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Ksr ebm-16-12-16

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EBM “The Evidences to bring forward in Ayurveda Medicine”
Dr KSR Prasad
On 16-12-2016@PG Induction-2016, Wardha
Ayurveda is not a household or folklore treatment publicizes but it is a well constructed therapeutics built on validated concepts after through discussions

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Ksr ebm-16-12-16

  1. 1. EBM- Evidences to bring forward in Ayurveda EBMEBM “The Evidences to bring forward in Ayurveda Medicine” Dr KSR PrasadDr KSR Prasad On 16-12-2016@PG Induction-2016, Wardha Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  2. 2. EBM EBM- Evidences to bring forward in Ayurveda EBM ‐ “The Evidences to bring forward in Ayurveda Medicine” Dr KSR Prasad On 16-12-2016@PG Induction-2016 WardhaOn 16-12-2016@PG Induction-2016, Wardha Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  3. 3. Wh t i E id B d M di i EBM- 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/
  4. 4. I t d ti EBM- Evidences to bring forward in Ayurveda Introduction  • Ayurveda being the traditional medicine,  present day scientific world feels that is do not p y have 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/
  5. 5. T th t EBM- Evidences to bring forward in Ayurveda Truth story P 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 Dhatug to 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/
  6. 6. 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/
  7. 7. EBM EBM- 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 (Chikitsa Chatushpada) are the components of EBM – Not a new trend at least for Ayurveday Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  8. 8. D fi iti EBM- Evidences to bring forward in Ayurveda Definition  • Evidence based medicine (EBM) was  originally defined as the conscientious, g y explicit, 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/
  9. 9. St t EBM EBM- 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/
  10. 10. C iti i EBM EBM- 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/
  11. 11. Th ti ihili EBM- 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 y treatment 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/
  12. 12. P di hift EBM- 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 observationalp gy studies are thought as outdated • In an article only "Introduction" and "Discussion"y are considered as appropriate and relevant • one must be cautious in the interpretation ofp information derived from clinical experience and intuition, for it may at times be misleading. Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  13. 13. Wh EBM EBM- Evidences to bring forward in Ayurveda Why EBM N     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 information3 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/
  14. 14. using evidence more critically validity: most articles should be ignored using evidence more critically EBM Journal Process • 140+ journals scanned Number Needed to Read to 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 Read to find 1 valid & relevant is 200+ more critically EBP: informing decisions with the best up‐to‐date evidence
  15. 15. Wh EBM i A d i i d EBM- 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/
  16. 16. T t t EBM- Evidences to bring forward in Ayurveda Treatment  h b k• There are many books   writes classical  Be aware that  treatment options  should be based on prescriptions or guides  themselves as markers should 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/
  17. 17. 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 there condition 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. 
  18. 18. Wh t id / kill t d l EBM- 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/
  19. 19. EBM- Evidences to bring forward in Ayurveda Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  20. 20. EBM- Evidences to bring forward in Ayurveda Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  21. 21. EBM- Evidences to bring forward in Ayurveda Level I:     Meta‐analysis of  multiple RCTs  (‘ ld d d’)(‘gold standard’) Level II:   Individual RCTs Level III: Quasi‐experimental Level IV:  Non‐experimental;  qualitative Level V:   Program evaluation;  QI; RU; case reports Level VI: Opinion of respected p p authorities Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  22. 22. EBM- Evidences to bring forward in Ayurveda Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  23. 23. EBM- Evidences to bring forward in Ayurveda using evidence more  systematically Total 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/
  24. 24. P ti EBM EBM- 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; and b 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/
  25. 25. 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/
  26. 26. EBP E id B d P ti EBM- Evidences to bring forward in Ayurveda EBP – Evidence Based Practice  Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  27. 27. 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/
  28. 28. EBM- Evidences to bring forward in Ayurveda Thank YouThank You Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/

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