1. SCIENCE BASED PRACTICE:SCIENCE BASED PRACTICE:
WHAT IT MEANS &WHY??WHAT IT MEANS &WHY??
Dr.Remya Krishnan, PhD ( Ayurveda)
Associate Professor (Applied Pharmacology)
Special Thanks to:
Dr.Rajkumar ,PhD (Ayurveda)
Associate Professor ( Diagnostics ),
RGAMC, Mahe ( Govt of Puducherry)
drremyaraj@gmail.com

2. SO MANY QUESTIONS . . .SO MANY QUESTIONS . . .
Evidence-Based Practice (EBP): What is the best approach
for curing an infective fever in apatient?
What clinical practice guidelines are provided by the science
pertinent to the situation in specific in this patient in
specific ?
Here we need to do these things :
1. Know the science
2. Recognise the science
3. Appraise the clinical situation by science.
4. Appraise the patient by science
5. Translate the “science of treatment” into the patient .
6. Evaluate the result based on science

3. Role of Basic scienceRole of Basic science
 Evidence-based practice (EBP) – utilizes the BASIC
SCIENCE evidence in making patient care decisions . EBP
translates guidelines in Science into practice
 Science of Ayurveda comprises of siddhanthas ( Basic
Science evidence ) and tatwas (Applied Science
evidence) in the form of practice guidelines and
reminders to be employed in medical decision process.
 Applied Research (R) - applies a standardised
methodology based on Basic science by employing
science based guidelines in diagnosis / management of
a particular clinical situation in a particular patient

4. Important in delivery of evidence
 Avoid team work , make independent science based evidence
based decisions (“ shastram jyothi: prakashaartham darshanam
buddhiratmanah”)
 Call for independent scientific reasoning and application
 On the target application of science based guidelines .
 Evaluation and documentation of outcome based on scientific
parameters .
Evidence must begin from
Science and ends in Science

5. WHAT IS EVIDENCE-BASED PRACTICE?
 Conscientious use of Patient and Situation oriented
Science Based Evidence (SBE) to make TIMELY decisions
What is required ?
1. Appraisal of patient based on parameters in
science
2. Appraisal of disease and state and stage of the
disease based on parameters in science
3. Translation of outcome of appraisal ( SBE) into the
patient infront .

6. LEVELS OF EVIDENCE IN DIAGNOSISLEVELS OF EVIDENCE IN DIAGNOSIS
 III Evidence – Diagnosis of the disease by Roga
pareeksha (nidana panchaka) parameters in science
( Silver evidence)
 II Evidence – Diagnosis of hetu and roga ( Golden
evidence )
 I Evidence – Diagnosis based on the patient response
to the disease in specific (Diamond evidence)
The same disease manifests with variable symptoms
and intensity in separate individuals for which , there
are specific scientific evidence based reasons.
Level 1 Evidence is the Diamond evidence in diagnosis

7. LEVELS OF EVIDENCE IN TREATMENTLEVELS OF EVIDENCE IN TREATMENT
 III Evidence- Science based guidelines against the
disease in general ( Silver evidence )
 II Evidence- Science based guidelines against the cause
and the disease- hetu and vyadhi ( Golden evidence )
 I Evidence- Science based guidelines targeted to the
patient specific response to the disease (Diamond
evidence)
 Level I Evidence is the Diamond evidence in treatment

8. EVIDENCE-BASED PRACTICEEVIDENCE-BASED PRACTICE
The process of doing the “right thing” in the “right
situation” in “right time” (samyak prayoga –
siddhi).
Adopt:
 Accurate Clinical guidelines ( science based
rationale)
 Logical reasoning based on intended guidelines
Identify key/critical activities that must occur in
predictable manner
 Protocols
Detailed procedures for implementing the
actions in guidelines

9. QUALITY IMPROVEMENTQUALITY IMPROVEMENT
Process that utilizes a system to monitor
and evaluate the quality and
appropriateness of care based on
evidence-based practice and research

10. ASPECTS OF QUALITY IMPROVEMENTASPECTS OF QUALITY IMPROVEMENT
 On-going process to improve quality of care
 Every individual doctor with clear scientific knowledge ,
knowledge based aims and clear outcome measures of
results are to be achieved based on evidence based
guidelines
 Implementing TRANSFORMATION from the current
erroneous “Medicine oriented approach “to “Science
oriented approach” in all Ayurvedic teaching institutes ,
hospitals and clinics by proper education for evidence
based practice and providing circulating guidelines and
reminders on the same . Evaluate the process changes
to see if changes are being uniformly applied and
evaluated

11. FOCUSFOCUS
1. What are we trying to accomplish? Approval for
science and attainment of patient health or
approval of drug and attainment of wealth?????
2. How will we know and establish that the
change we perform is an improvement?
3. How can we improve in science based medical
practice and constantly update ourselves in
knowledge ??

12. Science based GUIDELINESScience based GUIDELINES
 Need both qualifiable as well as quantifiable measures
 Need to know the difference between your practice and
Science based practice
 Education on science based evidence based guidelines
 Data bases on science based guidelines for diagnosis
and management .

13. BARRIERS TO EVIDENCE-BASED PRACTICEBARRIERS TO EVIDENCE-BASED PRACTICE
 Lethargic community .
 Lack of professional attitude and enthusiasm for
intellectual growth.
 Organizational constraints – lack of support from
governing bodies and organizations of Ayurveda
towards Science Based Evidence Based Ayurveda .
 Peer pressure to continue with practices that are
steeped in tradition – “we’ve always done it this way
and we are not changing now”

14. BARRIERS TO EVIDENCE-BASED PRACTICEBARRIERS TO EVIDENCE-BASED PRACTICE
 Lack of knowledge/awareness unfamiliar with
scientific intentions , science based guidelines and
guideline accessibility
 Lack of confidence in the guideline developement and
utilisation
 Inability to incorporate these guidelines into the
clinical decision making process

15. ARE WE WRONG?!ARE WE WRONG?!
 Conduct a self appraisal on the reasons for your
diffidence as a medical practitioner ?
 Admit your failures as failures as soon as you realise
them .
 Admit your mistakes as mistakes as soon as you
recognise them.
 Admit your ignorance as ignorance .
 Recognition of self ignorance immensely help us for
intellectual progress .
 Get rid of ego, pride and all negative emotions .
 Get ready for learning , arguments in science and
application of science in practice !

16. Science based practice is integralScience based practice is integral
 Science and Science based evidence based practice are
integral to the delivery of quality patient care
 Each informs the other and improves upon the other
 It requires dedication to science and compassion to
serve humanity , burning desire to develop
independent vision in science and scientific reasoning
skills (shastra sahitha tarka), creativity, leadership and
thereby succeed in profession.
 “Doing the right thing” in all these areas contributes to
an environment of excellence, quality patient care and
professional satisfaction !

17. You are a Change Agent !
Welcome , Ayurvedic community !!