Teamwork - Understanding the hindrances What are some common hindrances to teamwork? A. An overemphasis on hierarchy and red-tape. Genuine teamwork does not focus on level, hierarchy or status. B. Reward structures that are not team-oriented. You get what you pay for– if you want teamwork, you must reward it. Exhorting team effort while rewarding stars will get you more stars.
Bardzo tanie apteki z dostawą w całej Polsce kupic levitra i ogromny wybór pigułek.
Homeopathy service in a National
Health Service community menopause
clinic: audit of clinical outcomes
School of Health and Related Research, University of Sheffield, Sheffield, UK substances. These doses (usually in tablet form) are Sheffield’s National Health Service community menopause individually prescribed according to the principle of ‘like clinic has run a homeopathy service since 1998. The service provides an alternative treatment option for those women In 2004 an audit was undertaken of the homeopathy who cannot take hormone replacement therapy, do not want service. The audit cycle includes the following steps: it, have found it ineffective, or have been advised to stop it. observing current practice, setting standards of care, com- Patients receive homeopathic treatment (monthly consulta- paring practice with standards, and implementing change. tions plus individualized homeopathic medicines) for up to six sessions. An audit was undertaken of all patients referred to this service between 2001 and 2003, in which patients completed the Measure Yourself Medical Outcome Profile. Patients reported significant benefit from the service. The greatest response was seen in those reporting headaches, Since the inception of the homeopathy service, all patients vasomotor symptoms, emotional/psychological symptoms and referred have been asked to complete the Measure tiredness/fatigue as their primary symptoms. Yourself Medical Outcome Profile (MYMOP).2 Using these routinely collected data, a clinical audit was Keywords: Homeopathy, hot flushes, menopause, primary
undertaken of all patients referred from 1 January 2001 to 31 December 2003 (n = 124). The MYMOP is a patient- generated outcome measure. Each patient is asked to name the two symptoms that bother her the most and score them on a seven-point Likert scale (from 0, ‘as good Introduction
as it could be’, to 6, ‘as bad as it could be’). Patients are also asked to score their ‘general wellbeing’ on a scale of Sheffield’s National Health Service community 0–6. Scores are documented before, during and at the end menopause clinic has provided a homeopathy service since 1998. The service is provided for women with distressing menopausal symptoms who are not taking hormone replacement therapy (HRT) because they cannot take it, do not want it or have found it ineffective, or because it produced intolerable side-effects and the One hundred and twenty-four women were referred to the Patients are offered up to six consultations with one of homeopathy service; their median age was 53 years. Initial the two homeopaths. The initial consultation lasts 50–60 and final MYMOP data were obtained for 102 women minutes and subsequent consultations 15–30 minutes. (81.4%) (5 women had none and 17 women had initial Patients receive monthly consultations and individual- but no final data). Regularly listed symptoms were hot ized homeopathic medicines. Individualized homeopathy flushes, tiredness, anxiety, mood swings, crying, sleeping uses low-dose/ultra-molecular doses of specially prepared difficulties, mood swings, headaches, and joint and muscle Fifteen women reported that their primary symptom stayed the same and four documented a worse score; Correspondence: Clare Relton, Research Fellow and
however, the remaining 83 reported an improvement at Homeopath, Medical Care Research Unit, ScHARR, the end of homeopathic treatment. The mean decrease Regent Court, 30 Regent Street, University of Sheffield, Sheffield S1 4DA, UK. Email: [email protected] (improvement) in the score for their primary symptom was Journal of the British Menopause Society Vol. 11 No. 2 June 2005 C Relton & E Weatherley-Jones Homeopathy service 2.0 (95% confidence interval 1.64–2.43, P Acknowledgements: This audit was supported by the
improvement of 0.8 on the MYMOP scale has been sug- Department of Health National Coordinating Centre for gested to indicate clinically significant improvement).3 Research Capacity Development (NCCRCD).
Further analysis showed an average MYMOP score change of 1.5 for wellbeing and 2.0 for vasomotor symp- Competing interests: None declared.
1 Thompson EA. Homeopathy and the menopause. The results of this audit are comparable to those of a previous outcome study and service evaluation of this 2 Paterson C, Britten N. In pursuit of patient-centred outcomes: homeopathy service in 1999–2000, which found that a qualitative evaluation of MYMOP, Measure Yourself Medical 88% of patients (n = 37) reported clinically significant 3 Guyatt GH, Juniper EF, Walter S, Griffith L, Goldstein RS. improvement in their primary symptom, with a mean Interpreting treatment effects in randomised trials. Br Med J improvement of –2.0 in the scores for primary symptoms.4 1998;316:690–3
Greatest clinical benefit was reported by women for 4 Thomas KJ, Luff D, Strong P. Complementary Medicine Service headaches, tiredness, vasomotor symptoms, locomotor in a Community Clinic for Patients with Symptoms Associated with the Menopause: Outcome Study and Service Evaluation. Other observational studies of homeopathic treatment 5 Clover A, Ratsey D. Homeopathic treatment of hot flushes: a of menopausal symptoms have used different outcome pilot study. Homeopathy 2002;91:75–9
measures, but do report high levels of benefit in meno- 6 Thompson EA, Reilly D. The homeopathic approach to the treatment of symptoms of oestrogen withdrawal in breast pausal symptoms as well as improved mood and quality of cancer patients. A prospective observational study. Homeopathy 2003;92:131–4
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Journal of the British Menopause Society Vol. 11 No. 2 June 2005
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