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EBM- Evidences to bring forward in Ayurveda
EBMEBM“The Evidences to bring forward in Ayurveda Medicine”
Dr KSR PrasadDr KSR PrasadOn 16-12-2016@PG Induction-2016, Wardha
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
EBMEBM- Evidences to bring forward in Ayurveda
EBM ‐ “The Evidences to bring forward in Ayurveda Medicine”
Dr KSR PrasadOn 16-12-2016@PG Induction-2016 WardhaOn 16-12-2016@PG Induction-2016, Wardha
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
Wh t i E id B d M di iEBM- Evidences to bring forward in Ayurveda
What is Evidence Based Medicine • Evidence based medicine is the integration of• Evidence based medicine is the integration of best relevant scientific research evidences i h li i l i j d d iwith clinical expertise judgments and patient
values and preferences
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
I t d tiEBM- Evidences to bring forward in Ayurveda
Introduction • Ayurveda being the traditional medicine, present day scientific world feels that is do not p yhave any EBM based structures and Evidences of concepts and treatmentsof concepts and treatments
• Ayurveda is not a household or folklore bl b lltreatment publicities but it is a well
constructed therapeutics built on validated concepts after through discussions
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
T th tEBM- Evidences to bring forward in Ayurveda
Truth storyP t d i tifi l li i• Present day scientific values are lingering around the truth
• It is like a three blind rats running for the• It is like a three blind rats running for the search of truth – They can never see the truth– They can never see the truth
» Ayurveda has a specific system of balancing the Dosha and Dhatugto bring in to normalcy through a sequence of procedure – at present it is called as “Block‐Box”present it is called as Block‐Box method of research
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
EBM- Evidences to bring forward in Ayurveda
?• Assume that you are the health professional• A community in your area is concerned with its high rate of childhood obesity andits high rate of childhood obesity and requests your help.
• How do you proceed?– You need an Evidence for your statementYou need an Evidence for your statement
• It is Evidence Based Medicine
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
EBMEBM- Evidences to bring forward in Ayurveda
EBM• At present era first described in 1992
– As a new approach to teaching medicinepp g– Called as a “revolution” in medical practice
All h th t d l ith P ti t• All approaches that deals with a Patient, Physician, Nursing and Medicine (ChikitsaChatushpada) are the components of EBM– Not a new trend at least for Ayurveday
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
D fi itiEBM- Evidences to bring forward in Ayurveda
Definition • Evidence based medicine (EBM) was originally defined as the conscientious, g yexplicit, and judicious use of current best evidence in making decisions about thebest evidence in making decisions about the care of individual patients.
h “ h f b h• Otherwise – “The integration of best research evidence with clinical expertise and patient values.”
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
St t EBMEBM- Evidences to bring forward in Ayurveda
Steps to EBM• Make a need in to an answerable question• Search for the best evidenceSearch for the best evidence• Assess the evidence• Check how one’s clinical expertise on an individual patient is possible p p
• Evaluate the entire scenario • You get the EBM
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
C iti i EBMEBM- Evidences to bring forward in Ayurveda
Criticism on EBM• De‐emphasizes patient values
– Doshabeda “Vikara”
• Doesn’t account for individual variation P k i– eg: Prakruti
• Devalues clinical judgmentj g– Swasa as a symptom and disease do not have similar treatment in generalsimilar treatment in general
• Leads to therapeutic nihilism = ?
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
Th ti ihiliEBM- Evidences to bring forward in Ayurveda
Therapeutic nihilism• Therapeutic nihilism is a contention that curing people, or societies, of their ills by g p p ytreatment is impossible.
• In medicine it was connected to the idea that• In medicine, it was connected to the idea that many "cures" do more harm than good, and h h l h bthat one should instead encourage the body to heal itself.– Eg: Radiation therapy
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
P di hiftEBM- Evidences to bring forward in Ayurveda
Paradigm shift• A clinical experience is thought as an unsystematicA clinical experience is thought as an unsystematic
observations and instrumental diagnosis is brought as ultimate
• Understanding the basic physiological mechanisms shift as pathology and its result oriented observational p gystudies are thought as outdated
• In an article only "Introduction" and "Discussion" yare considered as appropriate and relevant
• one must be cautious in the interpretation of pinformation derived from clinical experience and intuition, for it may at times be misleading.
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
Wh EBMEBM- Evidences to bring forward in Ayurveda
Why EBMN f id (i l / h i l) New types of evidence (instrumental /chemical) are being generated which can create changes in th ti t t t dthe way patients are treated
Although evidence is needed on a daily basis, ll h dusually physicians don’t get it. Reasons are many ‐
1. Lack of time (busy practice)
2. Out-of-date textbooks (Ayurveda is 2000 years old), and
3. The disorganization of information 3 e d so ga at o o o at o
4. Printing of non reliable articles in predatory medical journals
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
using evidence more criticallyvalidity: most articles should be ignored
using evidence more critically
EBM Journal Process
• 140+ journals scannedNumber Needed to Readto find 1 valid is 20+140 journals scanned
– 60,000 articles• Is it valid? (<5%)
– Intervention: RCTIntervention: RCT– Prognosis: inception cohort– Etc
• Is it relevant?Is it relevant?– 6‐12 GPs & specialists asked:
Relevant? Newsworthy?
N b N d d t R d• < 0.5% selected Number Needed to Readto find 1 valid & relevant is 200+
more critically EBP: informing decisions with the best up‐to‐date evidence
Wh EBM i A d i i dEBM- Evidences to bring forward in Ayurveda
Why EBM in Ayurveda is in need• There is a need of showing the Ayurveda traditional
Knowledge statistically and clinically significant ith t ti l ti b twithout any negative correlation between a
physician’s knowledge for up to date care of patient It i t k th t th h i i d h d• It is to know that the physician do have good care knowledge after so many years of leaving his medical school because of the 2000 years time tested valuesschool because of the 2000 years time tested values
• EBM makes Knowledge translation – increasing the uptake of the best available evidence into practiceuptake of the best available evidence into practice –which is always a challenge
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
T t tEBM- Evidences to bring forward in Ayurveda
Treatment h b k• There are many books writes classical
Be aware that treatment options should be based onprescriptions or guides
themselves as markersshould be based on clinical need and the effectiveness of
• In fact the prescriptions are derived at only with
treatment options, and that decisions y
the consensus of patient after concluding the
should be arrived at through assessment and discussion withafter concluding the
concerns and needs and discussion with
the patient
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
R ibili & Skill d l
EBM- Evidences to bring forward in Ayurveda
Responsibility & Skill development i h ibili f• It is the responsibility of
the concerned physician to ll t th i f ti
Must be aware of their responsibility to
maintain theircollect the information regarding the patients condition and the suitable
maintain their knowledge and skills throughout therecondition and the suitable
skills or therapeutics prescribed to the patient
throughout there careers.
prescribed to the patient looking at his disease severity and economical
Scholars are expected to keep up to date and to apply knowledgeseverity and economical
conditions to apply knowledge necessary for good
clinical care.
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
clinical care.
Wh t id / kill t d lEBM- Evidences to bring forward in Ayurveda
What evidences /skills to develop f h i h kill d l k• Most of the time the skill development takes a
duration of time and half of it becomes mostly td t d ithi 5 f d tioutdated within 5 years of duration
– But the 2000 years Ayurveda is not outdated • The other half is not bothered by any body as it never comes in to lime light or implemented by h b dthe Governing bodies – Thus the skills development is an uninterrupted
ill i h d fprocess till we are in the concerned area of “Recommending a therapeutics for Patient”
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
EBM- Evidences to bring forward in Ayurveda
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
EBM- Evidences to bring forward in Ayurveda
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
EBM- Evidences to bring forward in Ayurveda
Level I: Meta‐analysis of multiple RCTs (‘ ld d d’)(‘gold standard’)Level II: Individual RCTsLevel III: Quasi‐experimentalLevel IV: Non‐experimental; qualitativeLevel V: Program evaluation; QI; RU; case reportsLevel VI: Opinion of respected p pauthorities
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
EBM- Evidences to bring forward in Ayurveda
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
EBM- Evidences to bring forward in Ayurveda
using evidence more systematicallyTotal mortality from trials of β‐
blockers in 2° prevention after MI.
systematically
blockers in 2 prevention after MI.
Black square & horizontal line correspond to odds ratio (OR) & 95% confidence interval (CI) for each trial. The size of the black square reflects the weight of eachsquare reflects the weight of each trial. The diamond represents the combined OR & 95 CI, showing a 22% reduction in odds of death
Egger, M. et al. BMJ 1997;315:1533‐1537
22% reduction in odds of death
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
P ti EBMEBM- Evidences to bring forward in Ayurveda
Practice EBM• 1. Ask a focused question.q• 2. Acquire (systematically search for) epidemiological evidence to help answer question.
• 3. Appraise evidence found for its validity, effect size, precision (ideally all the relevant evidence)
• 4. Apply the evidence in practice:– a. amalgamate the valid evidence with other relevant information (values & preferences, clinical/health issues, & system issues) and make an evidence‐based decision; andb act (implement) the decision in practice– b. act (implement) the decision in practice
• 5. Assess your performance (write an article)
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
Cli i l Q ti “PICO”EBM- Evidences to bring forward in Ayurveda
Clinical Questions ‐ “PICO”lExample:
• In a 5 year old child with conjunctivitis y j(patient) will topical antibiotics (intervention) compared to no treatment (comparison) lead p ( p )to quicker symptom relief (outcome)?
• In a 5 year old child with conjunctivitisIn a 5 year old child with conjunctivitis (patient) will topical antibiotics (intervention) compared to no treatment (comparison) leadcompared to no treatment (comparison) lead to improved cure rates (outcome)?
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
EBP E id B d P tiEBM- Evidences to bring forward in Ayurveda
EBP – Evidence Based Practice
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
EBM- Evidences to bring forward in Ayurveda
Take Home Message • Try to ask one patient for ‐
1. What causes the disease?2 How was the disease diagnosed?2. How was the disease diagnosed? 3. How was the patient treated?4 Wh i h l hi f h di ?4. What is the natural history of the disease?5. Consider formulating a PICO
And try to find some evidence for it
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
EBM- Evidences to bring forward in Ayurveda
Thank YouThank You
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/