Introduction Continuous advancements in information and communication technologies along with the consequent massive adoption of web services provide today, practical and effective decision support tools for many professions [1, 2]. The vital need for high levels of accuracy and effectiveness in homeopathic prescribing was the driving force behind the development of a new online homeopathy expert system. VithoulkasCompass (VC) is a web-based decision support tool, designed to aid the homeopathic practitioner in finding the individual correct remedy, by inputting relevant symptoms. [3] Calibration and refinement of the algorithms and mechanisms that lead to the proposal of the correct remedy by the expert system are key areas of continuous, on-going research, always confirming new developments against a very large number of real world cases from the archives of the International Academy of Classical Homeopathy (IACH). [4] VithoulkasCompass is a scientifically developed expert system to support homeopathic practitioners-a solid foundation for the future of clinical research in homeopathy. We define as headache or cephalalgia (from the Greek words κεφαλή which means head and άλγος which means pain) the pain anywhere in the region of head and neck. [5] Headache has many classifications by different associations. A well-known classification is the International Classification of Headaches Disorder [6]. The three main categories in this classification are the primary headaches, the secondary headaches which are attributed to trauma and other sources and the cranial neuralgias. This study includes mainly primary headaches as well as a few cases of cranial neuralgias. The search headaches and homeopathy in PubMed returns 55 results. Although many of these studies report the beneficial effect of homeopathy in the treatment of chronic headaches the need of further studies in this field is apparent. Aim The aim of this study is to evaluate the assistance of the decision support system VithoulkasCompass on chronic headache cases, based on homeopathy experts questionnaire and on the prescribed homeopathic remedies effectiveness. A statistical assessment of VC expert system platform has been performed on different aspects like 1
the gender and distribution of age of the patients, and quality research regarding the contribution of Vithoulkas Compass. Materials and Methods We have collected 84 cases with headache as the main complaint for which we have data about the evaluation of the case s follow up after the prescription. The evaluation of the follow up is as follows: In 9 cases no change has been recorded. In 8 cases small improvement was noted. In 25 of the cases the report was moderate improvement and in 42 the report was large improvement or case cleared. Thirty one (31) of these cases were analyzed in a more detailed way. Seventeen (17) of these cases are coming from IACH (international Academy of Classical Homeopathy) and 14 from younger homeopaths. All are cases having as main complain chronic headaches. Age distribution of female and male patients is shown in figure 1. The patients administered the subsequent remedies shown in table 2. A team of scientists guided by Prof. Vithoulkas of the IACH and the Aegean University evaluated the results of the VC system and the curative effect of the consequent administered remedies. Apis mellifica Arsenicum album Baryta carbonica Belladonna Bryonia Causticum Elaps corrallinus Gelsemium Graphites Lac-caninum Magnesia carbonic Medorrhinum Nattrium muriatic Nux vomica Pulsatilla Sanguinaria Sepia Staphysagria Stramonium Sulphuric acid [Table 2. Prescribed remedies] [Figure 1. Age distribution of female and male patients] The methodology includes two phases. In the first phase the performance of the software on cases already solved by homeopathy experts and specifically Professor s George Vithoulkas was analysed, comparing the remedy provided by the human expert with the corresponding proposal of the system. It was initiated with the selection of successful cases from highly skilled expert homeopaths. Successful cases are cases where follow-ups clearly indicate that the remedy acted curatively. After repertorisation of the cases an assessment process was performed on how 2
accurately the proposed, software-generated remedies, successfully matched the human-prescribed remedies. The second phase assessed the support that the software provides live in front of the patient - on cases solved by less experienced homeopaths. This evaluation process is based on statistical analysis of success rates derived from the assessment of the follow-up on patients cases, according to the principles of classical homeopathy. Cases taken by homeopaths with the support of VC expert system were reviewed. After the initial input and the analysis of the case, a first set of proposed remedies was provided by the system. If the case was clear, the homeopath proceeded with the appropriate prescription. If the case was not clear, the differential analysis functions of the software were utilized in order to suggest symptoms not revealed by the patient. The suggested symptoms are used to verify the proposed remedies and to finally single out the correct remedy. Along these lines, the contribution of the differential analysis function was also effectively assessed. The following questionnaire was given to homeopath doctors in order to evaluate VC. The first two questions are subjective and the practitioner gives his own opinion, whereas the next is objective. How helpful was the program? Do the propose remedies match with the patients picture? Very helpful: The use of VC decisively supported the user to pick up the correct remedy. Yes: We call the essence of the remedy fits with the overall picture of the patient. This is a subjective evaluation, a based on the knowledge of the remedy by the practitioner. Helpful: VC helped the user to decide which remedy is the most appropriate. Not sure: The practitioner is not sure about the above correlation. This may be due insufficient knowledge of the remedy, by the practitioner. Indifferent: The user would have found the correct remedy even without VC support. No: The practitioner considers that there is no correlation between the essence of the remedy, as he/she know it and the overall picture of the patient. Follow up (large improvement, moderate improvement, no improvement) Have you used the differential analysis modes? large improvement The differential analysis modes consist of the 1) differential analysis, 2) the differential analysis + and 3) the specific differential. moderate improvement The above features are for proposing candidate symptoms for the practitioner to ask the patient during the consultation. no improvement Yes means that the user has used at least one of the above features. Have you chosen one of the first two remedies? Yes No [Table 1. Questionnaire] 3
Results The study of the above cases and analysis of questionnaire revealed the following outcomes. 1) Figure 2 demonstrates the ordinal place of the prescribed remedy in the proposed remedies group. Additionally the results are divided in 2 categories one for newer practitioners and one for expert ones. [Figure 2. Demonstrates experts - newer practitioners remedy selection] 2) According to the evaluation of the proposed remedies, in 68% of the cases the first remedy matches very well with the patient s clinical feature. Only in 10% of the cases there is not a sufficient match between the proposed remedy and the patients clinical feature. In 20% of the cases the picture was not clear so as the evaluator could not positively decide on the similarity (figure 3). [ Figure 3. Correspondence between proposed remedy and patient clinical feature.] 4
3) Figure 4 depicts the effect on patients categorized in gender female and male and in more categories depending on the position of the prescribed remedy in the top proposed remedies. It shows that when one of the first two top remedies was prescribed the curative effect was more significant. [Figure 4. Patients response regarding gender and remedy score] 4) The following figure 5 shows that initial symptoms were not completely sufficient to proceed to prescription and differential analysis module was utilised in order to clarify the picture in 64% of the new cases. [Figure 5. Utilization of Differential analysis module] 5) Finally an overall evaluation of the contribution of VC in order to derive the most suitable prescribed remedy is given in figure 6. [Figure 6. Overall evaluation of the assistance of VC in order to find the remedy] 5
Conclusions Initial statistical analysis demonstrates that VithoulkasCompass expert system has a high accuracy in proposing appropriate remedies for treating patients suffering from chronic headaches, as well as showing high efficiency on individually prescribed homeopathic remedies in many headache cases. VithoulkasCompass online software program is a tool that is considered very helpful for the finding of correct remedy as well during the case taking. It is a live system for the homeopathic community, which facilitates teamwork and provides a solid foundation for the future of clinical research in homeopathy. Further investigations will be conducted in the future using more cases in order to verify these findings. References 1. Shim, J.P. et al, 2002. Past, present, and future of decision support technology. Decision Support Systems. 33 (3), 111-126. 2. Leung, G et al., 2003. Randomised controlled trial of clinical decision support tools to improve learning of evidence based medicine in medical students. British Medical Journal. 327, 1090. 3. VithoulkasCompass.com Software Program. [Online]. http://www.vithoulkascompass.com/. Accessed 21-05-13. 4. Tapakis L., 2011. The evolution of professional homeopathic training via internet: Seeking effectiveness and quality performance in case taking and homeopathic prescribing by utilizing web technologies; the case of Vithoulkas Compass. Liga Conference Dec 2011. 5. Elsevier Science Health Science Division, 2008. Dorland s Medical Dictionary. 6. Olesen, J., 2008. The International Classification of Headache Disorders. Headache. 58 (5) pp 691-693. Authors: Theodoros E. LILAS, Assistant Professor in Information Technology, University of the Aegean, 2A Korai St., Chios, 82100 Greece, e-mail: lilas@aegean.gr Eleftherios Tapakis, MD Homeopath, Member of the Hellenic Homeopathic Medical Society e-mail: etapakis@gmail.com, ltapakis@vithoulkascompass.com 6