led to the development of a self-report ALPHA. Satisfaction, yield and reliability of the self-report and provider-completed ALPHA forms were studied and found to be comparable. Physicians and patients reported good satisfaction and usefulness of the ALPHA form in identifying antenatal psychosocial risk factors. The provider ALPHA was further tested in clinical practice. ALPHA endorsement was obtained from physicians, nurses and midwives. A program planning process, which included multidisciplinary involvement, evaluation and endorsement by professional organizations, aided the development, refinement and application of the ALPHA forms as primary care tools. ALPHA topic headings are incorporated into the official 2000 Ontario Antenatal Record and the ALPHA adopted for use on Prince Edward Island.

Understanding a patient is one of the most difficult tasks a homoeopathic physician faces; every new patient presents a new challenge. Building a rapport with every patient is not only a crucial task for the homoeopath, not all patients cooperate with the process, which in itself could be an individualistic feature. To perceive a man in disease, the homoeopath must be a master of interview techniques to create a Hahnemannian integrated totality, which is a challenging task. This paper demonstrated the role of the interview technique in perceiving the uncooperative patient to define therapeutic problem definition and resolution in homoeopathic clinical practice. Listening, observing, questioning, interpreting confronting and empathising were effective interview techniques to successfully create a Hahnemannian integrated totality to understand the man behind the sickness in uncooperative patients. This study demonstrated the successful application of interview techniques that enable a homoeopath to understand a patient as a person through the complaints in terms of integrated Hahnemannian totality to construct a therapeutic problem resolution.

A systematic review of clinical assessment for undergraduate nursing students

Background: Nosodes are the homoeopathic medicines prepared from diseased products of biological origin. These are commonly used in clinical practice for the prophylaxis and treatment of ailments including infectious diseases. Objective: This review aims at the usage of nosodes for the management of epidemics. Methods: The homoeopathic research literature was searched to find examples of the use of nosodes in different ways and to evaluate their role and position in homoeopathic practice with special reference to epidemic diseases. Results: Research evidence for use of the nosodes as prophylactics and for the treatment of various infectious and non-infectious diseases is emerging. Nosodes such as Meningococcinum,nosoLEP and Malaria officinalis have been used successfully in controlling meningitis, leptospirosis and malaria, respectively. The use of nosodes as isopathy is somewhat acceptable in the mainstream medicine due to its similarity to vaccination. Although it is feasible to use nosodes in a short span of time and can be administered easily, the method of preparation and the safety issues are of much concern and therefore, should be used with utmost care. The safety issues outlined by the World Health Organization should be satisfied before their application in public health. Conclusion: The challenge for the future is to refine the method of preparation and to develop a harmonised way of preparing the nosodes, which is conducive to all the homoeopathic pharmacopoeias across the globe. Nosodes prepared as per the homoeopathic principles have potential to be used as prophylactics in epidemics, but only if there is sufficient experimental evidence of its effectiveness and safety.

The Journal of Integrated Standardized Homoeopathy (JISH) is an open access peer-reviewed journal committed to publishing high-quality articles, with the main aim to promote Evidence based Scientific Homoeopathy, by publishing original research papers in Homoeopathy, well documented evidence based case reports and papers demonstrating the application of Homoeopathy in different areas of Clinical practice, Homoeopathic Medical Education, Community care, Hospital based Homoeopathic Practice, Drug proving, clinical research, extramural research, and collaborative research in Homoeopathy.

Clinical policies control several aspects of clinical practice, including individual treatment and care, resource management and healthcare professionals' etiquette. This article presents Clinical Policy Ethics Assessment Tool, an ethical assessment tool for clinical policies that could be used not only by clinical ethics committees but also by policy committees or other relevant groups. The aim of this study was to find or create a tool to identify ethical issues and/or confirm ethical validity in nursing practice policies, protocols and guidelines. The development of Clinical Policy Ethics Assessment Tool involved first a literature review, followed by modification of the Research Protocol Ethics Assessment Tool, which was created to identify research protocols' ethical issues, and finally, a trial of Clinical Policy Ethics Assessment Tool to ensure its reliability and validity. The policies analysed trialling Clinical Policy Ethics Assessment Tool were in the public domain and did not contain any confidential information. Despite that, Clinical Policy Ethics Assessment Tool also had the approval of a research ethics committee. Research Protocol Ethics Assessment Tool was chosen as the template for a Clinical Policy Ethics Assessment Tool, to which several modifications were added to adapt it to work within a nursing practice context. Clinical Policy Ethics Assessment Tool was tested twice, which resulted in a general test-retest reliability coefficient = 0.86, r = 0.84, α1 = 0.817, α2 = 0.824 and interclass correlation coefficient = 0.874. Contemporary nursing practice in a developed country is often ruled by clinical policies. The use of Clinical Policy Ethics Assessment Tool could confirm the ethical validity of those clinical practice policies, impacting on nurses' education, values and quality of care. Clinical Policy Ethics Assessment Tool has the potential to detect ethical issues and facilitate the correction and improvement of clinical policies and guidelines in a structured way. This is especially so as it has shown reliability in detecting issues in clinical policies involving human participants and in encouraging policymakers to consider common ethical dilemmas in nursing practice.

Behavioural phenotypes in translation

The current shift towards competency-based residency training has increased the need for objective assessment of skills. In this study, we developed and validated an assessment tool that measures technical and non-technical competency in transurethral resection of bladder tumour (TURBT). The 'Test Objective Competency' (TOCO)-TURBT tool was designed by means of cognitive task analysis (CTA), which included expert consensus. The tool consists of 51 items, divided into 3 phases: preparatory (n = 15), procedural (n = 21), and completion (n = 15). For validation of the TOCO-TURBT tool, 2 TURBT procedures were performed and videotaped by 25 urologists and 51 residents in a simulated setting. The participants' degree of competence was assessed by a panel of eight independent expert urologists using the TOCO-TURBT tool. Each procedure was assessed by two raters. Feasibility, acceptability and content validity were evaluated by means of a quantitative cross-sectional survey. Regression analyses were performed to assess the strength of the relation between experience and test scores (construct validity). Reliability was analysed by generalizability theory. The majority of assessors and urologists indicated the TOCO-TURBT tool to be a valid assessment of competency and would support the implementation of the TOCO-TURBT assessment as a certification method for residents. Construct validity was clearly established for all outcome measures of the procedural phase (all r > 0.5, p < 0.01). Generalizability-theory analysis showed high reliability (coefficient Phi ≥ 0.8) when using the format of two assessors and two cases. This study provides first evidence that the TOCO-TURBT tool is a feasible, valid and reliable assessment tool for measuring competency in TURBT. The tool has the potential to be used for future certification of competencies for residents and urologists. The methodology of CTA might be valuable in the development of assessment tools in other areas of clinical practice.

e20660 Background: End user input into the design of decision support tools is critical to enhance integration and future routine use in clinical practice. As part of the development of an evidence-based, tailored, computerized breast cancer (BC) risk assessment and management tool, we examined clinicians’ requirements. Methods: Australian breast surgeons (BSs) and primary care clinicians (PCCs) were recruited through local professional networks. Facilitated focus group discussions about current practice of assessing and managing BC risk and perceptions of the proposed tool were audiotaped transcribed and managed using QSR NVivo. A coding framework was developed based on the transcripts, data were coded and each code further analyzed to identify key themes. Results: Four focus groups, involving 12 BSs, 17 PCCs (12 doctors, 5 practice nurses) were conducted. 55 % were male, mean age 45yrs (range 25-67), mean of 14yrs in practice (range1-25+). Clinicians identified difficulties assessing and managing BC risk and lack of available tools to standardise their current inconsistent approach to risk assessment and management. Most felt confident identifying high risk women, but found differentiating women at population risk from those at moderately increased risk more difficult. They felt a tool would help them reassure anxious low to moderate risk women and avoid unnecessary onward referral or investigations and better identify and refer or manage high risk women. Desirable features in a tool included: evidence-based, accessible (web-based), visual, simple data entry process, displays absolute risk (rather than relative) and mutable risk and risk reduction estimates in multiple formats (words, pictographs, graphs) to improve comprehension, printable summary sheets. Clinicians felt that women could input risk factors before the clinic visit but that joint consumer and clinician data entry was preferable and women should only receive a risk estimate with a clinician present. Conclusions: Development of tools for BC risk assessment and management should address these clearly identified needs of end users in order to optimise translation of current and future knowledge into clinical practice.